Impact of Goal-Directed Fluid Resuscitation on Systemic Inflammation in Acute Pancreatitis

Does a goal-directed fluid resuscitation protocol reduce systemic inflammation in acute pancreatitis patients, and what is the comparative impact of lactated Ringer's solution versus normal saline?

• Randomized controlled trial

Goal-directed fluid resuscitation with lactated Ringer's solution or normal saline; standard fluid resuscitation with lactated Ringer's solution or normal saline

• Goal-directed fluid resuscitation with lactated Ringer's solution
• Standard fluid resuscitation with normal saline

Incidence of systemic inflammatory response syndrome (SIRS)

• 84% reduction in LR cohort, 0% reduction in NS cohort

Administration of lactated Ringer's solution also reduced levels of CRP, compared with normal saline (51.5 vs 104 mg/dL, respectively; P = .02).

Potential Issues and Biases

The study was relatively small with only 40 participants and the inclusion and exclusion criteria were not detailed. The lack of standardization of the volume of fluid administered to patients could potentially introduce bias. Additionally, the study was conducted only in New England hospitals which may limit the generalizability of the findings.

Conclusion

Patients with acute pancreatitis who were resuscitated with lactated Ringer's solution had reduced systemic inflammation compared with those who received saline.