6/30/23, 12:46 AM WATERFALL Pathway Feedback Search Clinical Topics Home Studies WATERFALL WATERFALL Disease Acute pancreatitis Trial question Is early aggressive fluid resuscitation superior to moderate fluid resuscitation in patients with acute pancreatitis? Study design Multi-center Open label RCT Population Characteristics of study participants 51.0% female N = 249 49.0% male 249 patients (127 female, 122 male) Inclusion criteria: adult patients who presented to the emergency department with acute pancreatitis Key exclusion criteria: moderately severe or severe disease; HF; hypernatremia, hyponatremia, hyperkalemi; life expectancy < 1 year; chronic pancreatitis; chronic renal failure; decompensated cirrhosis Interventions N=122 aggressive fluid resuscitation (bolus of 20 mL/kg of body weight, followed by 3 mL/kg/hour) N=127 moderate fluid resuscitation (bolus of 10 mL/kg in patients with hypovolemia or no bolus in patients with normovolemia, followed by 1.5 mL/kg/hour) Primary outcome https://web.pathway.md/studies/recK3edHXKrTBCRGT 1/2 6/30/23, 12:46 AM WATERFALL Pathway Development of moderately severe or severe pancreatitis 22.1 % 22.1 17.3 16.6 % 11.1 % 5.5 % No significant difference 0.0 % Aggressive fluid resuscitation Moderate fluid resuscitation No significant difference in the development of moderately severe or severe pancreatitis (22.1% vs. 17.3%; RR 1.3, 95% CI 0.78 to 2.18) Secondary outcomes Significant increase in fluid overload (20.5% vs. 6.3%; RR 2.85, 95% CI 1.36 to 5.94) No significant difference in organ failure (7.4% vs. 3.9%; RR 1.23, 95% CI 0.47 to 3.23) No significant difference in respiratory failure (7.4% vs. 2.4%; RR 2.19, 95% CI 0.63 to 7.64) Safety outcomes No significant differences in dyspnea, local complications. Significant difference in fluid overload (20.5% vs. 6.3%). Conclusion In adult patients who presented to the emergency department with acute pancreatitis, aggressive fluid resuscitation was not superior to moderate fluid resuscitation with respect to the development of moderately severe or severe pancreatitis. Reference Enrique de-Madaria, James L Buxbaum, Patrick Maisonneuve et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000. Open reference URL https://web.pathway.md/studies/recK3edHXKrTBCRGT 2/2