World Journal of Surgery

, Volume 37, Issue 10, pp 2428–2435 | Cite as

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

  • Matthew D. Haydock
  • Anubhav Mittal
  • Marc van den Heever
  • Jeremy I. Rossaak
  • Saxon Connor
  • Michael Rodgers
  • Maxim S. Petrov
  • John A. Windsor
  • On behalf of the Pancreas Network of New Zealand



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.


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.


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.


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.


  1. 1.
    Haydock MD, Mittal A, Wilms HR et al (2012) Fluid therapy in acute pancreatitis: anybody’s guess. Ann Surg 257(2):182–188. doi:10.1097/SLA.1090b1013e31827773ff CrossRefGoogle Scholar
  2. 2.
    Loveday BPT, Srinivasa S, Vather R et al (2010) High quantity and variable quality of guidelines for acute pancreatitis: a systematic review. Am J Gastroenterol 105:1466–1476PubMedCrossRefGoogle Scholar
  3. 3.
    Johnson CD (2005) UK guidelines for the management of acute pancreatitis. Gut 54:iii1–iii9CrossRefGoogle Scholar
  4. 4.
    Uhl W, Warshaw A, Imrie C et al (2002) IAP guidelines for the surgical management of acute pancreatitis. Pancreatology 2:565–573PubMedCrossRefGoogle Scholar
  5. 5.
    Forsmark CE, Baillie J (2007) AGA institute technical review on acute pancreatitis. Gastroenterology 132:2022–2044PubMedCrossRefGoogle Scholar
  6. 6.
    Toouli J, Brooke-Smith M, Bassi C et al (2002) Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol 17:S15–S39PubMedCrossRefGoogle Scholar
  7. 7.
    Banks PA, Freeman ML, Fass R et al (2006) Practice guidelines in acute pancreatitis. Am J Gastroenterol 101:2379–2400PubMedCrossRefGoogle Scholar
  8. 8.
    Pezzilli R, Zerbi A, Di Carlo V et al (2010) Practical guidelines for acute pancreatitis. Pancreatology 10:523–535PubMedCrossRefGoogle Scholar
  9. 9.
    Hirota M, Takada T, Kitamura N et al (2010) Fundamental and intensive care of acute pancreatitis. J Hepato Biliary Pancreat Sci 17:45–52CrossRefGoogle Scholar
  10. 10.
    Du XJ, Hu WM, Xia Q et al (2011) Hydroxyethyl starch resuscitation reduces the risk of intra-abdominal hypertension in severe acute pancreatitis. Pancreas 40:1220–1225PubMedCrossRefGoogle Scholar
  11. 11.
    Wu BU, Hwang JQ, Gardner TH et al (2011) Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol 9(710–717):e711Google Scholar
  12. 12.
    Lobo DN (2012) Intravenous 0.9% saline and general surgical patients: a problem, not a solution. Ann Surg 255:830–832PubMedCrossRefGoogle Scholar
  13. 13.
    Lobo DN, Stanga Z, Simpson JA et al (2001) Dilution and redistribution effects of rapid 2-litre infusions of 0.9% (w/v) saline and 5% (w/v) dextrose on haematological parameters and serum biochemistry in normal subjects: a double-blind crossover study. Clin Sci 101:173–179PubMedCrossRefGoogle Scholar
  14. 14.
    Lobo DN, Stanga Z, Aloysius MM et al (2010) Effect of volume loading with 1 liter intravenous infusions of 0.9% saline, 4% succinylated gelatine (Gelofusine) and 6% hydroxyethyl starch (Voluven) on blood volume and endocrine responses: a randomized, three-way crossover study in healthy volunteers. Crit Care Med 38:464–470PubMedCrossRefGoogle Scholar
  15. 15.
    Drummer C, Gerzer R, Heer M et al (1992) Effects of an acute saline infusion on fluid and electrolyte metabolism in humans. Am J Physiol Renal Physiol 262:F744–F754Google Scholar
  16. 16.
    Chowdhury AH, Cox EF, Francis ST et al (2012) A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and Plasma-Lyte® 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg 256:18–24PubMedCrossRefGoogle Scholar
  17. 17.
    Brown A, Baillargeon JD, Hughes MD et al (2002) Can fluid resuscitation prevent pancreatic necrosis in severe acute pancreatitis? Pancreatology 2:104–107PubMedCrossRefGoogle Scholar
  18. 18.
    Gardner TB, Vege SS, Chari ST et al (2009) Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality. Pancreatology 9:770–776PubMedCrossRefGoogle Scholar
  19. 19.
    Wall I, Badalov N, Baradarian R et al (2011) Decreased mortality in acute pancreatitis related to early aggressive hydration. Pancreas 40:547–550PubMedCrossRefGoogle Scholar
  20. 20.
    Warndorf MG, Kurtzman JT, Bartel MJ et al (2011) Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. Clin Gastroenterol Hepatol 9:705–709PubMedCrossRefGoogle Scholar
  21. 21.
    De-Madaria E, Soler-Sala G, Sanchez-Paya J et al (2011) Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study. Am J Gastroenterol 106:1843–1850PubMedCrossRefGoogle Scholar
  22. 22.
    Eckerwall G, Olin H, Andersson B et al (2006) Fluid resuscitation and nutritional support during severe acute pancreatitis in the past: what have we learned and how can we do better? Clin Nutr 25:497–504PubMedCrossRefGoogle Scholar
  23. 23.
    Mao EQ, Tang YQ, Li L et al (2007) Strategy of controlling fluid resuscitation for severe acute pancreatitis in acute phase. [Chinese]. Zhonghua wai ke za zhi [Chin J Surg] 45:1331–1334Google Scholar
  24. 24.
    Mao EQ, Fei J, Peng YB et al (2010) Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis. Chin Med J (Engl) 123:1639–1644Google Scholar
  25. 25.
    Mao EQ, Tang YQ, Fei J et al (2009) Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J (Engl) 122:169–173Google Scholar
  26. 26.
    Shoemaker WC, Appel P, Bland R (1983) Use of physiologic monitoring to predict outcome and to assist in clinical decisions in critically ill postoperative patients. Am J Surg 146:43–50PubMedCrossRefGoogle Scholar
  27. 27.
    Mole DJ, Hall A, McKeown D et al (2011) Detailed fluid resuscitation profiles in patients with severe acute pancreatitis. HPB 13:51–58PubMedCrossRefGoogle Scholar
  28. 28.
    Reddy N, Wilcox CM, Tamhane A et al (2008) Protocol-based medical management of post-ERCP pancreatitis. J Gastroenterol Hepatol 23:385–392PubMedCrossRefGoogle Scholar
  29. 29.
    Legrand M, Payen D (2011) Understanding urine output in critically ill patients. Ann Intensive Care 11:13CrossRefGoogle Scholar
  30. 30.
    Cook C, Heath F, Thompson RL (2000) A meta-analysis of response rates in Web- or Internet-based surveys. Educ Psychol Meas 60:821–836CrossRefGoogle Scholar
  31. 31.
    Ogawa M, Hirota M, Hayakawa T et al (2002) Development and use of a new staging system for severe acute pancreatitis based on a nationwide survey in Japan. Pancreas 25:325–330PubMedCrossRefGoogle Scholar
  32. 32.
    van Geenen E-JM, Mulder CJJ, van der Peet DL et al (2010) Endoscopic treatment of acute biliary pancreatitis: a national survey among Dutch gastroenterologists. Scand J Gastroenterol 45:1116–1120PubMedCrossRefGoogle Scholar
  33. 33.
    Loveday BPT, Rossaak JI, Mittal A et al (2011) Survey of trends in minimally invasive intervention for necrotizing pancreatitis. Aust N Z J Surg 81:56–64CrossRefGoogle Scholar
  34. 34.
    Satoh K, Shimosegawa T, Masamune A et al (2011) Nationwide epidemiological survey of acute pancreatitis in Japan. Pancreas 40:503–507PubMedCrossRefGoogle Scholar
  35. 35.
    King NKK, Siriwardena AK (2004) European survey of surgical strategies for the management of severe acute pancreatitis. Am J Gastroenterol 99:719–728PubMedCrossRefGoogle Scholar
  36. 36.
    Petrov MS, Vege SS, Windsor JA (2012) Global survey of controversies in classifying the severity of acute pancreatitis. Eur J Gastroenterol Hepatol 24:715–721PubMedCrossRefGoogle Scholar
  37. 37.
    Johnson TP, Wislar JS (2012) Response rates and nonresponse errors in surveys. JAMA 307:1805–1806PubMedCrossRefGoogle Scholar
  38. 38.
    Krosnick JA (1999) Survey research. Annu Rev Psychol 50:537–567PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Matthew D. Haydock
    • 1
  • Anubhav Mittal
    • 1
  • Marc van den Heever
    • 1
  • Jeremy I. Rossaak
    • 1
    • 2
  • Saxon Connor
    • 3
  • Michael Rodgers
    • 4
  • Maxim S. Petrov
    • 1
  • John A. Windsor
    • 1
  • On behalf of the Pancreas Network of New Zealand
  1. 1.Department of Surgery, School of Medicine, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  2. 2.Department of SurgeryTauranga HospitalTaurangaNew Zealand
  3. 3.Department of SurgeryChristchurch HospitalChristchurchNew Zealand
  4. 4.Department of SurgeryNorth Shore HospitalAucklandNew Zealand

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