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Faster Rate of Initial Fluid Resuscitation in Severe Acute Pancreatitis Diminishes In-Hospital Mortality

Gardner T.B.a, c · Vege S.S.a · Chari S.T.a · Petersen B.T.a · Topazian M.D.a · Clain J.E.a · Pearson R.K.a · Levy M.J.a · Sarr M.G.b
aMiles and Shirley Fiterman Center for Digestive Diseases, and bDepartment of General Surgery, Mayo Clinic Rochester, Rochester, Minn., and cSection of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, N.H., USA Pancreatology 2009;9:770–776 (DOI:10.1159/000210022)

Abstract

Background/Aims: We evaluated the impact of the initial intravenous fluid resuscitation rate within the first 24 h of presentation to the emergency room on important outcomes in severe acute pancreatitis. Methods: Patients presenting directly with a diagnosis of severe acute pancreatitis were identified retrospectively. Patients were divided into two groups – those who received ≧33% (‘early resuscitation’) and <33% (‘late resuscitation’) of their cumulative 72-hour intravenous fluid volume within the first 24 h of presentation. The primary clinical outcomes were in-hospital mortality, development of persistent organ failure, and duration of hospitalization. Results: 17 patients were identified in the ‘early resuscitation’ group and 28 in the ‘late resuscitation’ group and there were no baseline differences in clinical characteristics between groups. Patients in the ‘late resuscitation’ group experienced greater mortality than those in the ‘early resuscitation’ group (18 vs. 0%, p < 0.04) and demonstrated a trend toward greater rates of persistent organ failure (43 vs. 35%, p = 0.31). There was no difference in the total amount of fluid given during the first 72 h. Conclusions: Patients with severe acute pancreatitis who do not receive at least one third of their initial 72-hour cumulative intravenous fluid volume during the first 24 h are at risk for greater mortality than those who are initially resuscitated more aggressively.

 

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