Aims: Guidelines recommend aggressive fluid resuscitation in patients with acute pancreatitis (AP) to minimize organ failure. This study aimed to determine whether early crystalloid fluid management is associated with mortality and/or critical care. Methods: 9,489 AP patients aged ≧18 years were categorized into four study groups: ventilation, hemodialysis, a combination of ventilation and hemodialysis, and neither ventilation nor hemodialysis. We analyzed demographics, mortality, comorbidities, complications, AP severity, surgery of the biliary/pancreatic system, and fluid volume (FV) during the initial 48 h (FV48) and during hospitalization (FVH), and calculated the FV ratio (FVR) as FV48/FVH. The impact of FV48 and FVR on mortality and the care process was assessed according to AP severity. Results: 1.1% of AP patients received ventilation, 1.7% received hemodialysis and 1.0% received both treatments. FV48 and FVR were higher in patients requiring ventilation compared with those not requiring ventilation. A high FV48 increased mortality and a high FVR decreased mortality in patients with severe AP. A high FV48 required ventilation in patients with severe AP, which was independently associated with mortality. Conclusion: Since relatively too much or too little early FV is associated with mortality, FV should be continuously monitored and managed according to AP severity.

Keywords:
Acute pancreatitis therapy, Fluid volume management, Critical care, Mortality
1.
Sekimoto M, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, Hirota M, Kimura Y, Takeda K, Isaji S, Koizumi M, Otsuki M, Matsuno S: JPN guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg 2006;13:1–24.
2.
Heinrich S, Schäfer M, Rousson V, Clavien PA: Evidence-based treatment of acute pancreatitis: a look at established paradigms. Ann Surg 2006;243:154–168.
3.
Eckerwall G, Olin H, Andersson B, Andersson R: Fluid resuscitation and nutritional support during severe acute pancreatitis in the past: what have we learned and how can we do better? Clin Nutr 2006;25:497–504.
4.
UK Working Party on Acute Pancreatitis: UK guidelines for the management of acute pancreatitis. Gut 2005;54:iii1–iii9. DOI: 10.1136/gut.2004.057026.
5.
Banks PA, Freeman ML: Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006;101:2379–2400.
6.
Pezzilli R, Zerbi A, Di Carlo V, Bassi C, Delle Fave GF: Practical guidelines for acute pancreatitis. Pancreatology 2010;10:523–535.
7.
Hirota M, Takada T, Kitamura N, Ito T, Hirata K, Yoshida M, Mayumi T, Kataoka K, Takeda K, Sekimoto M, Hirota M, Kimura Y, Wada K, Amano H, Gabata T, Arata S, Yokoe M, Kiriyama S: Fundamental and intensive care of acute pancreatitis. J Hepatobiliary Pancreat Sci 2010;17:45–52.
8.
Loveday BP, Srinivasa S, Vather R, Mittal A, Petrov MS, Phillips AR, Windsor JA: High quantity and variable quality of guidelines for acute pancreatitis: a systematic review. Am J Gastroenterol 2010;105:1466–1476.
9.
Cao Y, Xu Y, Lu T, Gao F, Mo Z: Meta-analysis of enteral nutrition versus total parenteral nutrition in patients with severe acute pancreatitis. Ann Nutr Metab 2008;53:268–275.
10.
Forsmark CE, Baillie J: AGA Institute Clinical Practice and Economics Committee; AGA Institute Governing Board. AGA Institute technical review on acute pancreatitis. Gastroenterology 2007;132:2022–2044.
11.
Hayden P, Wyncoll D: Severe acute pancreatitis. Curr Anaesth Crit Care 2008;19:1–7.
12.
Pandol SJ, Saluja AK, Imrie CW, Banks PA: Acute pancreatitis: bench to the bedside. Gastroenterology 2007;133:1056.e1–1056.e25.
13.
Beger HG, Rau BM: Severe acute pancreatitis: clinical course and management. World J Gastroenterol 2007;13:5043–5051.
14.
Lankisch PG: Treatment of acute pancreatitis: an attempted historical review. Pancreatology 2010;10:134–141.
15.
Gardner TB, Vege SS, Chari ST, Petersen BT, Topazian MD, Clain JE, Pearson RK, Levy MJ, Sarr MG.: Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality. Pancreatology 2009;9:770–776.
16.
Mao EQ, Tang YQ, Fei J, Qin S, Wu J, Li L, Min D, Zhang SD: Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J 2009;122:169–713.
17.
Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA: New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 2004;57:1288–1294.
18.
Hirota M, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, Sekimoto M, Kimura Y, Takeda K, Isaji S, Koizumi M, Otsuki M, Matsuno S: JPN guidelines for the management of acute pancreatitis: severity assessment of acute pancreatitis. J Hepatobiliary Pancreat Surg 2006;13:33–41.
19.
Hayashida K, Imanaka Y, Otsubo T, Kuwabara K, Ishikawa KB, Fushimi K, Hashimoto H, Yasunaga H, Horiguchi H, Anan M, Fujimori K, Ikeda S, Matsuda S: Development and analysis of a nationwide cost database of acute-care hospitals in Japan. J Eval Clin Pract 2009;15:626–633.
20.
Zhan C, Miller MR: Administrative data based patient safety research: a critical review. Qual Saf Health Care 2003;12:58–63.
21.
Iwanaka T, Miyata H: National Clinical Database: its design and organization (in Japanese). Nippon Geka Gakkai Zasshi 2010;111:306–310.
22.
Greenhalgh DG: Burn resuscitation: the results of the ISBI/ABA survey. Burns 2010;36:176–182.
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2011
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