EUH Resident Report: Fluid management in acute pancreatitis – LR vs. saline

The Bottom Line: Data from the HYSLAR RCT found that fluid restriction with HYS is associated with a trend toward a reduced overall rate of complication when adjusted for pancreatic gland texture alone (21% reduction) and a significant reduction in complications when adjusting for pancreatic gland texture, age, and preoperative weight (25% reduction). The total number of complications occurring in the HYS arm (N = 93) was significantly reduced as compared with the LAR arm (N = 123).

Reference: Lavu H, Sell NM, Carter TI, et al. The HYSLAR trial: A prospective randomised control trial of the use of a restrictive fluid regime with 3% hypertonic saline versus lactated Ringers in patients undergoing pancreaticoduodenectomy. Annals of Surgery, 2014 Sept; 260(3): 445-453. doi:10.1097/SLA.0000000000000872

For additional reading: Beyer G, Mayerle J, Simon P, Lerch MM. Fluid resuscitation in acute pancreatitis. Pancreapedia: Exocrine Pancrease Knowledge Base, 2016. doi:10.3998/panc.2016.1

Lipinski M, Rydzewska-Rosolowska A, Rydzewska A, Rydzewska G. Fluid resuscitation in acute pancreatitis: Normal saline or lactated Ringer’s solution? World Journal of Gastroenterology, 2015 Aug 21; 21(31):9367-9372. doi:10.3748/wjg.v21.i31.9367

Summary: Although insufficient fluid resuscitation has been well described to have damaging effects, leading to end organ tissue hypoperfusion, in recent years, greater scrutiny has been applied to the harmful effects of overresuscitation.Recent published works in the anesthesia, liver surgery, and colorectal surgery literature have supported the use of goal-directed and restrictive fluid management strategies. Such data have indicated an earlier return of bowel function, fewer blood transfusions, and reduced rates of cardiopulmonary, wound, and anastomotic complications. Our data suggest that a level of moderate fluid restriction, with the use of HYS to maintain appropriate end organ tissue perfusion, may be an effective strategy.

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