Clinical outcomes between aggressive versus moderate fluid resuscitation in the management of acute pancreatitis: a quasi-experimental study
DOI:
https://doi.org/10.52442/jrmi.v12i1.1011Keywords:
Acute Pancreatitis, Fluid Therapy, Multiple Organ Failure, Ringer’s LactateAbstract
Introduction: Early intravenous fluid resuscitation is essential in acute pancreatitis (AP), but the optimal volume strategy remains uncertain. Aggressive hydration raises concerns about iatrogenic damage from excessive fluid intake.
Objectives: To compare the clinical outcomes of moderate versus aggressive fluids resuscitations in the management of acute pancreatitis.
Materials and Methods: A quasi-experimental, alternate-allocation comparison study was conducted between October 2023 to March 2025. About 260 adults with first‐episode AP were enrolled and alternately assigned to aggressive (20 mL/kg bolus followed by 3 mL/kg/h) or moderate (10 mL/kg bolus if hypovolemic, followed by 1.5 mL/kg/h) lactated Ringer’s (LR) protocols. The primary endpoints comprised hospital length of stay (LOS) and incidence of persistent organ failure. Secondary outcomes included ICU admissions, treatments, SIRS (Systemic Inflammatory Response Syndrome) at 24 and 48 hours, changes in hematocrit and blood urea nitrogen (BUN), pancreatic necrosis, and in-hospital mortality.
Results: Baseline characteristics were balanced across 260 patients. About 8.5% patients on aggressive LR and 6.2% on moderate LR experienced persistent organ failure (p=0.43). Median hospital LOS for aggressive LR was 6 days (IQR 4–8) and for moderate LR was 5 days (IQR 3–7) (p=0.05). ICU admission (15.4% vs 9.2%; p=0.08), any organ failure (8.5% vs 6.2%; p=0.43), invasive interventions (10.0% vs 7.7%; p=0.49), and mortality (2.3% vs 1.5%; p= 0.67) were comparable. Despite no improvement in clinical outcomes, aggressive LR yielded greater 24-hour reductions in hematocrit and BUN (p<0.05).
Conclusions: Larger volumes of LR did not improve outcomes in this cohort. Adoption of customized, moderate-volume techniques with regular reassessment in early AP is supported by these data.
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