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National Survey of Fluid Therapy in Acute Pancreatitis: Current Practice Lacks a Sound Evidence Base

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Abstract

Background

Fluid therapy (FT) is a critical intervention in managing acute pancreatitis (AP). There is a paucity of evidence to guide FT and virtually no data on current prescribing practice. This survey aims to characterize current practice and opinion with regard to FT in AP throughout New Zealand.

Methods

Information was collected on fluid selection, administration, and goal-directed FT. The survey was distributed online and in print to all doctors employed in General Surgery Departments in New Zealand on 1 May 2012. Monthly email reminders were sent for 6 months.

Results

The overall response rate was 47 % (n = 190/408). Crystalloids were the preferred initial fluid for all categories of severity; however, colloid use increased with severity (p < 0.001). Fluid volume also increased with severity (p = 0.001), with 74 % of respondents prescribing >4 L for AP with organ failure (OF). Clinicians treating 26–50 patients per year with AP were less likely to prescribe colloid for AP with OF (8 vs 43 %) (p = 0.001). Rate of fluid administration in AP with OF varied according to physicians’ seniority (p = 0.004); consultants prescribed >4 L more than other groups (83 vs 68 %). Only 17 % of respondents reported the use of guidelines.

Conclusions

This survey reveals significant variation in prescription of FT for AP, and aggressive FT is commonly prescribed for AP with OF. There is little adherence to published guidelines or best available evidence.

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Acknowledgments

The authors are grateful to Tarik Sammour, Benjamin Loveday, and Ursula van den Heever for their voluntary assistance in promoting and distributing the survey in their respective medical centers.

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Authors and Affiliations

  1. Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand

    Matthew D. Haydock, Anubhav Mittal, Marc van den Heever, Jeremy I. Rossaak, Maxim S. Petrov & John A. Windsor

  2. Department of Surgery, Tauranga Hospital, Tauranga, New Zealand

    Jeremy I. Rossaak

  3. Department of Surgery, Christchurch Hospital, Christchurch, New Zealand

    Saxon Connor

  4. Department of Surgery, North Shore Hospital, Auckland, New Zealand

    Michael Rodgers

Authors
  1. Matthew D. Haydock
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  2. Anubhav Mittal
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  3. Marc van den Heever
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  4. Jeremy I. Rossaak
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  5. Saxon Connor
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  6. Michael Rodgers
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  7. Maxim S. Petrov
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  8. John A. Windsor
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Consortia

On behalf of the Pancreas Network of New Zealand

Corresponding author

Correspondence to Matthew D. Haydock.

Additional information

Matthew D. Haydock and Anubhav Mittal contributed equally to this study.

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Haydock, M.D., Mittal, A., van den Heever, M. et al. National Survey of Fluid Therapy in Acute Pancreatitis: Current Practice Lacks a Sound Evidence Base. World J Surg 37, 2428–2435 (2013). https://doi.org/10.1007/s00268-013-2105-7

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  • DOI: https://doi.org/10.1007/s00268-013-2105-7

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