Detailed fluid resuscitation profiles in patients with severe acute pancreatitis

Background and aim: Appropriate and timely initial fluid resuscitation in acute pancreatitis (AP) is critical. The aim of this retrospective study was to evaluate fluid therapy on an hour-by-hour basis in relation to standard indices of adequate resuscitation during AP.

Methods: Emergency room shock charts, fluid balance sheets and intensive care (ICU) charts for all patients with AP admitted to ICU in a large acute hospital were examined. Vital signs, clinical course and fluid administered during the first 72 h after admission were tabulated against urine output, central venous pressure (CVP) and inotrope/vasopressor therapy.

Results: Sixty-three consecutive patients with AP were initially evaluated. Inter-hospital transfers with established organ dysfunction (n = 11) or where records had insufficient detail (n = 22) were excluded. In the remaining 30 patients, in-hospital death occurred in 7. The cumulative volume of crystalloid given was significantly less at 48 h in patients who died in hospital (3331 +/- 800 ml vs. survivors, 7287 +/- 544 ml; P < 0.001). Non-survivors had a higher CVP, and received more inotropes/vasopressors.

Conclusion: In severe AP-associated organ failure, fluid resuscitation profiles differ between survivors and non-survivors. CVP alone as a crude indicator of adequate resuscitation may be unreliable, potentially leading to the use of inotropes/vasopressors in the inadequately filled patient.