Acute Pancreatitis

An important update regarding fluid management in acute pancreatitis: an RCT in which 249 patients were randomized to aggressive LR (20mL/kg bolus followed by 3mL/kg/hr) vs moderate LR (10mL/kg bolus followed by 1.5mL/kg/hr). The aggressive group developed more volume overload without improvement in probability of progressing to severe pancreatitis. Full abstract as follows: Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis BACKGROUND Early aggressive hydration is widely recommended for the management of acute pancreatitis, but evidence for this practice is limited. METHODS At 18 centers, we randomly assigned patients who presented with acute pancreatitis to receive goal-directed aggressive or moderate resuscitation with lactated Ringer’s solution. Aggressive fluid resuscitation consisted of a bolus of 20 ml per kilogram of body weight, followed by 3 ml per kilogram per hour. Moderate fluid resuscitation consisted of a bolus of 10 ml per kilogram in patients with hypovolemia or no bolus in patients with normovolemia, followed by 1.5 ml per kilogram per hour in all patients in this group. Patients were assessed at 12, 24, 48, and 72 hours, and fluid resuscitation was adjusted according to the patient’s clinical status. The primary outcome was the development of moderately severe or severe pancreatitis during the hospitalization. The main safety outcome was fluid overload. The planned sample size was 744, with a first planned interim analysis after the enrollment of 248 patients. RESULTS A total of 249 patients were included in the interim analysis. The trial was halted owing to between-group differences in the safety outcomes without a significant difference in the incidence of moderately severe or severe pancreatitis (22.1% in the aggressive-resuscitation group and 17.3% in the moderate-resuscitation group; adjusted relative risk, 1.30; 95% confidence interval [CI], 0.78 to 2.18; P=0.32). Fluid overload developed in 20.5% of the patients who received aggressive resuscitation and in 6.3% of those who received moderate resuscitation (adjusted relative risk, 2.85; 95% CI, 1.36 to 5.94, P=0.004). The median duration of hospitalization was 6 days (interquartile range, 4 to 8) in the aggressive-resuscitation group and 5 days (interquartile range, 3 to 7) in the moderate-resuscitation group. CONCLUSIONS In this randomized trial involving patients with acute pancreatitis, early aggressive fluid resuscitation resulted in a higher incidence of fluid overload without improvement in clinical outcomes. www.nejm.org/doi/full/10.1056/NEJMoa2202884?query=…

Thank you for this! This was a great video, and I especially appreciated your sharing of the changes in the patient's CT with development of WON. I will definitely be following this series going forward.

Many thanks 🙏🏻. No need to refer to any other source of information after listening to this video. Complete coverage of the topic...!!!! Thanks for the efforts taken !!! 🙏🏻🙏🏻.

I'm currently dealing with acute pancreatitis. It hurts. I have no medical background but this really helped to explain the intricacies of what's going on. Thank you.

Great to see you are making new videos!

Much appreciated. Thank you for time and effort.

I love this channel. This is always the 1st place I look

Another gem....i absolutely enjoy your lectures....thanks so much for sharing...stay safe

Great Video as alway! Thank you Dr Strong.

Thank you so much for your concised beautiful presentation.

I've learnt a lot from you Dr Strong ! Thankyou so much !

Great video as always Dr Strong !

Great content! Gave me a better understanding! Thank you!

I had severe acute pancreatitis...was put into acoma for 11 days......I have never drank alcohol...smoked or touched drugs!.....I have a horrible bowel disease.......which caused the gall bladder stones...they removed 78 stones from my gall bladder......so painful......

Wow, your lectures are really informative. They really encourage me to make more videos for Medical students on my channel. Keep up the good work! 😊

great discussion, i have surely added on more knowledge on this subject

Thanks for your effort.

It took me about 30 videos, but I finally figured it out. You look like Chris Parnell :) Definitely one of my favorite SNL cast members. Anyway, thank you for the explanations!

Very useful Thanks for sharing.

Wonderful!!!! Thank you