Early aggressive hydration in acute pancreatitis results in fluid overload without improving outcomes: NEJM

Researchers have found in a randomized trial that early vigorous hydration led to a greater incidence of fluid overload without improving clinical outcomes in patients with acute pancreatitis. The findings of this study were published in The New England Journal of Medicine.

Although early forceful hydration is frequently advised for the treatment of acute pancreatitis, there is less support for this approach. Therefore, in order to confirm the effectiveness of vigorous or moderate fluid resuscitation in acute pancreatitis, Enrique de-Madaria and colleagues undertook this study.

At 18 locations, researchers administered goal-directed aggressive or moderate resuscitation with Ringer Lactate solution to patients who arrived with acute pancreatitis. An aggressive fluid bolus of 20 ml/kg of body weight was followed by 3 ml/kg every hour. A bolus of 10 ml/kg for patients with hypovolemia or no bolus for those with normovolemia was followed by 1.5 ml/kg per hour for all of the patients in this group receiving moderate fluid resuscitation. Patients' clinical state was evaluated at 12, 24, 48, and 72 hours, and fluid resuscitation was modified as necessary. The main result was the onset of mild, moderate, or severe pancreatitis while the patient was being treated in the hospital.

The key findings of this study were:

1. Due to between-group disparities in safety outcomes without a statistically significant difference in the frequency of moderately severe or severe pancreatitis, the experiment was terminated.

2. In 20.5% of patients who underwent vigorous resuscitation and in 6.3% of patients who received moderate resuscitation, fluid excess manifested itself.

3. In the aggressive-resuscitation group, the median hospital stay was 6 days (interquartile range: 4 to 8), whereas in the moderate-resuscitation group, it lasted 5 days (interquartile range: 3 to 7).

Reference: 

de-Madaria, E., Buxbaum, J. L., Maisonneuve, P., García García de Paredes, A., Zapater, P., Guilabert, L., Vaillo-Rocamora, A., Rodríguez-Gandía, M. Á., Donate-Ortega, J., Sánchez-Marin, C., Cobreros, M., … Bolado, F. (2022). Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. In New England Journal of Medicine (Vol. 387, Issue 11, pp. 989–1000). Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2202884