Systematic review and meta-analysis of fluid therapy protocols in acute pancreatitis: type, rate and route
Por:
Di Martino, M, Van Laarhoven, S, Ielpo, B, Ramia, J, Manuel-Vazquez, A, Martinez-Perez, A, Pavel, M, Miranda, P, Orti-Rodriguez, R, de la Serna, S, Rabbione, G, Sanz-Garcia, A and Martin-Perez, E
Publicada:
1 nov 2021
Ahead of Print:
8 jul 2021
Resumen:
Background: Adequate fluid resuscitation is paramount in the management of acute pancreatitis (AP). The aim of this study is to assess benefits and harms of fluid therapy protocols in patients with AP. Methods: MEDLINE, Embase, Science Citation Index and clinical trial registries were searched for randomised clinical trials published before May 2020, assessing types of fluids, routes and rates of administration. Results: A total 15 trials (1073 participants) were included. Age ranged from 38 to 73 years; follow-up period ranged from 0.5 to 6 months. Ringer lactate (RL) showed a reduced number of severe adverse events (SAE) when compared to normal saline (NS) (OR 0.48; 95%CI 0.29-0.81, p = 0.006); additionally, NS showed reduced SAE (RR 0.38; 95%IC 0.27-0.54, p < 0.001) and organ failure (RR 0.30; 95%CI 0.21-0.44, p < 0.001) in comparison with hydroxyethyl starch (HES). High fluid rate fluid infusion showed increased mortality (OR 2.88; 95%CI 1.41-5.88, p = 0.004), increased number of SAE (RR 1.42; 95%CI 1.04-1.93, p = 0.030) and higher incidence of sepsis (RR 2.80; 95%CI 1.51-5.19, p = 0.001) compared to moderate fluid rate infusion. Conclusions: In patients with AP, RL should be preferred over NS and HES should not be recommended. Based on low-certainty evidence, moderate-rate fluid infusion should be preferred over high rate infusion.
Filiaciones:
Di Martino, M:
Univ Autonoma Madrid UAM, Hosp Univ La Princesa, Inst Invest Sanitaria Princesa IIS IP, Dept Gen & Digest Surg,HPB Unit, Madrid, Spain
Van Laarhoven, S:
Univ Hosp Bristol & Weston NHS Fdn, Dept HPB Surg, Bristol, Avon, England
Ielpo, B:
Univ Mar Hosp, HPB Unit, Parc Salut, Barcelona, Spain
:
Valencian Int Univ VIU, Fac Hlth Sci, Valencia 46002, Spain
Hosp Gen Univ Alicante, Dept Surg, ISABIAL, Alicante, Spain
Manuel-Vazquez, A:
Hosp Univ Getafe, Dept Gen & Digest Surg, Madrid, Spain
Martinez-Perez, A:
Valencian Int Univ VIU, Fac Hlth Sci, Valencia 46002, Spain
Pavel, M:
Hosp Univ Tarragona Joan XXIII, HPB Unit, Dept Gen Surg, Tarragona, Spain
Univ Rovira & Virgili, Dept Med & Cirugia, Reus, Spain
Miranda, P:
Hosp Univ Juan Ramon Jimenez, Unidad Cirugia Hepatobiliopancreat, Huelva, Spain
Orti-Rodriguez, R:
Hosp Univ Nuestra Senora de Candelaria, Dept Gen & Digest Surg, Santa Cruz De Tenerife, Spain
de la Serna, S:
Univ Complutense Madrid, Hosp Univ Clin San Carlos, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Dept Gen & Digest Surg,HPB Surg Unit, Madrid, Spain
Rabbione, G:
Hosp Univ La Princesa, Inst Invest Sanitaria Princesa IIS IP, Data Anal Unit, Madrid, Spain
Sanz-Garcia, A:
Hosp Univ La Princesa, Inst Invest Sanitaria Princesa IIS IP, Data Anal Unit, Madrid, Spain
Martin-Perez, E:
Univ Autonoma Madrid UAM, Hosp Univ La Princesa, Inst Invest Sanitaria Princesa IIS IP, Dept Gen & Digest Surg,HPB Unit, Madrid, Spain
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