TY - JOUR
T1 - Early crystalloid fluid volume management in acute pancreatitis
T2 - Association with mortality and organ failure
AU - Kuwabara, Kazuaki
AU - Matsuda, Shinya
AU - Fushimi, Kiyohide
AU - Ishikawa, Koichi B.
AU - Horiguchi, Hiromasa
AU - Fujimori, Kenji
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2011/9
Y1 - 2011/9
N2 - Aims: Guidelines recommend aggressive fluid resuscitation in patients with acute pancreatitis (AP) to minimize organ failure. This study aimed to determine whether early crystalloid fluid management is associated with mortality and/or critical care. Methods: 9,489 AP patients aged ≥18 years were categorized into four study groups: ventilation, hemodialysis, a combination of ventilation and hemodialysis, and neither ventilation nor hemodialysis. We analyzed demographics, mortality, comorbidities, complications, AP severity, surgery of the biliary/pancreatic system, and fluid volume (FV) during the initial 48 h (FV48) and during hospitalization (FVH), and calculated the FV ratio (FVR) as FV48/FVH. The impact of FV48 and FVR on mortality and the care process was assessed according to AP severity. Results: 1.1% of AP patients received ventilation, 1.7% received hemodialysis and 1.0% received both treatments. FV48 and FVR were higher in patients requiring ventilation compared with those not requiring ventilation. A high FV48 increased mortality and a high FVR decreased mortality in patients with severe AP. A high FV48 required ventilation in patients with severe AP, which was independently associated with mortality. Conclusion: Since relatively too much or too little early FV is associated with mortality, FV should be continuously monitored and managed according to AP severity.
AB - Aims: Guidelines recommend aggressive fluid resuscitation in patients with acute pancreatitis (AP) to minimize organ failure. This study aimed to determine whether early crystalloid fluid management is associated with mortality and/or critical care. Methods: 9,489 AP patients aged ≥18 years were categorized into four study groups: ventilation, hemodialysis, a combination of ventilation and hemodialysis, and neither ventilation nor hemodialysis. We analyzed demographics, mortality, comorbidities, complications, AP severity, surgery of the biliary/pancreatic system, and fluid volume (FV) during the initial 48 h (FV48) and during hospitalization (FVH), and calculated the FV ratio (FVR) as FV48/FVH. The impact of FV48 and FVR on mortality and the care process was assessed according to AP severity. Results: 1.1% of AP patients received ventilation, 1.7% received hemodialysis and 1.0% received both treatments. FV48 and FVR were higher in patients requiring ventilation compared with those not requiring ventilation. A high FV48 increased mortality and a high FVR decreased mortality in patients with severe AP. A high FV48 required ventilation in patients with severe AP, which was independently associated with mortality. Conclusion: Since relatively too much or too little early FV is associated with mortality, FV should be continuously monitored and managed according to AP severity.
KW - Acute pancreatitis therapy
KW - Critical care
KW - Fluid volume management
KW - Mortality
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U2 - 10.1159/000328965
DO - 10.1159/000328965
M3 - Article
C2 - 21757973
AN - SCOPUS:79960221933
VL - 11
SP - 351
EP - 361
JO - Pancreatology
JF - Pancreatology
SN - 1424-3903
IS - 3
ER -