WATERFALL STUDY PowerPoints presentation

Study

1. WATERFALL STUDY R.S.C SURAWEERA SR CRITICAL CARE CLINICAL FELLOW

2. Clinical question In adults with acute pancreatitis does aggressive fluid resuscitation compared to moderate resuscitation result in a reduction in the development of moderately severe or severe pancreatitis?

3. pathogenesis

4. basis

5. setting

6. Inclusion criteria

7. Exclusion criteria

8. 676 assessed —> 249 randomized 122 to aggressive group 127 to moderate group All those not randomized due to exclusion criteria or not providing consent

9. Baseline statistics intervention vs control group

10. bisap

11. Panpromise

12. Charlson comorbidity score

13. Aggressive fluid regime

14. Moderate fluid restriction

15. Management common to both groups

16. Strengths

17. weaknesses

18. CONCLUSIONS FROM WATERFALL clinicians should focus on a steady rate of initial RESUS 1.5 ml/kg/ hr per hour —administer a bolus of 10 ml/kg signs of initial hypovolemia careful clinical and hemodynamic monitoring are essential during the first 72 hour admission euvolemic and avoid fluid overload. diuresis in patients with fluid overload in the first 72 hours is most likely beneficial focus on trials evaluating other pharmacologic therapies instead of crystalloid fluids.

19. fluid volume administration in the emergency room

20. Meta-analysis

21. Summary of the metaanalysis

22. Fluid overload and mortality in critical care