Table 1.
Main studies investigating fluid administration in acute pancreatitis
| Authors | Study design | Type of IV fluid | Rate of administration | Resuscitation endpoint | Study endpoint | Results |
|---|---|---|---|---|---|---|
| De-Madaria E, [130] | RCT (n = 249) | RL | Aggressive: bolus 20 ml/kg–3 ml/kg/h Moderate: bolus 10 ml/kg–1.5 ml/kg/h. In both groups, assessments at 3, 12, 24, 48, and 72 h to check for fluid overload or hypovolemia | BUN, Ht, UO, signs of dehydration, SBP | Development of moderately severe or severe pancreatitis during the hospitalization. Safety outcome signs of fluid overload | No difference in the primary outcome between the two groups. Higher incidence of fluid overload in the aggressive resuscitation group |
| Gad MM, [39] | Metanalysis (n = 2686) | / | Aggressive vs Non-aggressive | / | Mortality, PN, OF, AKI, RF | No difference between the two groups |
| Li L, [134] | RC (n = 912) | / | Rapid: ≥ 3 ml/kg/h Slow: < 3 ml/kg/h | / | Rate of MV, LOS | MV and hospital LOS associated with rapid FT in SAP and Ht ≥ 44% |
| Cuèllar-Monterrubio JE, [135] | RCT (n = 88) | Hartmann solution | Aggressive: bolus 20 ml/kg–3 ml/kg/h for 24 h -30 ml/kg/day Non-aggressive: 1.5 ml/kg/h for 24 h, then 30 ml/kg/day | Vital signs, UO, BUN, Ht, lactate, SIRS | Development of SIRS and OF | No difference in outcome |
| Ye B, [88] | RC (n = 179) | NS, RL |
Aggressive (> 4 L/day) Non-aggressive (< 4 L/day) |
Vital sign, UO > 0.5 ml/kg/h, Ht < 45% |
AKI development Chloride exposure |
> 4 L/day and higher chloride exposure associated with AKI |
| Yamashita T, [51] | RC (n = 1097) | / |
Aggressive ≥ 6 lt/day Non-aggressive < 6 lt/day |
/ | In-hospital mortality | ≥ 6 L within 24 h associated with less mortality |
| Buxbaum JL, [131] | RCT (n = 60) | RL |
Aggressive: 20 ml/h bolus + 3 ml/kg/h Standard: 10 ml/h + 1.5 ml/kg/h (median 3.91 L/24 h) |
Ht, BUN, Cr |
Decrease in Ht, BUN, Cr Reduced pain Tolerance to oral feeding |
Higher clinical improvement, reduced SIRS development, and less hemoconcentration in Aggressive group |
| Singh VK, [77] | RC (n = 1010) | / |
FVER Group I < 500 ml Group II 500–1000 ml Group III > 1000 ml FV24 Group I < 3200 ml Group II 3200 – 4300 ml Group III > 4300 ml |
/ | LC, OF, Invasive treatment, mortality |
FVER 500–1000 ml and > 1000 ml associated with better outcomes FV24 > 4300 ml associated with higher LC |
| Weitz [136] | RC (n = 391) | Ringer’s solution | / | / | Severity, LC, OF, PN | Higher fluid volume associated with severity and LC |
| Wall I, [50] | RC (n = 286) | / |
Until year 1998 = 113 ml/h in first 6 h From 1998 to 2008 = 284 ml/h in first 6 h |
/ | OF, PN, mortality | Less mortality and PN up to year 2008 |
| Warndorf MG, [49] | RC (n = 434) | NS (in 85% of cases) |
Early FT: ≥ 1/3 of the total 72 h fluid volume administered in the first 24 h Late FT: < 1/3 administered in the first 24 h (2.403 ml/24 h) |
/ | Mortality, SIRS, OF, ICU, LOS | Less SIRS, ICU, OF associated with early FT |
| De-Madaria E, [74] | RC (n = 247) |
NS plus D5%/D10% |
FT volume in first 24 h: Group A: < 3.1 L Group B: 3.1 – 4.1 L Group C: > 4.1 L |
Ht < 44%, UO > 50 ml/h, low Cr, normal SBP | OF, PN, APFC, mortality | Group C had more RF and AKI rate |
| Kuwabara K, [76] | RC (n = 9849) | Crystalloids |
FV48 FVR |
/ | Mortality, MV, Dialysis |
Higher FV48 associated with increased rate of MV, dialysis, mortality Higher FVR associated with lower mortality in the severe AP group |
| Wu B, [47] | RCT | NS vs RL | Standard 20 ml/kg bolus + 3 ml/kg/h vs physician judgment | BUN | SIRS | No difference between different rates; difference between RL and NS |
| Mole DJ, [137] | RC (n = 30) | NS, HS, D5-50%, sodium bicarbonate, phosphate; colloids (Gelofusine, Albumin 4.5%); blood products | / | Physician’s judgment | Volume of fluids administered | Less fluids associated with higher mortality |
| Gardner TB, [48] | RC (n = 45) | NS (71%), D5% + NaCl 0.45% (20%), RL (9%) |
Early FT: 203 ml/h in first 24 h Late FT: 71 ml/h in first 24 h |
/ | Mortality, OF, LOS | Higher mortality rate in Agg group |
| Mao E, [79] | RCT (n = 115) | NS, RL, plasma, HES 6% | Depending on goal-Ht |
Ht < 35% vs > 35% |
Incidence of sepsis, mortality | Goal Ht < 35%: major incidence of sepsis and higher mortality rate. Higher amount of fluid volume |
| Mao E, [78] | RCT (n = 76) | NS, RL, plasma, HES 6% |
Group I: 10–15 ml/kg/h Group II: 5–10 ml/kg/h |
HR, MAP, UO, Ht < 35% | APACHE II score, MV, ACS and sepsis incidence, mortality | Group I: higher incidence of MV and ACS, higher mortality rate |
| Eckerwall G [75] | RC (n = 99) | Crystalloids, Colloids (mainly albumin) |
> 4000 ml/24 h Vs< 4000 ml/24 h |
/ | Respiratory complications, ICU admission rate, mortality | More respiratory complications and need for intensive care admissions with > 4000 ml/24 h |
/ Not specified; AKI Acute kidney injury; APFC Acute peripancreatic fluid collections; ACS Acute Compartment Syndrome; BUN Blood urea nitrogen; Cr Creatinine; D5–10–50% Dextrose solution 5–10–50%; FT fluid therapy; FVER Fluid Volume in Emergency Room, within 4 h from admission; FV24 Fluid volume administered in first 24 h, since admission to the hospital ward. FV48 Fluid volume per day in the initial 48 h; FVR (Fluid volume ratio) Average fluid volume per day in the first 48 h, compared to fluid volume per day during total hospitalization; HD Hemodialysis; Ht Hematocrit; HES 6% Hydroxyethyl starch 6%; ICU Intensive Care Unit; LOS Hospital Length of stay; LC Local complications; MV Mechanical ventilation; NS Normal saline; PN Pancreatic necrosis; OF organ failure; RF Respiratory failure; RC Retrospective Cohort, RCT Randomized Clinical Trial; RL Ringer Lactate; SBP Systolic blood pressure; SIRS Systemic Inflammatory Response Syndrome; UO Urinary output