EAGLE: Early goal-directed volume resuscitation in severe acute pancreatitis: A randomised multi-centre study

EAGLE：重症急性胰腺炎的早期目标导向容量复苏：一项随机多中心研究

• 批准号: 99800852
• 负责人: Professor Dr. Wolfgang Huber (†)
• 金额: --
• 依托单位: Klinik und Poliklinik für Innere Medizin II: Gastroenterologie
• 依托单位国家: 德国
• 项目类别: Clinical Trials
• 财政年份: 2009
• 资助国家: 德国
• 起止时间: 2008-12-31 至 2012-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/99800852?language=en
• 关键词: EAGLE; Early; goal; directed; volume

Acute pancreatitis (AP) is a common disorder with rising incidence varying between 35 and 80 per 100,000 in Europe and the USA. About 15% of patients develop necrotizing pancreatitis (NP) with a mortality of up to 42% and frequently prolonged hospitalisation in the survivors (1-5). Despite a fulminant pathophysiology comparable to that of sepsis, the management of NP is still re-active, symptomatic and mainly based on paradigms with low grade evidence. In sepsis beneficial effects of early goal-directed fluid resuscitation resulting in reduced mortality have been clearly shown. With regard to these data and several studies of NP demonstrating the deleterious effects of fluid loss and haemoconcentration within the first 24h after admission, early goal-directed fluid resuscitation has the potential of improving outcome also in NP (1; 6-11). Therefore, it is the aim of this RCT to demonstrate beneficial effects of early goaldirected resuscitation using an algorithm based on modern haemodynamic parameters such as Intrathoracic Blood Volume Index (ITBI), Extravascular Lung Water Index (ELWI) and Stroke Volume Variation (SVV) which can be easily and safely obtained due to recent progress in haemodynamic monitoring. The algorithm is aimed at maintaining adequate resuscitation (ITBI, SVV) as well as preventing pulmonary over-hydration (ELWI).The use of a similar algorithm in cardiac surgery patients resulted in a significant reduction in catecholamine use, lactate levels, duration of ventilation and ICU stay (12).

急性胰腺炎(AP)是一种常见疾病，在欧洲和美国的发病率从35/10万到80/10万不等。约15%的患者发展为坏死性胰腺炎(NP)，死亡率高达42%，幸存者的住院时间经常延长(1-5例)。尽管有与脓毒症相似的暴发性病理生理学，但NP的治疗仍然是反应性的、有症状的，主要基于低级别证据的范例。在脓毒症中，早期以目标为导向的液体复苏的有益效果已清楚地显示出来，从而降低了死亡率。考虑到这些数据和几项关于NP的研究表明入院后最初24小时内液体丢失和血液浓缩的有害影响，早期目标导向液体复苏也有可能改善NP的预后(1；6-11)。因此，这项随机对照试验的目的是使用一种基于现代血流动力学参数的算法，如胸腔内血容量指数(ITBI)、血管外肺水指数(ELWI)和每搏输出量变异(SVV)，来证明早期目标导向复苏的有益效果，由于血流动力学监测的最新进展，这些参数可以容易和安全地获得。该算法旨在维持足够的复苏(ITBI，SVV)以及预防肺过度水合(ELWI)。在心脏手术患者中使用类似的算法，可显著减少儿茶酚胺的使用、乳酸水平、呼吸机持续时间和ICU住院时间(12)。