Early aggressive fluid resuscitation shows no difference in respiratory failure days in severe acute pancreatitis

BACKGROUND: A recent trial showed that early aggressive fluid resuscitation in acute pancreatitis(AP) was associated with increased fluid overload characterized by respiratory symptoms/signs. However, the generalizability of these results in more severe AP is unknown. We aimed to evaluate the association between early fluid strategies and the incidence and duration of respiratory failure in patients with predicted severe acute pancreatitis(pSAP). METHODS: This is a secondary analysis using data from a multicenter, cluster-randomized trial of pSAP. The entire cohort was divided into three groups according to the amount of fluid volume. According to the interquartile range(IQR) value of fluid volume over the first two trial days, patients were assigned to conservative(quartile-1), moderate(quartile-2&3), and aggressive(quartile-4) fluid strategies, respectively. A multivariable quantile regression model was used to demonstrate their effect on respiratory-failure-free-days(RFFD) to trial-day7. RESULTS: Overall, 259 pSAP patients were included, and the median(IQR) volume of fluid intake was 7.09(5.59-9.34) L. From lowest to highest, the three groups received median(range) fluid intake of 4.60(1.96-5.59), 7.09(5.59-9.34), and 11.22(9.34-18.78) L, respectively. The median(IQR) of RFFDs to trial-day7 were 5(2.3-7), 5(2-7), and 6(4-7) for each group. After adjustment for potential confounders, neither the conservative nor aggressive-group showed significant difference in RFFD compared with the moderate-group(p = 0.305 and 0.554, respectively). Moreover, the aggressive group had a higher SIRS free-days to trial-day7 compared with the moderate-group(adjusted p = 0.029). Subgroup analysis revealed that early aggressive fluid intake was not associated with decreased RFFDs to trial-day7 in all subgroups. CONCLUSION: A higher amount of balanced fluids given according to the hematocrit and other clinical parameters does not appear to contribute to respiratory dysfunction in patients with pSAP.