IJSR - International Journal of Scientific Research

Dr. Ashis Kumar Barman; Dr.(Col) Debabrata Banerjee; Lt Col Jasmeet Kaur; Dr. Debarshi Jana

Volume : VIII, Issue : VIII, August - 2019

ROLE OF EARLY FLUID RESUSCITATION IN REDUCING SEVERITY IN ACUTE PANCREATITIS

Dr. Ashis Kumar Barman, Dr. Col Debabrata Banerjee, Lt Col Jasmeet Kaur, Dr. Debarshi Jana

Abstract :

Acute pancreatitis is acute inflammation of the pancreas, and has high morbidity and mortality rates. OBJECTIVE: To assess the role of fluid resuscitation in cases of acute pancreatitis and establish association between early resuscitation and reduction in severity; to compare with already existing data in relation to fluid resuscitation guidelines in cases of acute pancreatitis. METHOD: All consecutive patients admitted with pancreatitis in CH (EC) were screened and those who met the inclusion criteria were recruited to the study. The study period was 18 months from 01 Sep 2016 to 31 Oct 2018. Consecutive sampling technique was applied until the desired sample size was achieved. RESULT: One hundred twelve eligible patients were enrolled into the study. There were 45 (40.2%) females and 67 (59.8%) males giving a male to female ratio of 1:1.5. The mean age of the study population was 41 years with age range of 12–88 years. 79 patients had a identifiable aetiology. 45(40%) cases had history of alcohol binge, 28(25%) cases had biliary aetiology, 4(3.5%) cases had history of ERCP, and 2 (1.8%) cases had significant drug history. The average BMI was 22.925 with lowest being 18.6 and highest being 30.1Kg/m2. At day 1 of admission 104(92.8%) patients had a BISAP score less than 2 and 8 (7.1%) patients had score of 3 more. We evaluated the impact of the initial intravenous fluid resuscitation rate within the first 24 h of presentation to the emergency room on important outcomes in severe acute pancreatitis. Patients presenting directly with a diagnosis of severe acute pancreatitis were identified retrospectively. Patients were divided into two groups â€“ those who received â‰§33% (‘early resuscitation’) and <33% (‘late resuscitation’) of their cumulative 72–hour intravenous fluid volume within the first 24 h of presentation. They were further divided into mild, moderate and severe groups based on severity of pancreatitis. 47% percent of the patients had mild, 35% moderate and 18% had severe pancreatitis. The primary clinical outcomes were in–hospital mortality, persistent organ failure, and duration of hospitalization. 105 patients were identified in the ‘early resuscitation’ group and 07 in the ‘late resuscitation’ group and there were no baseline differences in clinical characteristics between groups. Patients with severe pancreatitis in the ‘late resuscitation’ group experienced greater mortality than those in the ‘early resuscitation’ group (16.7 vs. 0%, p = 0.0098) and demonstrated a trend toward greater rates of persistent organ failure (33.3 vs. 100%, p = 0.0678). Patients with moderate pancreatitis in the ‘late resuscitation’ group experienced significantly greater duration of hospitalization ( >10 days) than those in the ‘early resuscitation’ group (100% vs. 40%, p = 0.0372). There was no difference in the total amount of fluid given during the first 72 h. Patients with severe acute pancreatitis who do not receive at least one third of their initial 72–hour cumulative intravenous fluid volume during the first 24 h are at risk for greater mortality than those who are initially resuscitated more aggressively. CONCLUSION: In patients with severe acute pancreatitis, early fluid resuscitation was associated with reduced organ failure at 72 hours and significantly reduced mortality at 30 days. In patients with moderately severe pancreatitis, early fluid resuscitation was associated with reduced duration of hospitalization.