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Fluid resuscitation in acute pancreatitis
Timothy B Gardner1, Santhi Swaroop Vege, Randall K Pearson
1Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
Summary
Aggressive intravenous fluid resuscitation is crucial for acute pancreatitis, but optimal fluid type, targets, and timing require further human investigation. This review explores current knowledge and future research needs for effective pancreatitis fluid therapy.
Area of Science:
- Gastroenterology and Hepatology
- Critical Care Medicine
- Pancreatic Diseases
Background:
- Acute pancreatitis is a prevalent inflammatory pancreatic disorder with significant morbidity and a 5% mortality rate.
- Current management lacks specific pharmacologic treatments, emphasizing aggressive intravenous fluid resuscitation.
- Key questions regarding optimal fluid type, resuscitation targets, and timing remain unanswered in human studies.
Purpose of the Study:
- To review pancreatic microcirculation and pathophysiological changes in acute pancreatitis.
- To analyze existing animal and human studies on fluid resuscitation in acute pancreatitis.
- To highlight current recommendations and identify critical areas for future clinical trials.
Main Methods:
- Review of existing literature on pancreatic microcirculation and pathophysiology.
- Analysis of animal experimental data on fluid resuscitation.
- Evaluation of limited human studies addressing fluid resuscitation in acute pancreatitis.
Main Results:
- Acute pancreatitis causes significant pathophysiological alterations affecting pancreatic microcirculation.
- Optimal fluid resuscitation strategies, including fluid type (crystalloid vs. colloid) and targets, are not well-defined in humans.
- Limited human data necessitates further research into fluid resuscitation protocols.
Conclusions:
- Further well-designed human clinical trials are essential to determine optimal fluid resuscitation strategies for acute pancreatitis.
- Future research should focus on varying fluid solutions, rates, patient monitoring, and safety.
- Investigating specific patient groups and clinical markers for fluid resuscitation is critical.
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Assessment:
Assessment: