Evaluating the efficacy of different volume resuscitation strategies in acute pancreatitis patients: a systematic review and meta-analysis.

Autor: Kumari R; Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, USA., Sadarat F; Department of Medicine, University of Buffalo, New York, USA., Luhana S; Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, USA., Parkash O; Department of Medicine, Montefiore Medical Center, Weikfield, NY, USA., Lohana AC; Department of Medicine, WVU Camden Clark Medical Center, West, VA, USA., Rahaman Z; Department of Medicine, University of Buffalo, New York, USA., Wang HY; Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, USA., Mohammed YN; Department of Medicine, Western Michigan University, Pontiac, USA., Kumar SK; Department of Medicine, Bahria University Health Sciences Karachi, Karachi, Pakistan., Chander S; Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, USA. subhash.chander@mssm.edu.; Department of Medicine, University of Buffalo, New York, USA. subhash.chander@mssm.edu.
Jazyk: angličtina
Zdroj: BMC gastroenterology [BMC Gastroenterol] 2024 Mar 25; Vol. 24 (1), pp. 119. Date of Electronic Publication: 2024 Mar 25.
DOI: 10.1186/s12876-024-03205-y
Abstrakt: Introduction: Acute pancreatitis poses a significant health risk due to the potential for pancreatic necrosis and multi-organ failure. Fluid resuscitation has demonstrated positive effects; however, consensus on the ideal intravenous fluid type and infusion rate for optimal patient outcomes remains elusive.
Methods: A comprehensive literature search was conducted using PubMed, Embase, the Cochrane Library, Scopus, and Google Scholar for studies published between 2005 and January 2023. Reference lists of potential studies were manually searched to identify additional relevant articles. Randomized controlled trials and retrospective studies comparing high (≥ 20 ml/kg/h), moderate (≥ 10 to < 20 ml/kg/h), and low (5 to < 10 ml/kg/h) fluid therapy in acute pancreatitis were considered.
Results: Twelve studies met our inclusion criteria. Results indicated improved clinical outcomes with low versus moderate fluid therapy (OR = 0.73; 95% CI [0.13, 4.03]; p = 0.71) but higher mortality rates with low compared to moderate (OR = 0.80; 95% CI [0.37, 1.70]; p = 0.55), moderate compared to high (OR = 0.58; 95% CI [0.41, 0.81], p = 0.001), and low compared to high fluids (OR = 0.42; 95% CI [0.16, 1.10]; P = 0.08). Systematic complications improved with moderate versus low fluid therapy (OR = 1.22; 95% CI [0.84, 1.78]; p = 0.29), but no difference was found between moderate and high fluid therapy (OR = 0.59; 95% CI [0.41, 0.86]; p = 0.006).
Discussion: This meta-analysis revealed differences in the clinical outcomes of patients with AP receiving low, moderate, and high fluid resuscitation. Low fluid infusion demonstrated better clinical outcomes but higher mortality, systemic complications, and SIRS persistence than moderate or high fluid therapy. Early fluid administration yielded better results than rapid fluid resuscitation.
(© 2024. The Author(s).)
Databáze: MEDLINE
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