Early, aggressive fluid resuscitation in acute pancreatitis led to a higher incidence of fluid overload without improving clinical outcomes in the landmark WATERFALL trial.
led to a higher incidence of fluid overload without improving clinical outcomes in the landmark WATERFALL trial.
"This moderate fluid resuscitation strategy is associated with a much lower frequency of fluid overload and a trend toward improved outcomes. For such reasons, it should be considered as a new standard of care in the early management of acute pancreatitis," de-Madaria said.
A total of 249 patients were included in the interim analysis — 122 in the aggressive-resuscitation group and 127 in the moderate-resuscitation group. This clear signal of harm was coupled with no significant difference in the incidence of moderately severe or severe pancreatitis . "Unlike in most other randomized, controlled trials of fluid resuscitation in acute pancreatitis, patients with varying baseline pancreatitis severity were included, and changes in the rate of resuscitation were determined on the basis of a dynamic assessment of hemodynamic testing, imaging, and clinical factors," he adds.First, the need to focus on a steady rate of initial resuscitation — no more than 1.5 mL/kg of body weight per hour.
Gardner says the trial also highlights the need to focus research efforts on evaluating other pharmacologic therapies instead of crystalloid fluids.
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