[HTML][HTML] Systematic review and meta-analysis of fluid therapy protocols in acute pancreatitis: type, rate and route
M Di Martino, S Van Laarhoven, B Ielpo, JM Ramia… - Hpb, 2021 - Elsevier
M Di Martino, S Van Laarhoven, B Ielpo, JM Ramia, A Manuel-Vázquez, A Martínez-Pérez…
Hpb, 2021•ElsevierBackground Adequate fluid resuscitation is paramount in the management of acute
pancreatitis (AP). The aim of this study is to assess benefits and harms of fluid therapy
protocols in patients with AP. Methods MEDLINE, Embase, Science Citation Index and
clinical trial registries were searched for randomised clinical trials published before May
2020, assessing types of fluids, routes and rates of administration. Results A total 15 trials
(1073 participants) were included. Age ranged from 38 to 73 years; follow-up period ranged …
pancreatitis (AP). The aim of this study is to assess benefits and harms of fluid therapy
protocols in patients with AP. Methods MEDLINE, Embase, Science Citation Index and
clinical trial registries were searched for randomised clinical trials published before May
2020, assessing types of fluids, routes and rates of administration. Results A total 15 trials
(1073 participants) were included. Age ranged from 38 to 73 years; follow-up period ranged …
Background
Adequate fluid resuscitation is paramount in the management of acute pancreatitis (AP). The aim of this study is to assess benefits and harms of fluid therapy protocols in patients with AP.
Methods
MEDLINE, Embase, Science Citation Index and clinical trial registries were searched for randomised clinical trials published before May 2020, assessing types of fluids, routes and rates of administration.
Results
A total 15 trials (1073 participants) were included. Age ranged from 38 to 73 years; follow-up period ranged from 0.5 to 6 months. Ringer lactate (RL) showed a reduced number of severe adverse events (SAE) when compared to normal saline (NS) (OR 0.48; 95%CI 0.29–0.81, p = 0.006); additionally, NS showed reduced SAE (RR 0.38; 95%IC 0.27–0.54, p < 0.001) and organ failure (RR 0.30; 95%CI 0.21–0.44, p < 0.001) in comparison with hydroxyethyl starch (HES).
High fluid rate fluid infusion showed increased mortality (OR 2.88; 95%CI 1.41–5.88, p = 0.004), increased number of SAE (RR 1.42; 95%CI 1.04–1.93, p = 0.030) and higher incidence of sepsis (RR 2.80; 95%CI 1.51–5.19, p = 0.001) compared to moderate fluid rate infusion.
Conclusions
In patients with AP, RL should be preferred over NS and HES should not be recommended. Based on low-certainty evidence, moderate-rate fluid infusion should be preferred over high-rate infusion.
Elsevier
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