Protocol‐based medical management of post‐ERCP pancreatitis

Abstract

A protocol-based management strategy was associated with less severe pancreatitis, shorter length of hospital stay, need for fewer imaging studies, and use of antibiotics. Prospective validation of these findings is justified.

Fluid Therapy in Acute Pancreatitis

“…The use of bedside assessment of heart rate, blood pressure, and urine output as goals of fluid responsiveness has been shown to be beneficial in a goal-directed FT protocol. 28 In the study by Wu et al, 21 blood urea nitrogen was investigated as a goal for guiding FT in AP. The responsiveness to FT was determined by whether or not the patients' blood urea nitrogen changed, in either direction.…”

“…However, in a more recent study, if a set goal of a hematocrit level of less than 35% was achieved rapidly, it was associated with increased incidence of sepsis (78.6% vs 57.6%; P = 0.016) and mortality (43.9% vs 15.3%; P < 0.05) when compared with slow hemodilution. 9 A study by Reddy et al, 28 using a protocolbased approach centered around heart rate, blood pressure, urinary output, and hematocrit level, was associated with less severe pancreatitis (crude odds ratio = 11.2; 95% confidence interval = 1.9-68.7; P = 0.02), shorter length of hospital stay (median value 7 days vs 3 days; P = 0.01), reduced requirement of computed tomographic imaging studies (100% vs 15.6%; P < 0.001), and reduced use of antibiotics (50% vs 3.1%; P = 0.01).…”

Clinical update on fluid therapy and nutritional support in acute pancreatitis

“…Standardized FT protocols are lacking for AP [76,77] but several studies applied goal-directed approaches [40,78,86,96]. The FT suggested at the University of Michigan (Table 1) illustrates a goaldirected algorithm, adapted from our previously published version [40].…”

Acute pancreatitis – a complication of endoscopic retrograde cholangiopancreatography

“…W opisanej grupie chorych właśnie w tym czasie autorzy stwierdzali biochemiczne cechy ostrego stanu zapalnego. Intensywne nawodnienie, wyrównanie zaburzeń elektrolitowych, leczenie przeciwbólowe oraz profilaktyka powikłań są podstawą leczenia [5]. Znaczenie rokownicze może mieć opracowanie protokołu postępowania z chorymi po ECPW.…”