Background & Aims Early fluid resuscitation is recommended to reduce morbidity and mortality among patients with acute pancreatitis (AP), although the impact of this intervention has not been quantified. We investigated the association between early fluid resuscitation and outcome of patients admitted to the hospital with AP. Methods Non-transfer patients admitted to our center with AP, from 1985 to 2009, were identified retrospectively. Patients were stratified into groups based on early (n=340) or late resuscitation (n=94). Early resuscitation was defined as receiving ≥ 1/3 of the total 72 h fluid volume within 24 hours of presentation, whereas late resuscitation was defined as receiving ≤ 1/3 of the total 72 h fluid volume within 24 hours of presentation. The primary outcomes were frequency of the systemic inflammatory response syndrome (SIRS), organ failure, and death. Results Early resuscitation was associated with decreased SIRS, compared with late resuscitation, at 24 h (15% vs. 32% P=0.001), 48 h (14% vs. 33%, P =0.001), and 72 h (10% vs. 23%, P =0.01), as well as reduced organ failure at 72 h (5% vs. 10%, P <0.05), a lower rate of admission to the intensive-care unit (6% vs. 17%, P< 0.001), and a reduced length of hospital stay (8 vs. 11 days, P=0.01). Subgroup analysis demonstrated that these benefits were more pronounced in patients with interstitial, rather than severe, pancreatitis at admission. Conclusions In patients with AP, early fluid resuscitation was associated with reduced incidence of SIRS and organ failure at 72 hours. These effects were most pronounced in patients admitted with interstitial, rather than severe, disease.

Bilateral side-by-side SEMS placement above or below the SO results in similar success rates, stent patency duration, and stent occlusion rates. Significantly fewer complications, with a trend toward lower rates of pancreatitis, were observed for SEMS placed above the SO.

In comparison with hetastarch, HBOC-201 resuscitation of swine with HS increased survival (with severe HS), did not increase evidence of oxidative potential, and had histopathologic and/or functional effects on organs that were clinically equivocal (myocardium, lungs, hepatic parenchyma, jejunum, and renal cortex/medulla) and potentially adverse (hepatobiliary and renal papilla). The effects of HBOC-201-resuscitation in HS should be corroborated in controlled clinical trials.