Fluid resuscitation in the early management of acute pancreatitis – evidence from a systematic review and meta-analysis
Date
2023
Authors
Dawson, A.
Karunakaran, M.
Sharma, Z.D.
Ullah, S.
Barreto, S.G.
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Journal article
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HPB, 2023; 25(12):1451-1465
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Abby Dawson, Monish Karunakaran, Zubin D. Sharma, Shahid Ullah, Savio G. Barreto
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Abstract
Background: Third space fluid loss is one of the hallmarks of the pathophysiology of acute pancreatitis (AP) contributing to complications, including organ failure and death. We conducted a systematic review of literature to determine the ideal fluid resuscitation in the early management of AP, primarily comparing aggressive versus moderate intravenous fluid resuscitation (AIR vs MIR). Methods: A systematic review of major reference databases was undertaken. Meta-analysis was performed using random-effects model. Bias was assessed using Cochrane risk of bias and ROBINS-I tools for randomized and non-randomised studies, respectively. Results: Twenty studies were included in the analysis. Though there was no significant difference in mortality between AIR and MIR groups (8.3% versus 6.0%; p = 0.3), AIR cohort had significantly higher rates of organ failure (p = 0.009), including pulmonary (p = 0.02) and renal (p = 0.01) complications. Similarly, there was no difference in mortality between normal saline (NS) and Ringer’s lactate (RL) (3.17% versus 3.01%; p = 0.23), though patients treated with NS had a significantly longer length of hospital stay (LOS) (p = 0.009). Conclusions: Current evidence appears to support moderate intravenous resuscitation (level of evidence, low) with RL (level of evidence, moderate) in the early management of AP.
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Crown Copyright © 2023 Published by Elsevier Ltd on behalf of International Hepato-Pancreato-Biliary Association Inc. All rights reserved.