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World J Gastroenterol. Nov 21, 2014; 20(43): 16113-16122
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16113
New tools for optimizing fluid resuscitation in acute pancreatitis
Perrine Bortolotti, Fabienne Saulnier, Delphine Colling, Alban Redheuil, Sebastien Preau
Perrine Bortolotti, Fabienne Saulnier, Delphine Colling, Sebastien Preau, Critical Care Center, University Hospital of Lille, 59037 Lille, France
Perrine Bortolotti, Fabienne Saulnier, Delphine Colling, Sebastien Preau, Laboratoire de Physiologie, EA 4484, Lille Nord de France University, 59037 Lille, France
Alban Redheuil, Cardiovascular Imaging, Pitié Salpêtrière Hospital Institute of Cardiology, 75013 Paris, France
Alban Redheuil, Sorbonne Universités, Laboratoire d’Imagerie Biomédicale, 75005 Paris, France
Alban Redheuil, Université Pierre et Marie Curie-Paris 6, 75005 Paris, France
Alban Redheuil, ICAN Imaging Core Lab, 75005 Paris, France
Author contributions: Bortolotti P and Preau S contributed equally to this work by performing literature search, writing and drafting the manuscript; Saulnier F, Colling D and Redheuil A carefully reviewed the submitted version.
Correspondence to: Sebastien Preau, MD, PhD, Critical Care Center, University Hospital of Lille, Avenue du Professeur Emile Laine, 59037 Lille, France. seb.preau@gmail.com
Telephone: +33-20-444084 Fax: +33-20-445094
Received: March 2, 2014
Revised: May 2, 2014
Accepted: June 12, 2014
Published online: November 21, 2014
Abstract

Acute pancreatitis (AP) is a frequent disease with degrees of increasing severity responsible for high morbidity. Despite continuous improvement in care, mortality remains significant. Because hypovolemia, together with microcirculatory dysfunction lead to poor outcome, fluid therapy remains a cornerstone of the supportive treatment. However, poor clinical evidence actually support the aggressive fluid therapy recommended in recent guidelines since available data are controversial. Fluid management remains unclear and leads to current heterogeneous practice. Different strategies may help to improve fluid resuscitation in AP. On one hand, integration of fluid therapy in a global hemodynamic resuscitation has been demonstrated to improve outcome in surgical or septic patients. Tailored fluid administration after early identification of patients with high-risk of poor outcome presenting inadequate tissue oxygenation is a major part of this strategy. On the other hand, new decision parameters have been developed recently to improve safety and efficiency of fluid therapy in critically ill patients. In this review, we propose a personalized strategy integrating these new concepts in the early fluid management of AP. This new approach paves the way to a wide range of clinical studies in the field of AP.

Keywords: Pancreatitis, Fluid, Passive leg raising, Preload, Central venous pressure

Core tip: Fluid therapy is a cornerstone of the early supportive treatment of acute pancreatitis. However, poor clinical evidence actually support the aggressive fluid therapy recommended in recent guidelines since available data are controversial. In this review, based on our experience of fluid management in the critically ill patients, we propose a tailored fluid administration relying on the individual benefit to risk balance, as a part of a global goal-directed hemodynamic strategy.