2020
DOI: 10.1007/s10620-019-05985-w
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Early Rapid Fluid Therapy Is Associated with Increased Rate of Noninvasive Positive-Pressure Ventilation in Hemoconcentrated Patients with Severe Acute Pancreatitis

Abstract: Background/Aims Hematocrit is a widely used biomarker to guide early fluid therapy for patients with acute pancreatitis (AP), but there is controversy over whether early rapid fluid therapy (ERFT) should be used in hemoconcentrated patients. This study investigated the association of hematocrit and ERFT with clinical outcomes of patients with AP. Methods Data from prospectively maintained AP database and retrospectively collected fluid management details were stratified according to actual severity defined by … Show more

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Cited by 35 publications
(41 citation statements)
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“…Unfortunately, the tools to guide fluid management to establish when fluid administration is no longer beneficial are inadequate. In the past, the fluid reposition based on haemoconcentration was proposed, without robust data supporting this strategy; more recently, new publications reported worse outcomes [ 45 ].…”
Section: Discussionmentioning
confidence: 99%
“…Unfortunately, the tools to guide fluid management to establish when fluid administration is no longer beneficial are inadequate. In the past, the fluid reposition based on haemoconcentration was proposed, without robust data supporting this strategy; more recently, new publications reported worse outcomes [ 45 ].…”
Section: Discussionmentioning
confidence: 99%
“…Data on in-hospital mortality were extracted from 12 studies [12,[14][15][16][17][18][19][20][28][29][30][31] that assessed 3,067 patients (Fig. 2).…”
Section: Primary Outcomementioning
confidence: 99%
“…Pooled data from 6 trials [12,15,20,28,29,31] con rmed a signi cant disadvantage in the AFT group in terms of the incidence of respiratory failure rate (53.8% and 23.4%; OR, 3.81; 95% CI, 1.76-8.23; P = 0.0007; Additional le 1: Fig. S5) with signi cant moderate heterogeneity (χ2 = 15.91; df, 5; P = 0.007; I 2 , 69%).…”
Section: Secondary Outcomesmentioning
confidence: 99%
“…Aggressive fluid resuscitation for prevention of necrotizing and severe pancreatitis has long been regarded as the cornerstone of early management of AP [41], but controversy persists in matters of the type, rate, and duration of fluid administration [42]. There has been promising evidence to support the role of early aggressive fluid resuscitation with Lactated Ringers in mild AP [43]; however, in subjects with predicted SAP, prolonged aggressive volume administration may be harmful [44]. Specifically, in SAP patients with systemic vascular leak syndrome, aggressive fluid resuscitation may increase thirdspacing and intra-abdominal pressure, which can lead to the development of abdominal compartment syndrome and respiratory failure [44][45][46].…”
Section: Fluid Resuscitationmentioning
confidence: 99%
“…There has been promising evidence to support the role of early aggressive fluid resuscitation with Lactated Ringers in mild AP [43]; however, in subjects with predicted SAP, prolonged aggressive volume administration may be harmful [44]. Specifically, in SAP patients with systemic vascular leak syndrome, aggressive fluid resuscitation may increase thirdspacing and intra-abdominal pressure, which can lead to the development of abdominal compartment syndrome and respiratory failure [44][45][46]. Thus, after initiation of fluid therapy, endpoints such as urine output, mean arterial pressure, oxygen saturation with respiratory rate, and intra-abdominal pressure should be closely monitored early in the disease course.…”
Section: Fluid Resuscitationmentioning
confidence: 99%