Update on the strategy for intravenous fluid treatment in acute pancreatitis

Table 2 Summary of randomized controlled trials comparing different intravenous fluid resuscitation strategies in acute pancreatitis

Ref.	Design	N	Participants	Randomization	Aggressive resuscitation	Volume	Nonaggressive resuscitation	Volume	Effect of early aggressive resuscitation
Mao et al[44], 2009	Superiority	76	Severe AP	72 h	Rapid volume expansion (10-15 ml/kg/h)	4 ± 2 L Crystalloid; 1.3 ± 0.8 L; Colloid in 24 h	Controlled volume expansion (5-10 ml/kg/h)	2.4 ± 1.9 L Crystalloid; 0.9 ± 0.6 L; Colloid in 24 h	Harmful, more sepsis, mortality, mechanical ventilation, and ACS
Mao et al[46], 2010	Superiority	115	Severe AP	24 h	Rapid hemodilution with goal Hct < 35% at 48 h	-	Slow hemodilution with goal Hct > 35% at 48 h	-	Harmful, more sepsis, and mortality
Wu et al[31], 2011	Factorial	40	Any severity	6 h	Goal-directed with 20 ml/kg bolus + 3 or 1.5 ml/kg/h of LR or NS	4.3 L in 24h	LR or NS fluid therapy adjusted by treating physician	4.6 L in 24h	Similar, SIRS, and CRP at 24 h
Buxbaum et al[22], 2017	Superiority	60	Predicted mild AP	4 h	20 ml/kg bolus + 3 ml/kg/h of LR	5.6 L in 24 h; 7.6 L in 36 h	10 ml/kg bolus then 1.5 ml/kg/h of LR	3.9 L in 24 h; 5.6 L in 36 h	Beneficial, less composite outcome, SIRS, and hemoconcentration
Cuéllar-Monterrubio JE et al[45], 2020	Two-tailed	88	Any severity AP, more than 24 hr disease onset	4 h	20 mL/kg bolus + 3 mL/kg/hr first 24 hours and then 30 mL/kg for the next 24 hours	8.54 ± 1.83 L in 48 h	20 ml/kg bolus (if hypovolemia, 3/45) - 1.5 ml/kg/h of HS first 24 hours and then 30 mL/kg for the next 24 hours	5.13 ± 1.28 L in 48 h	No benefit, no differences found in SIRS, pancreatic necrosis, Respiratory complication, AKI, and LOS
De-Madaria E et al[47], 2022	Two-tailed	249	Mild AP, less than 24 h disease onset	8 h	20 ml/kg bolus + 3 ml/kg/h of LR	7.8 (6.5-9.8) L in 48h	10 mL/kg bolus (if hypovolumia) - 1.5 ml/kg/h of LR	5.5 (4.0-6.8) L in 48 h	Harmful, more fluid overload

AP: Acute pancreatitis; ACS: Abdominal compartment syndrome; LR: Lactated Ringer’s; NS: Normal saline; SIRS: Systemic inflammatory response syndrome; CRP: C-reactive protein; HS: Hartmann’s solution; AKI: Acute kidney injury; LOS: Length of stay.