Abstract: We included two studies, involving a total of 94 participants, in the review. Continuous veno-venous hemofiltration versus no intervention We included one study in which 64 participants with severe acute pancreatitis were randomized to undergo CVVH (32 participants) or no intervention (32 participants). There were no deaths in either group (very low-quality evidence). Adverse events, length of stay in the intensive care unit (ICU), length of hospital stay, total hospital cost, and quality of life were not reported in the study. One type of continuous veno-venous hemofiltration versus a different type of continuous veno-venous hemofiltration We included one study in which 30 participants with severe acute pancreatitis were randomized to undergo high-volume CVVH (15 participants) or standard CVVH (15 participants). High-volume CVVH may lead to little or no difference in in-hospital mortality rates (20.0% in the high-volume CVVH group versus 33.3% in the standard CVVH group; risk ratio (RR) 0.60, 95% confidence interval (CI) 0.17 to 2.07; 30 participants; 1 study; low-quality evidence). We are uncertain whether high-volume hemofiltration reduces rates of adverse events (13.3% in both groups; RR 1.00, 95% CI 0.16 to 6.20; 30 participants; 1 study; very low-quality evidence). Length of ICU stay, length of hospital stay, total hospital cost, and quality of life were not reported in the study. The quality of the current evidence is very low or low. For both comparisons addressed in this review, data are sparse. It is unclear whether CVVH has any effect on mortality or complications in patients with severe acute pancreatitis. It is also unclear whether high-volume CVVH is superior, equivalent or inferior to standard CVVH in patients with severe acute pancreatitis.

Plain-language summary: We searched for all relevant, well-conducted studies conducted up to September 2019. We included two randomized controlled trials (experiments in which participants are randomly allocated to two or more interventions, possibly including a control intervention or no intervention, and the results are compared). One study randomized 64 people with severe acute pancreatitis to receive either CVVH (32 people) or no intervention (32 people). The other study randomized 30 people with severe acute pancreatitis to receive either high-volume (high-speed) CVVH (15 people) or standard CVVH (15 people). There were no in-hospital deaths in either group. We cannot tell from our results whether CVVH has an important effect on death or complications for people with severe acute pancreatitis because the sample size was small. High-volume CVVH may have little to no difference on numbers of in-hospital deaths (20.0% with high-volume CVVH versus 33.3% with standard CVVH). We are uncertain whether high-volume CVVH reduces numbers of adverse events (13.3% in both groups). We cannot tell from our results whether high-volume CVVH is superior, equivalent or inferior to standard CVVH for people with severe acute pancreatitis because the sample size was small and the results were imprecise. Most of the included studies had some limitations in terms of how they were conducted or reported. Overall, the quality of the evidence varied from very low to low.