Use of Lactated Ringers Solution Compared With Normal Saline Is Associated With Shorter Length of Stay in Pediatric Acute Pancreatitis

Abstract

Objective The aim of the study was to evaluate lactated ringers (LR) versus normal saline (NS) in pediatric acute pancreatitis (AP). Methods This retrospective study used Pediatric Health Information System database of primary AP patients, 2013 to 2017. Results The study included 1581 first time AP patients with exclusive use of a single fluid (111 LR, 1470 NS) for the first 48 hours. The LR cohort had a significantly shorter length of stay (P < 0.001) compared with NS. A multivariable logistic regression analysis suggests use of NS in the first 48 hours (after controlling for total parenteral nutrition, operation, and infection during the admission) had a significantly increased likelihood of requiring a hospitalization for 4 days or more compared with the LR group (odds ratio, 3.31; 95% confidence interval, 1.95–5.62). The overall cost was significantly less in the LR group. There was no statistical difference observed in risk factors for AP, intensive care transfer, organ dysfunction, or mortality. Conclusions This represents the first large data set analysis of LR versus NS in pediatric AP. The use of LR was associated with a shorter length of stay and reduced cost compared with NS. Future randomized trials will help determine the ideal fluid choice for pediatric AP.

Perioperative Fluid Management in Surgical Patients: A Review

“…22 LR was found to be useful in reducing hospital stays and costs compared to normal saline in pediatric acute pancreatitis. 23 LR also reduced systemic inflammation in acute pancreatic patients when compared to normal saline. 24 Elective orthopedic and colorectal surgery patients had a comparable incidence of post-operative complications when comparing normal saline and LR infusions.…”

Faster discharge with lactated ringers than normal saline in first 72 h of acute pancreatitis: A multicenter randomized trial

“…Choosakul et al also performed a randomized control trial of 47 adults with AP and found that there was no significant difference in the two arms after the first 24 h, but did note that there was a reduction in SIRS at 24 h in the LR group 8 . When we previously investigated the exclusive use of LR in pediatric AP using a retrospective analysis of the PHIS database, we found that the use of LR was associated with a decreased length of hospital stay and admission cost 11 . However, this had never been investigated prospectively in the pediatric AP population until now.…”

“…8 When we previously investigated the exclusive use of LR in pediatric AP using a retrospective analysis of the PHIS database, we found that the use of LR was associated with a decreased length of hospital stay and admission cost. 11 However, this had never been investigated prospectively in the pediatric AP population until now. In fact there remains significant room for improvement and research into optimal a Please note also that these are selected outcomes examined by the authors.…”

“…We have previously shown in a retrospective analysis of the PHIS database that patients who exclusively received LR had a shorter length of stay (LOS) compared to NS. 11 Thus, the purpose of this study is to evaluate in a prospective randomized controlled clinical trial model the efficacy of using LR as a resuscitative fluid during the first 48 h of an AP episode as compared with NS. Efficacy was assessed primarily by measuring the inflammatory marker CRP; with secondary determinants of efficacy being changes in biochemical profile, systemic inflammatory response syndrome (SIRS), time to feeds, LOS in the hospital, and development of severe disease.…”

Acute pancreatitis in children: risk factors, management, and outcomes

“…Adult studies suggest that lactated ringers (LR) is associated with superior outcomes, including decreased length of stay, morbidity, or ICU stay compared with normal saline (NS) [21,22 ▪ ]. A review of the PHIS database found lactated ringers was associated with decreased length of stay and less healthcare dollars spent, but no change in ICU, organ dysfunction, or mortality [23]. A follow-up randomized control trial comparing lactated ringer (LR) to normal saline (NS) found LR may improve length of stay, but there was no change in SIRS or development of complicated or severe acute pancreatitis [24].…”