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Fluid Therapy in Acute Pancreatitis: Anybody's Guess

Haydock, Matthew D. CertSc; Mittal, Anubhav PhD, MBChB, FRACS; Wilms, Heath R. MBus; Phillips, Anthony PhD, MBChB; Petrov, Maxim S. MD, MPH; Windsor, John A. MD, FRACS

doi: 10.1097/SLA.0b013e31827773ff
Feature

Objective: The aim of this study was to systematically review and evaluate the quality of current evidence about fluid therapy (FT) in acute pancreatitis (AP).

Background: Intravenous FT is thought to be important in the early management of patients with AP. Clinically relevant questions remain regarding the type of fluid, the rate of administration, and the goal of FT.

Methods: A comprehensive literature search for human studies was performed using online databases (MEDLINE, EMBASE, PubMed, and the Cochrane Library). The quality of the entire body of evidence was then graded according to the Grading of Recommendations Assessment, Development and Evaluation Working Group guidelines in relation to 3 key areas: type of fluid, rate of fluid administration, and goal-directed FT.

Results: The initial search yielded 410 studies, of which 15 met the inclusion criteria. Only 2 randomized studies compared types of fluids. Nine studies looked at aggressive versus nonaggressive resuscitation protocols, of which 4 concluded that an aggressive approach yielded better outcomes and 5 concluded that a nonaggressive approach was better. Two studies investigated goal-directed FT, using different goals; one demonstrating benefit and the other none. Analysis of the body of evidence as per the Grading of Recommendations Assessment, Development and Evaluation Working Group revealed that the majority of evidence was of low or very low quality.

Conclusions: FT is considered a cornerstone of the early management of patients with AP and yet the evidence on which it is based remains paltry and of poor quality. This systematic review has demonstrated the equipoise necessary for the design of randomized controlled trials to answer pressing questions relating to the type of fluid, the rate of administration, and how FT should be guided.

Intravenous fluid therapy is important in the early management of patients with acute pancreatitis. This systematic review demonstrates that significant questions remain regarding the type of fluid to select, the rate at which to administer fluids, and goals to direct fluid therapy.

Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

Reprints: John A. Windsor MD, FRACS, Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand. E-mail: j.windsor@auckland.ac.nz.

Disclosure: Supported by the University of Auckland Summer Studentship (to M.D.H.). The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.