TY - JOUR
T1 - Systematic review and meta-analysis of fluid therapy protocols in acute pancreatitis
T2 - type, rate and route
AU - Di Martino, Marcello
AU - Van Laarhoven, Stijn
AU - Ielpo, Benedetto
AU - Ramia, Jose M.
AU - Manuel-Vázquez, Alba
AU - Martínez-Pérez, Aleix
AU - Pavel, Mihai
AU - Beltran Miranda, Pablo
AU - Orti-Rodríguez, Rafael
AU - de la Serna, Sofía
AU - Ortega Rabbione, Guillermo J.
AU - Sanz-Garcia, Ancor
AU - Martín-Pérez, Elena
N1 - Publisher Copyright:
© 2021 International Hepato-Pancreato-Biliary Association Inc.
PY - 2021/11
Y1 - 2021/11
N2 - 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.
AB - 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.
U2 - 10.1016/j.hpb.2021.06.426
DO - 10.1016/j.hpb.2021.06.426
M3 - Review article
SN - 1365-182X
VL - 23
SP - 1629
EP - 1638
JO - HPB
JF - HPB
IS - 11
ER -