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• W4255178112 abstract "Lotte Boxhoorn and colleagues1Boxhoorn L Voermans RP Bouwense SA et al.Acute pancreatitis.Lancet. 2020; 396: 726-734Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar correctly point out in their Seminar that evidence from randomised controlled trials shows that aggressive fluid replacement in pancreatitis leads to an increase in mortality (mean initial infusion of 408 mL/h vs 264 mL/h).2Mao EQ Tang YQ Fei J et al.Fluid therapy for severe acute pancreatitis in acute response stage.Chin Med J (Engl). 2009; 122: 169-173PubMed Google Scholar Although the authors acknowledge the scarcity of evidence regarding fluid management, they proceed to mention outdated guidelines advising excessive fluid resuscitation (5–10 mL/kg per h, or 350–700 mL/h for a 70 kg individual). To date, there are no published data supporting this recommendation. There is only one randomised trial showing clinical improvement in mild pancreatitis with higher fluid infusion rates (3·8 mL/kg per h vs 1·8 mL/kg per h).3Buxbaum JL Quezada M Da B et al.Early aggressive hydration hastens clinical improvement in mild acute pancreatitis.Am J Gastroenterol. 2017; 112: 797-803Crossref PubMed Scopus (48) Google Scholar This study tested for blood urea nitrogen, haematocrit, and creatinine as part of the primary endpoint, which raised appropriate concerns with regards to the interpretation of the results, because these variables are directly influenced by fluid administration.4de-Madaria E Martínez JF Aparicio JR Lluís F Aggressive fluid resuscitation in acute pancreatitis: in aqua sanitas?.Am J Gastroenterol. 2017; 112: 1617-1618Crossref PubMed Scopus (5) Google Scholar Given the central role of the systemic immune response in pancreatitis pathophysiology, we believe that the developments in the fluid management of patients with sepsis should be taken into consideration. Fluid accumulation in sepsis has been consistently associated with adverse outcomes, including higher mortality, acute lung injury, acute kidney injury, and abdominal compartment syndrome.5Malbrain MLNG Langer T Annane D et al.Intravenous fluid therapy in the perioperative and critical care setting: executive summary of the International Fluid Academy (IFA).Ann Intensive Care. 2020; 10: 64Crossref Scopus (17) Google Scholar This last outcome is especially relevant given a reported incidence of 27% of fluid accumulation in severe pancreatitis.6De Waele JJ Leppäniemi AK Intra-abdominal hypertension in acute pancreatitis.World J Surg. 2009; 33: 1128-1133Crossref PubMed Scopus (85) Google Scholar Intervention trials in patients with sepsis have confirmed that a higher fluid balance increases mortality,7Andrews B Semler MW Muchemwa L et al.Effect of an early resuscitation protocol on in-hospital mortality among adults with sepsis and hypotension: a randomized clinical trial.JAMA. 2017; 318: 1233-1240Crossref PubMed Scopus (177) Google Scholar renal failure, and the need for mechanical ventilation.8Latham HE Bengtson CD Satterwhite L et al.Stroke volume guided resuscitation in severe sepsis and septic shock improves outcomes.J Crit Care. 2017; 42: 42-46Crossref PubMed Scopus (17) Google Scholar, 9Douglas IS Alapat PM Corl KA et al.Fluid response evaluation in sepsis hypotension and shock: a randomized clinical trial.Chest. 2020; 158: 1431-1445Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar Given there is no evidence of benefit from aggressive fluid resuscitation in acute pancreatitis,10Gad MM Simons-Linares CR Is aggressive intravenous fluid resuscitation beneficial in acute pancreatitis? A meta-analysis of randomized control trials and cohort studies.World J Gastroenterol. 2020; 26: 1098-1106Crossref PubMed Scopus (9) Google Scholar we believe a more cautious recommendation should be issued. We declare no competing interests. Acute pancreatitisAcute pancreatitis is an unpredictable and potentially lethal disease. The prognosis mainly depends on the development of organ failure and secondary infection of pancreatic or peripancreatic necrosis. In the past 10 years, treatment of acute pancreatitis has moved towards a multidisciplinary, tailored, and minimally invasive approach. Despite improvements in treatment and critical care, severe acute pancreatitis is still associated with high mortality rates. In this Seminar, we outline the latest evidence on diagnostic and therapeutic strategies for acute pancreatitis. Full-Text PDF Acute pancreatitisDiscussing acute pancreatitis, Lotte Boxhoorn and colleagues1 refer to the PYTHON trial,2 a multicentre randomised trial in which early enteral tube feeding within 24 h did not reduce the rate of infection (25% vs 26%) or mortality (11% vs 7%) when compared with on-demand feeding. Their conclusion was that enteral tube feeding can be initiated once patients have insufficient caloric intake after 72 h.1 Full-Text PDF Acute pancreatitis – Authors' replyWe thank Eduardo Argaiz and Alice Gallo de Moraes as well as Thomas Finucane and Robin McKenzie for their comments on our Seminar about acute pancreatitis.1 Full-Text PDF" @default.
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• W4255178112 title "Acute pancreatitis" @default.
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