Lactated Ringer's vs normal saline for acute pancreatitis: An updated systematic review and meta-analysis

Aziz, Muhammad; Ahmed, Zohaib; Weissman, Simcha; Ghazaleh, Sami; Beran, Azizullah; Kamal, Faisal; Lee‐Smith, Wade; Assaly, Ragheb; Nawras, Ali; Pandol, Stephen J.; McDonough, Stephanie; Adler, Douglas G.

doi:10.1016/j.pan.2021.06.002

Cited by 13 publications

(15 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of the patients with mild acute pancreatitis, around 20% progressed to moderate or severe acute pancreatitis, which is comparable to the literature. A recent systematic review confirms that Ringers reduces ICU admission and hospital stay [7]. Recent randomized unblinded trials of lower quality show reduced CRP levels and less organ failure with RL [8,9].…”

Section: Infected Necrosismentioning

confidence: 97%

Update on the management of acute pancreatitis

Berg

Boermeester

2023

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of reviewThis review provides insight into the recent advancements in the management of acute pancreatitis.Recent findingsModerate fluid resuscitation and Ringer's lactate has advantages above aggressive fluid resuscitation and normal saline, respectively. A normal “on-demand” diet has a positive effect on recovery from acute pancreatitis and length of hospital stay. A multimodal pain management approach including epidural analgesia might reduce unwarranted effects of opiate use. A more targeted use of antibiotics is starting to emerge. Markers such as procalcitonin may be used to limit unwarranted antibiotic use. Conversely, many patients with infected necrotizing pancreatitis can be treated with only antibiotics, although the optimal choice and duration is unclear. Delay of drainage as much as is possible is advised since it is associated with less procedures. If drainage is required, clinicians have an expanding arsenal of interventional options to their disposal such as the lumen-apposing metal stent for transgastric drainage and (repeated) necrosectomy. Immunomodulation using removal of systemic cytokines or anti-inflammatory drugs is an attractive idea, but up to now the results of clinical trials are disappointing. No additional preventive measures beside non-steroidal anti-inflammatory drugs (NSAIDs) can be recommended for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.SummaryMore treatment modalities that are less invasive became available and a trend towards less aggressive treatments (fluids, starvation, interventions, opiates) of acute pancreatitis is again emerging. Despite recent advancements, the pathophysiology of specific subgroup phenotypes is still poorly understood which reflects the disappointing results of pharmacological and immunomodulatory trials.

show abstract

Section: Infected Necrosismentioning

confidence: 97%

Update on the management of acute pancreatitis

Berg

Boermeester

2023

Current Opinion in Critical Care

View full text Add to dashboard Cite

show abstract

“…[42][43][44][45][46] shown to reduce IL-1β production both in vitro and in vivo, 54 which may account for the evidence suggesting that patients receiving lactated Ringer's solution instead of saline have reduced ICU admission rates and reduced length of hospital stay. 55 Recent data obtained from the WATERFALL clinical trial suggests that aggressive (20 mL/kg bolus for 2 hours, then 3 mL/kg/hour infusion) fluid resuscitation via lactated Ringer's solution increases the risk of volume overload without improvement in primary outcome of AP patients when compared with moderate (10 mL/kg bolus only if hypovolemic, then 1.5 mL/kg/hour infusion) fluid resuscitation. 56 This data is supported by evidence that aggressive hydration is associated with worse outcomes in patients with systemic inflammatory diseases including sepsis, 57 acute lung injury, 58 and critical care patients.…”

Section: Therapeutic Optionsmentioning

confidence: 99%

“…Clinical findings suggest that early fluid resuscitation is critical to improving outcomes in AP 53 . Lactate has been shown to reduce IL-1β production both in vitro and in vivo, 54 which may account for the evidence suggesting that patients receiving lactated Ringer's solution instead of saline have reduced ICU admission rates and reduced length of hospital stay 55 . Recent data obtained from the WATERFALL clinical trial suggests that aggressive (20 mL/kg bolus for 2 hours, then 3 mL/kg/hour infusion) fluid resuscitation via lactated Ringer's solution increases the risk of volume overload without improvement in primary outcome of AP patients when compared with moderate (10 mL/kg bolus only if hypovolemic, then 1.5 mL/kg/hour infusion) fluid resuscitation 56 .…”

Section: Current Clinical Strategiesmentioning

confidence: 99%

Acute Pancreatitis

Wiley,

Mehrotra,

Bauer

et al. 2023

Pancreas

View full text Add to dashboard Cite

Objective Severe acute pancreatitis (SAP), pancreatic inflammation leading to multiorgan failure, is associated with high morbidity and mortality. There is a critical need to identify novel therapeutic strategies to improve clinical outcomes for SAP patients. Materials and Methods A comprehensive literature review was performed to identify current clinical strategies, known molecular pathophysiology, and potential therapeutic targets for SAP. Results Current clinical approaches focus on determining which patients will likely develop SAP. However, therapeutic options are limited to supportive care and fluid resuscitation. The application of a novel 5-cytokine panel accurately predicting disease outcomes in SAP suggests that molecular approaches will improve impact of future clinical trials in AP. Conclusions Inflammatory outcomes in acute pancreatitis are driven by several unique molecular signals, which compound to promote both local and systemic inflammation. The identification of master cytokine regulators is critical to developing therapeutics, which reduce inflammation through several mechanisms.

show abstract

“…Its incidence is increasing in the United States and the rest of the world, but there is currently no effective drug therapy (2,3). While the 1 Division of Gastroenterology, Hepatology and Nutrition, Ohio State University, Columbus, Ohio, USA; 2 Department of Biomedical Informatics, Ohio State University, Columbus, Ohio, USA; 3 Division of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; 4 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; 5 MedStar Washington Hospital Center, Washington, District of Columbia, USA; 6 Asian Institute of Gastroenterology, Hyderabad, Telangana, India; 7 Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India; 8 Apollo Gleneagles Hospitals Kolkata, Kolkata, India; 9 Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; 10 Universidad Aut ónoma de Nueva Le ón, Monterrey, Mexico; 11 Division of Gastroenterology, Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio, USA; 12 University of Medicine and Pharmacy "Iuliu Hatieganu," Cluj-Napoca, Romania; 13 Eastern Maine Medical Center, Bangor, Maine, USA; 14 Hospital Nacional "Profesor Alejandro Posadas", Buenos Aires, Argentina; 15 University of Medicine and Pharmacy, Bucharest, Romania; 16 San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy; 17 Indiana University School of Medicine, Indianapolis, Indiana, USA; 18 Attikon University General Hospital, Athens, Greece; 19 Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina; harmful effects of aggressive volume of intravenous fluid (IVF) has been shown in a recently published landmark randomized controlled trial (RCT), it remains unclear which type of IVF should be administered (i.e., lactated ringers [LR] vs normal saline) (4)(5)(6). A recent pilot RCT showed that high-volume (median 5,600 mL/24 hours) administration of LR in patients with mild AP results in faster clinical recovery (7).…”

Section: Introductionmentioning

confidence: 99%

Lactated Ringers Use in the First 24 Hours of Hospitalization Is Associated With Improved Outcomes in 999 Patients With Acute Pancreatitis

et al. 2023

View full text Add to dashboard Cite

Objectives: Recent pilot trials in acute pancreatitis (AP) found that Lactated Ringers (LR) usage may result in decreased risk of moderately severe/severe AP compared with Normal Saline, but their small sample sizes limit statistical power. We investigated if LR usage is associated with improved outcomes in AP in an international, multi-center, prospective study. Methods: Subjects directly admitted with the diagnosis of AP were prospectively enrolled at 22 international sites between 2015 and 2018. Demographics, fluid administration, and AP severity data were collected in a standardized prospective manner to examine the association between LR and AP severity outcomes. Mixed-effects logistic regression analysis was performed to determine the direction and magnitude of the relationship between the type of fluid administered during the first 24 hours and the development of moderately severe/severe AP. Results: Data from 999 subjects were analyzed (mean age 51 years, female 52%, moderately severe/severe AP 24%). Usage of LR during the first 24 hours was associated with reduced odds of moderately severe/severe AP (aOR=0.52; p=0.014) compared to normal saline after adjusting for region of enrollment, etiology, BMI, and fluid volume and accounting for the variation across centers. Similar results were observed in sensitivity analyses eliminating the effects of admission organ failure, etiology and excessive total fluid volume. Conclusions: LR administration in the first 24 hours of hospitalization was associated with improved AP severity. A large scale randomized clinical trial is needed to confirm these findings.

show abstract

Lactated Ringer's vs normal saline for acute pancreatitis: An updated systematic review and meta-analysis

Cited by 13 publications

References 25 publications

Update on the management of acute pancreatitis

Update on the management of acute pancreatitis

Acute Pancreatitis

Lactated Ringers Use in the First 24 Hours of Hospitalization Is Associated With Improved Outcomes in 999 Patients With Acute Pancreatitis

Contact Info

Product

Resources

About