Evaluation of Fluid Resuscitation Strategy for Severe Acute Pancreatitis in Early Stage_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Hong , SUN Jiabang , ZHU Yan , JIA Jianguo , LI Fei , LIU Dachuan

Department of Surgical Intensive Care Unit， Xuanwu Hospital of Capital Medical University， Beijing 100053， China;

Corresponding author：

Keywords：

Severe acute pancreatitis; Fluid resuscitation; Organ dysfunction

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Objective 　To evaluate the effectiveness of fluid therapy on an early goal-directed approach to resuscitation basis and the standard fluid therapy of adequate resuscitation on the prognosis of severe acute pancreatitis （SAP）in early stage.
Methods 　The clinical data of SAP patients admitted to surgical intensive care unit within 72 h after onset of symptoms from January 2000 to November 2011 were analyzed retrospectively. A total of 97 patients with a confirmed diagnosis of SAP were divided into two groups based on whether adopting the early goal-directed fluid resuscitation strategies or not. Patients admitted from January 2000 to December 2004 did not adopt the early goal-directed fluid resuscitation strategies，therefore，being allocated into standard fluid therapy group （n=34）； patients admitted from January 2005 to November 2011 adopted the early goal-directed fluid resuscitation strategies and who were allocated into early goal-directed fluid therapy group （n=63）. With the exception of the fluid therapy strategies，the two group patients received standard treatment for SAP. The acute physiology and chronic health evaluation Ⅱ score （APACHEⅡ） and multiple organ dysfunction score （Marshall）， rate of multiple organ dysfunction syndrome （MODS） within the first week after admission，pancreatic infection rate，and in-hospital mortality were compared between the two groups.
Results 　Compared with the standard fluid therapy group on day 3 after admission，APACHEⅡ score and Marshall score decreased significantly in the early goal-directed fluid therapy group （APACHEⅡ score：7.38±4.01 versus 11.35±4.27， P=0.011；Marshall score：4.13±2.06 versus 6.82±3.15， P=0.016）. In addition，patients in the early goal-directed fluid therapy group experienced a trend toward lower rates of MODS with the first week after admission，pancreatic infection，and in-hospital mortality （rate of MODS：46.0% versus 61.8%，P=0.139；rate of pancreatic infection：31.7% versus 44.1%， P=0.226；in-hospital mortality：15.8% versus 23.5%，P=0.355） that did not reach statistical significance.
Conclusion 　Although early goal-directed fluid therapy for SAP in acute response stage may have ameliorated the patient’s condition and improved outcome to a certain degree，carefully designed human clinical trials should be performed in a randomized controlled manner to assess the role of such fluid resuscitation in SAP.

Citation： CHEN Hong,SUN Jiabang,ZHU Yan,JIA Jianguo,LI Fei,LIU Dachuan,.. Evaluation of Fluid Resuscitation Strategy for Severe Acute Pancreatitis in Early Stage. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(5): 507-511. doi: Copy

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5.	Huber W， Umgelter A， Reindl W， et al. Volume assessment in patients with necrotizing pancreatitis：a comparison of intrathoracic blood volume index， central venous pressure，and hematocrit， and their correlation to cardiac index and extravascular lung water index [J]. Crit Care Med， 2008， 36(8)：2348-2354.
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7.	中华医学会外科学分会胰腺外科学组．重症急性胰腺炎诊治草案 [J]．中华普通外科杂志， 2001，16(11)：699-700．.
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12.	Wu B．Goal-directed fluid resuscitation in acute pancreatitis. http：//clinicaltrialsgov/ct2/show/NCT00853515? term=resuscitation&rank=12.
13.	Dellinger RP， Levy MM， Carlet JM， et al. Surviving sepsis campaign：international guidelines for management of severe sepsis and septic shock：2008 [J]. Intensive Care Med， 2008，34(1)：17-60.
14.	Shapiro NI， Fisher C， Donnino M， et al. The feasibility and accuracy of point-of-care lactate measurement in emergency department patients with suspected infection [J]. J Emerg Med，2010， 39(1)：89-94.
15.	Nguyen HB， Rivers EP， Knoblich BP， et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock [J]. Crit Care Med， 2004， 32(8)：1637-1642.
16.	Arnold RC， Shapiro NI， Jones AE， et al. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis [J]. Shock， 2009， 32(1)：35-39.
17.	Jones AE， Shapiro NI， Trzeciak S， et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy：a randomized clinical trial [J]. JAMA， 2010， 303(8)：739-746.
18.	Baillargeon JD， Orav J， Ramagopal V， et al. Hemoconcentration as an early risk factor for necrotizing pancreatitis [J]. Am J Gastroenterol， 1998， 93(11)：2130-2134.
19.	Lankisch PG， Mahlke R， Blum T， et al. Hemoconcentration：an early marker of severe and/or necrotizing pancreatitis? A critical appraisal [J]. Am J Gastroenterol， 2001， 96(7)：2081-2085.
20.	Gardner TB， Olenec CA， Chertoff JD， et al. Hemoconcentration and pancreatic necrosis：further defining the relationship [J].Pancreas， 2006， 33(2)：169-173.
21.	Brown A， Orav J， Banks PA. Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis [J]. Pancreas，2000， 20(4)：367-372.
22.	Gan SI， Romagnuolo J. Admission hematocrit：a simple， useful and early predictor of severe pancreatitis [J]. Dig Dis Sci，2004， 49(11-12)：1946-1952.
23.	Brown A， Baillargeon JD， Hughes MD， et al. Can fluid resuscitation prevent pancreatic necrosis in severe acute pancreatitis?[J]. Pancreatology， 2002， 2(2)：104-107.
24.	Eckerwall G， Olin H， Andersson B， et al. Fluid resuscitation and nutritional support during severe acute pancreatitis in the past：what have we learned and how can we do better? [J]. Clin Nutr，2006， 25(3)：497-504.
25.	Mao EQ， Tang YQ， Fei J， et al. Fluid therapy for severe acute pancreatitis in acute response stage [J]. Chin Med J， 2009，122(2)：169-173.
26.	Gardner TB，Vege SS，Chari ST，et al．Slower rate of initial fluid resuscitation in severe acute pancreatitis is a risk for in-hospital mortality [J]．Gastroenterology， 2008， 134(Suppl 1)：A-141.
27.	Gardner TB，Vege SS，Chari ST，et al．Lack of aggressive early fluid resuscitation is associated with organ failure in acute pancreatitis [J]．Gastroenterology， 2008， 134(Suppl 1)：A-373.
28.	Finfer S， Bellomo R， Boyce N， et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit [J]. N Engl J Med， 2004， 350(22)：2247-2256.
29.	Perel P， Roberts I．Colloids versus crystalloids for fluid resuscitation in critically ill patients [J]．Cochrane Database Syst Rev，2011， 3：CD000567.

1. Mitchell RM， Byrne MF， Baillie J. Pancreatitis [J]. Lancet，2003， 361(9367)：1447-1455.
2. Johnson CD， Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis [J].Gut， 2004， 53(9)：1340-1344.
3. Pandol SJ， Saluja AK， Imrie CW， et al. Acute pancreatitis：bench to the bedside [J]. Gastroenterology， 2007， 132(3)：1127-1151.
4. Gardner TB， Vege SS， Pearson RK， et al. Fluid resuscitation in acute pancreatitis [J]. Clin Gastroenterol Hepatol， 2008， 6(10)：1070-1076.
5. Huber W， Umgelter A， Reindl W， et al. Volume assessment in patients with necrotizing pancreatitis：a comparison of intrathoracic blood volume index， central venous pressure，and hematocrit， and their correlation to cardiac index and extravascular lung water index [J]. Crit Care Med， 2008， 36(8)：2348-2354.
6. Mole DJ， McKeown D. Moving the goalposts? Fluid volume assessment in severe acute pancreatitis [J]. Crit Care Med，2008， 36(8)：2464-2466.
7. 中华医学会外科学分会胰腺外科学组．重症急性胰腺炎诊治草案 [J]．中华普通外科杂志， 2001，16(11)：699-700．.
8. Dellinger RP， Carlet JM， Masur H， et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock [J]. Crit Care Med， 2004， 32(3)：858-873.
9. Weil MH， Henning RJ. New concepts in the diagnosis and fluid treatment of circulatory shock. Thirteenth annual Becton，Dickinson and Company Oscar Schwidetsky MemorialLecture [J]. Anesth Analg， 1979， 58(2)：124-132.
10. Marshall JC， Cook DJ， Christou NV， et al. Multiple organ dysfunction score：a reliable descriptor of a complex clinical outcome [J]. Crit Care Med， 1995， 23(10)：1638-1652.
11. Huber W. Early goal-directed volume resuscitation in severe acute pancreatitis. http：//clinicaltrialsgov/ct2/show/NCT00894907?term=resuscitation&rank=11.
12. Wu B．Goal-directed fluid resuscitation in acute pancreatitis. http：//clinicaltrialsgov/ct2/show/NCT00853515? term=resuscitation&rank=12.
13. Dellinger RP， Levy MM， Carlet JM， et al. Surviving sepsis campaign：international guidelines for management of severe sepsis and septic shock：2008 [J]. Intensive Care Med， 2008，34(1)：17-60.
14. Shapiro NI， Fisher C， Donnino M， et al. The feasibility and accuracy of point-of-care lactate measurement in emergency department patients with suspected infection [J]. J Emerg Med，2010， 39(1)：89-94.
15. Nguyen HB， Rivers EP， Knoblich BP， et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock [J]. Crit Care Med， 2004， 32(8)：1637-1642.
16. Arnold RC， Shapiro NI， Jones AE， et al. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis [J]. Shock， 2009， 32(1)：35-39.
17. Jones AE， Shapiro NI， Trzeciak S， et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy：a randomized clinical trial [J]. JAMA， 2010， 303(8)：739-746.
18. Baillargeon JD， Orav J， Ramagopal V， et al. Hemoconcentration as an early risk factor for necrotizing pancreatitis [J]. Am J Gastroenterol， 1998， 93(11)：2130-2134.
19. Lankisch PG， Mahlke R， Blum T， et al. Hemoconcentration：an early marker of severe and/or necrotizing pancreatitis? A critical appraisal [J]. Am J Gastroenterol， 2001， 96(7)：2081-2085.
20. Gardner TB， Olenec CA， Chertoff JD， et al. Hemoconcentration and pancreatic necrosis：further defining the relationship [J].Pancreas， 2006， 33(2)：169-173.
21. Brown A， Orav J， Banks PA. Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis [J]. Pancreas，2000， 20(4)：367-372.
22. Gan SI， Romagnuolo J. Admission hematocrit：a simple， useful and early predictor of severe pancreatitis [J]. Dig Dis Sci，2004， 49(11-12)：1946-1952.
23. Brown A， Baillargeon JD， Hughes MD， et al. Can fluid resuscitation prevent pancreatic necrosis in severe acute pancreatitis?[J]. Pancreatology， 2002， 2(2)：104-107.
24. Eckerwall G， Olin H， Andersson B， et al. Fluid resuscitation and nutritional support during severe acute pancreatitis in the past：what have we learned and how can we do better? [J]. Clin Nutr，2006， 25(3)：497-504.
25. Mao EQ， Tang YQ， Fei J， et al. Fluid therapy for severe acute pancreatitis in acute response stage [J]. Chin Med J， 2009，122(2)：169-173.
26. Gardner TB，Vege SS，Chari ST，et al．Slower rate of initial fluid resuscitation in severe acute pancreatitis is a risk for in-hospital mortality [J]．Gastroenterology， 2008， 134(Suppl 1)：A-141.
27. Gardner TB，Vege SS，Chari ST，et al．Lack of aggressive early fluid resuscitation is associated with organ failure in acute pancreatitis [J]．Gastroenterology， 2008， 134(Suppl 1)：A-373.
28. Finfer S， Bellomo R， Boyce N， et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit [J]. N Engl J Med， 2004， 350(22)：2247-2256.
29. Perel P， Roberts I．Colloids versus crystalloids for fluid resuscitation in critically ill patients [J]．Cochrane Database Syst Rev，2011， 3：CD000567.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Evaluation of Fluid Resuscitation Strategy for Severe Acute Pancreatitis in Early Stage

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