Fluid resuscitation in acute pancreatitis

Area of Science:

• Gastroenterology
• Critical Care Medicine
• Translational Medicine

Background:

• Fluid resuscitation (FR) is a cornerstone of supportive care for acute pancreatitis (AP).
• Recent clinical practice has evolved from aggressive to more moderate FR strategies.
• Lactated Ringer's solution is currently the preferred fluid for resuscitation in AP.

Approach:

• This review critically evaluates existing literature on FR in AP.
• It examines the rationale, fluid types, administration rates, volumes, and duration of FR.
• The review also assesses monitoring parameters, ideal clinical trial outcomes, and future research recommendations.

Key Points:

• A shift towards moderate FR strategies is evident in AP management.
• Lactated Ringer's is the recommended fluid for resuscitation.
• Significant knowledge gaps persist regarding endpoints for adequate resuscitation and accurate volume status assessment in AP.

Conclusions:

• There is insufficient evidence to support goal-directed FR therapy in AP for reducing organ failure, infected necrosis, or mortality.
• The optimal method for guiding FR in AP remains undetermined.
• Further research is needed to establish evidence-based guidelines for FR in AP.