Table 2 Suggested fluid therapy regimens in severe acute pancreatitis
Authors, year | IV infusion rate (in the first 24 h) | Goals/endpoints | Comments |
|---|---|---|---|
De Waele E et al. [70] | 5–10 ml/kg/h | / | Up to 250–500 ml/h for 24 h. Up to ≥ 5000 ml may be necessary |
5–10 ml/kg/h | Clinical targets (UO > 0.5 -1 ml/kg/h) Invasive targets (ITBV, SVV) Laboratory markers (Ht 35–44%) | 2500–4000 mL in the first 24 h are usually sufficient | |
Buxbaum et al. [131] | 20 mL/kg bolus, then 3 ml/kg/h | Urea, Ht, creatinine | Higher clinical improvement with aggressive IV hydration Tested only on mild AP |
DiMagno MJ, [66] | 5–10 ml/kg/h until hemodynamic stability, then 3 ml/kg/h | HR < 120, MAP 65–86 mmHg, UO > 50 ml/h | After 6 h check BUN: ••••••If < 20 mg/dl or falling: change to 1.5 ml/kg/h ••••••If not, infusion of 5–10 ml/kg/h |
Yokoe M et al. [34] | 150–600 ml/h | MAP > 65 mmHg and UO > 0.5 ml/kg/h | Reduce to 130–150 ml/h when dehydration and shock are reversed |
Pezzilli R et al. [36] | Initial bolus of 20 ml/kg within 30–45 min, then 2 ml/kg/h | Normal UO, MAP, HR. BUN < 20 mg/dL, Ht 35–44% | Monitor every 8–12 h for the first 24–48 h |
Aggarwal et al. [67] | Bolus 1000 mL in 1 h, then 3 ml/kg/h (200 ml/h) | UO > 0.5 ml/kg/h, Ht 25–35%, drop in BUN | Continue for 24–48 h, until signs of volume depletion disappear |
Tenner S et al. [13] | 250–500 ml/h | Decrease Ht and BUN | Benefits are limited to first 12–24 h |
Fisher MJ, Gardner TB, [82] | 250–300 ml/h | Enough to produce a UO of 0.5 ml/kg/h | Tailor on patients’ characteristic, urine output, blood pressure, and modest decrease in hematocrit |
Nasr JY, Papachristou GI, [132] | Initial bolus 20 ml/kg, followed by 150–300 ml/h (3 ml/kg/h) | BUN, Ht | Subsequent maintenance: 2–3 ml/kg/h |
Wu BU et al. [47] | Bolus 20 ml/kg in 30 min, then 3 ml/kg/h maintenance (1.5 ml/kg/h for less hypovolemic patients) | Decreased BUN level | No improved outcome in early goal directed therapy was evidenced |
Pandol S et al. [133] | Level of dehydration: fluid rate -Severe: 500–1000 ml/h -Moderate: 300–500 ml/h -Mild: 250–350 ml/h | Vital signs, UO, Ht | Reassess every 1–2 h |