de-Madaria E, et al. N Engl J Med. 2022 Sep 15;387(11):989-1000.
Question and Methods: A multicenter, open-label, randomized control trial assessing the use of aggressive versus moderate fluid resuscitation in acute pancreatitis and the development of moderate severe or severe pancreatitis and fluid overload.
Findings: The trial stopped early given significant difference in development of fluid overload (20.5% in aggressive-resuscitation group versus 6.3% in moderate-resuscitation group; adjusted relative risk, 2.85; 95% CI, 1.36 – 5.94, P=0.004) without any significant difference in incidence of moderately severe/severe pancreatitis (22.1% in the aggressive-resuscitation group versus 17.3% in the moderate-resuscitation group; adjusted relative risk,1.30; 95% CI, 0.78 – 2.18; P=0.32).
Limitations: Given eligibility criteria, trial population may have had less severe disease. Open-label trial with subjective assessments of fluid status. Moderate-resuscitation group only received a bolus if they were hypovolemic, while aggressive-resuscitation group received an initial fluid bolus whether hypovolemic or not, possibly contributing to fluid overload.
Interpretation: In acute pancreatitis, aggressive fluid resuscitation should be avoided. Further, patients with normovolemia should not receive fluid boluses. Both of these may lead to fluid overload, which can be harmful for the patient.
Supervisor: Dr. Krishan Yadav