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Abstract(s)
Introdução: A Pancreatite Aguda (PA) está associada a um aumento das necessidades de fluidoterapia devido ao elevado sequestro de fluido (SF) e, em casos mais graves, à diminuição do tónus vascular periférico. Pensa-se que a hidratação intravenosa precoce, de carácter agressivo, diminua a morbilidade e a mortalidade ao diminuir a depleção do volume intravascular e ao manter a perfusão pancreática, podendo, também, prevenir a necrose pancreática e a falência de órgãos. Pretendeu-se realizar uma revisão da literatura sobre o papel da fluidoterapia no tratamento da PA e quais as recomendações atuais sobre o tipo de fluidoterapia e administração.
Material e Métodos: Pesquisa de artigos no motor de busca PubMed, em língua inglesa, que incluíram uma análise.
Resultados: A análise da literatura perscrutada revelou que o lactato de Ringer é o tipo de fluidoterapia preconizado para doentes com PA nas primeiras horas de tratamento. A administração deve ser estabelecida a uma taxa de 5-10ml/kg/h, tendo-se em conta medidas de avaliação à resposta da terapia, tais como: frequência cardíaca (<120 bpm), pressão arterial média (65-85 mmHg), débito urinário (0.5-1 ml/kg/h), HCT (HCT) (35-44%) e Nitrogénio Ureico no Sangue (BUN) (<20 mg/dl).
Conclusões: É importante reconhecer a PA grave precocemente, uma vez que o doente necessita de cuidados em regime de unidade de cuidados intensivos, de modo a que se proceda a uma ressuscitação de fluidos ideal e a um tratamento de suporte direcionado à disfunção orgânica.
Introduction: Acute Pancreatitis (PA) is associated with an increased need for fluid therapy due to high fluid sequestration and, in more severe cases, a decrease in peripheral vascular tone. Early, aggressive intravenous hydration is thought to decrease morbidity and mortality by decreasing intravascular volume depletion and maintaining pancreatic perfusion, and may also prevent pancreatic necrosis and organ failure. The aim of this study was to review the literature on the role of fluid therapy in the treatment of PA and the current recommendations on the type of fluid therapy and administration. Material and Methods: Search for articles in the English language on PubMed search engine, which included an analysis. Results: The literature review revealed that Ringer's lactate is the type of fluid therapy recommended for patients with PA within the first few hours of treatment. Administration should be established at a rate of 5-10 ml/kg/h, taking into account measures of response to therapy such as: heart rate (<120 bpm), mean arterial pressure (65-85 mmHg), urinary output (0.5-1 ml/kg/h), hematocrit (35-44%) and Blood Urea Nitrogen (BUN) (<20 mg/dl). Conclusions: It is important to recognize severe PA as early as possible, since the patient needs intensive care in order to achieve optimal fluid resuscitation and supportive care directed to organic dysfunction.
Introduction: Acute Pancreatitis (PA) is associated with an increased need for fluid therapy due to high fluid sequestration and, in more severe cases, a decrease in peripheral vascular tone. Early, aggressive intravenous hydration is thought to decrease morbidity and mortality by decreasing intravascular volume depletion and maintaining pancreatic perfusion, and may also prevent pancreatic necrosis and organ failure. The aim of this study was to review the literature on the role of fluid therapy in the treatment of PA and the current recommendations on the type of fluid therapy and administration. Material and Methods: Search for articles in the English language on PubMed search engine, which included an analysis. Results: The literature review revealed that Ringer's lactate is the type of fluid therapy recommended for patients with PA within the first few hours of treatment. Administration should be established at a rate of 5-10 ml/kg/h, taking into account measures of response to therapy such as: heart rate (<120 bpm), mean arterial pressure (65-85 mmHg), urinary output (0.5-1 ml/kg/h), hematocrit (35-44%) and Blood Urea Nitrogen (BUN) (<20 mg/dl). Conclusions: It is important to recognize severe PA as early as possible, since the patient needs intensive care in order to achieve optimal fluid resuscitation and supportive care directed to organic dysfunction.
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Keywords
Fluidoterapia Pancreatite Aguda Tratamento