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Liberal Fluid Resuscitation is Associated with Improved Outcomes in Pediatric Acute Pancreatitis
Nicholas Norris1, Peter Farrell2, Sherif Ibrahim3
1Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX.
Insights
Liberal intravenous fluid therapy in children with acute pancreatitis (AP) may reduce intensive care unit admissions. Early feeding alongside liberal fluids showed the lowest rates of moderate to severe AP manifestations.
Area of Science:
- Pediatric Gastroenterology
- Critical Care Medicine
Background:
- Acute pancreatitis (AP) in children requires careful management.
- Intravenous fluid therapy is a cornerstone of AP treatment, but optimal rates and types remain debated.
Purpose of the Study:
- To evaluate the outcomes of pediatric patients with acute pancreatitis based on different intravenous fluid therapy strategies.
- To analyze the impact of fluid rates, early enteral feeding, and fluid composition on AP outcomes.
Main Methods:
- Observational cohort study of index acute pancreatitis admissions between 2013 and 2023.
- Patients were categorized into liberal (>1.5x maintenance fluids) and conservative (<1.5x maintenance fluids) groups.
- Outcomes assessed included ICU admission, organ dysfunction, local complications, and AP severity.
Main Results:
- Liberal fluid therapy was associated with significantly lower intensive care unit admission or transfer rates compared to conservative management (OR, 0.32; P=.015).
- The combination of liberal fluids and early enteral feeding resulted in the lowest rate of moderate/severe AP manifestations.
- Higher rates of liberal fluids (>2x maintenance) did not increase the incidence of organ dysfunction or severe disease.
Conclusions:
- Pediatric patients with acute pancreatitis may benefit from liberal fluid therapy and early diet initiation.
- Conservative fluid resuscitation and nothing-by-mouth status may be less optimal for managing pediatric AP.
Objective:
To evaluate outcomes of children from an observational cohort registry of index acute pancreatitis (AP) admissions managed with different types and rates of intravenous fluid therapy.
Study Design:
Patients with index admission of AP between 2013 and 2023 were included. Those who received >1.5x the maintenance intravenous fluid rate were assigned to the liberal fluid group, and patients who received <1.5x maintenance fluids were assigned to the conservative group. Outcomes including intensive care unit admission rate, organ dysfunction, local pancreatic complications, and AP severity were evaluated. Influence of early enteral feeding and fluid composition on outcomes and clinical course were also analyzed.
Results:
Patients who received liberal fluids were less likely to be admitted or transferred to the intensive care unit compared with those receiving conservative management (OR, 0.32; 95% CI, 0.12-0.80; P = .015). The liberal fluid group with early feeding had the lowest rate of moderate/severe manifestations of AP compared with other combinations of diet and fluid orders. Patients within the liberal fluid group who received the highest fluid rates (>2x maintenance) did not have higher rates of organ dysfunction or severe disease.
Conclusions:
Children with AP may stand to benefit from liberal fluid therapy and continued diet compared with more conservative fluid resuscitation and nothing by mouth status.
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