New tools for optimizing fluid resuscitation in acute pancreatitis

Figure 1 Suggested algorithm for fluid management in acute pancreatitis. AP: Acute pancreatitis; MAP: Mean arterial pressure; HR: Heart rate; ScvO₂: Central venous oxygen saturation; UO: Urinary output; SV: Stroke volume; PP: Arterial pulse pressure; PLR: Passive leg raising; CVP: Central venous pressure; FC: Fluid challenge.

Figure 2 Schematic representation of central venous pressure/stroke volume of normal (solid line) and failing heart (dotted line). When the heart is fluid responsive, a fluid challenge induces a large increase in stroke volume (SV) and a small increase in central venous pressure (CVP). When the heart is fluid unresponsive, a fluid challenge induces a small increase in SV and a large increase in CVP. In contrast, there is no reliable threshold of CVP that can be used in current practice to predict a positive or negative response to fluid loading. This threshold depends mostly on the cardiac function at the time of fluid infusion.