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Comparison of moderate vs. aggressive fluid resuscitation in acute pancreatitis

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Created On: 16/03/2023

This study examined aggressive and moderate fluid resuscitation for the management of acute pancreatitis.

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Key take away

In individuals presenting with acute pancreatitis, the use of early aggressive fluid resuscitation led to a greater incidence of fluid overload without improvements in the clinical outcomes.

Background

This study examined aggressive and moderate fluid resuscitation for the management of acute pancreatitis.

Method

In this randomized trial, acute pancreatitis-affected subjects were randomly allocated at 18 centers to get goal-directed aggressive or moderate resuscitation using lactated Ringer's solution. A 20 ml bolus per kilogram of body weight, subsequently followed by 3 ml per kilogram every hour, made up aggressive fluid resuscitation. On the other hand, moderate fluid resuscitation comprised of a bolus of 10 ml per kilogram in people having hypovolemia or no bolus in people having normovolemia, subsequently followed by 1.5 ml per kilogram per hour in all people in this group.

At 12, 24, 48, and 72 hours, an assessment of participants was done. Fluid resuscitation was modified based on the clinical condition of each patient. The key endpoint was the development of severe pancreatitis or moderately severe pancreatitis while the patient was hospitalized. Fluid overload was the primary safety endpoint.

Result

The interim analysis comprised 249 patients in total. Without a considerable difference in the occurrence of moderately severe or severe pancreatitis (17.3% in the moderate-resuscitation arm and 22.1% in the aggressive-resuscitation arm; adjusted relative risk, 1.30), the trial was terminated due to between-group differences in the safety endpoints.

Notably, 20.5% of patients who got vigorous resuscitation experienced fluid overload, compared to 6.3% of patients who got moderate resuscitation (adjusted relative risk, 2.85). In the aggressive-resuscitation arm, the median hospital stays lasted six days, whereas, in the moderate-resuscitation arm, it lasted five days.