Patients having major general surgery experience fewer problems because of goal-directed fluid therapy (GDFT). For patients with acute pancreatitis (AP) in a general surgical unit, there are no reports of cardiac output assessment being utilized to optimize fluid delivery.
Following hospital admission, 50 patients with AP were randomly assigned to receive either ward-based GDFT (n = 25), with intravenous (IV) fluids provided in accordance with a protocol for stroke volume optimization, or standard care (SC) (n = 25), but with blinded cardiac output assessment. The main outcome was feasibility.
Recruitment of 50 of 116 eligible patients (43.1%) took place over 20 months, proving feasibility. About 36 (72%) completed the 48-hour period of the GDFT; 10 (20%) were released within that time, and 4 withdrew (3 GDFT, 1 SC). With just 3 people having a severe illness (6%, 1 GDFT, 2 SC), baseline characteristics were similar. Both groups received the same amounts of IV fluids (GDFT 5,465 (1,839 ml, SC 5,211 (1,745 ml)). The heart rate, blood pressure, respiratory rate, and oxygen saturations were all reduced in the GDFT group. GDFT was not linked to any negative effects. In terms of AP problems (GDFT 24%, SC 32%) or the length of stay in critical care (GDFT 0 (0), SC 0.7 (3) days), there was no indication of a difference. Hospital stays lasted 5 (2.9) days in the GDFT groups and 6.3 (7.6) days in the SC groups.
In the preliminary trial, ward-based GDFT was feasible and exhibited a potential effectiveness signal in AP. For clinical and financial efficacy to be confirmed, a bigger multi-site RCT was needed.
Reference: sciencedirect.com/science/article/pii/S1743919122005143
