Fluid resuscitation practice in patients with acute pancreatitis in Danish intermediate and intensive care units - a retrospective cohort study

Background Aggressive fluid therapy has been standard in acute pancreatitis management, but recent data favor a conservative approach. We evaluated fluid administration practices in adult acute pancreatitis patients in IMUs and ICUs from 2018 to 2022. Methods Retrospective cohort study of adult patients with acute pancreatitis admitted to multidisciplinary IMUs and ICUs in the Capital Region of Denmark (January 2018 to December 2022). Primary outcome was the total volume of fluids administered within 72 h of admission to the IMU/ICU. Secondary outcomes included the volume of intravenous (IV) IV crystalloids, non-crystalloid and non-iv fluid, as well as annual changes in fluid administration over the study period. Changes were evaluated using linear regression, adjusted for age, sex, department type, admission Ranson score, and admission creatinine level. Results A total of 382 patients were included. Over 72 h, median total fluid was 9,608 mL (IQR 6,166-12,752), comprising 3,341 mL (IQR 1,723-5,400) of IV crystalloids, 2,108 mL (IQR 1,050-3,763) of IV non‑crystalloids, and 2,450 mL (IQR 1,190-4,125) of non‑IV fluids. Fluid peaked in the first 24 h (2,000 mL crystalloid; IQR 1,000-3,200) and fell to 0 mL (IQR 0-1,000) between 48 and 72 h. From 2018 to 2022, total volumes fell non‑significantly by 345 mL/year (95% CI - 707 to 18; P = 0.062), while crystalloids declined significantly by 244 mL/year (95% CI - 482 to - 6.4; P = 0.044). Other fluid types were stable. Volume varied by vasoactive use, ventilation, etiology, and admission timing. Conclusion Patients with acute pancreatitis in the ICU/IMU receive large volumes of fluids-mainly IV crystalloids-especially during the first 24 h. While the overall fluid volume has not significantly decreased over five years, a modest reduction in crystalloid use was observed.