title: New tools for optimizing fluid resuscitation in acute pancreatitis.
abstract: Acute pancreatitis (AP) is a frequent disease with degrees of increasing severity responsible for high morbidity. Despite continuous improvement in care, mortality remains significant. Because hypovolemia, together with microcirculatory dysfunction lead to poor outcome, fluid therapy remains a cornerstone of the supportive treatment. However, poor clinical evidence actually support the aggressive fluid therapy recommended in recent guidelines since available data are controversial. Fluid management remains unclear and leads to current heterogeneous practice. Different strategies may help to improve fluid resuscitation in AP. On one hand, integration of fluid therapy in a global hemodynamic resuscitation has been demonstrated to improve outcome in surgical or septic patients. Tailored fluid administration after early identification of patients with high-risk of poor outcome presenting inadequate tissue oxygenation is a major part of this strategy. On the other hand, new decision parameters have been developed recently to improve safety and efficiency of fluid therapy in critically ill patients. In this review, we propose a personalized strategy integrating these new concepts in the early fluid management of AP. This new approach paves the way to a wide range of clinical studies in the field of AP.
authors.affiliation: Perrine Bortolotti, Fabienne Saulnier, Delphine Colling, Sebastien Preau, Critical Care Center, University Hospital of Lille, 59037 Lille, France.
authors.forename: Perrine
authors.initials: P
authors.lastname: Bortolotti
authors.affiliation: Perrine Bortolotti, Fabienne Saulnier, Delphine Colling, Sebastien Preau, Critical Care Center, University Hospital of Lille, 59037 Lille, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Saulnier
authors.affiliation: Perrine Bortolotti, Fabienne Saulnier, Delphine Colling, Sebastien Preau, Critical Care Center, University Hospital of Lille, 59037 Lille, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Colling
authors.affiliation: Perrine Bortolotti, Fabienne Saulnier, Delphine Colling, Sebastien Preau, Critical Care Center, University Hospital of Lille, 59037 Lille, France.
authors.forename: Alban
authors.initials: A
authors.lastname: Redheuil
authors.affiliation: Perrine Bortolotti, Fabienne Saulnier, Delphine Colling, Sebastien Preau, Critical Care Center, University Hospital of Lille, 59037 Lille, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Preau
mesh_terms: D016638:Critical Illness; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D019983:Guideline Adherence; D006439:Hemodynamics; D006801:Humans; D010195:Pancreatitis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D012307:Risk Factors; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance
keywords: Central venous pressure; Fluid; Pancreatitis; Passive leg raising; Preload