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balanced crystalloids

Shan Zhang, Xiaoke Dai, Chunbao Guo
Intravenous fluid prescription plays an important role in sepsis management, which may be associated with patient prognosis. The objective of the present study was to determine if the administration of crystalloid fluids is associated with clinical outcome for patients with severe sepsis and septic shock.The medical records of 79 patients with severe sepsis or septic shock at an academic tertiary care hospital between 2011 and 2016 were reviewed retrospectively. The patients were dichotomized based on the median 3-day amount of corrected crystalloid fluids as low (<193 mL/kg) versus high (>193 mL/kg)...
November 2018: Medicine (Baltimore)
Emmanuel Weiss, Catherine Paugam-Burtz, Samir Jaber
Liver failure can occur in patients with or without underlying chronic liver disease (mainly cirrhosis) and is, respectively, termed acute on chronic liver failure or acute liver failure (ALF). In both cases, it is associated with marked systemic inflammation and profound hemodynamic disturbances, that is, increased cardiac output, peripheral vasodilation, and decreased systemic vascular resistance, on top of several superimposed etiologies of shock. In patients with cirrhosis, sepsis is the main cause of intensive care unit admission but portal hypertension-related gastrointestinal hemorrhage is also common...
October 2018: Seminars in Respiratory and Critical Care Medicine
Rachael Dawson, Andrew Wignell, Paul Cooling, David Barrett, Harish Vyas, Patrick Davies
BACKGROUND: Plasma-Lyte 148 ® is a balanced, crystalloid intravenous (IV) fluid which is both calcium-free and isotonic. It prevents the hyperchloraemic metabolic acidosis and iatrogenic hyponatraemia seen with use of 0.9% sodium chloride and hypotonic solutions respectively. However, data on compatibility with commonly used drugs is lacking. AIM: To investigate the stability of Plasma-Lyte 148 ® and Plasma-Lyte 148 ® + 5% Glucose with eight commonly used therapeutic agents when compared with 5% Glucose and 0...
November 25, 2018: Paediatric Anaesthesia
Philippe Guerci, Bulent Ergin, Zuhre Uz, Yasin Ince, Martin Westphal, Michal Heger, Can Ince
BACKGROUND: Glycocalyx shedding after traumatic hemorrhagic or septic shock, as well as different resuscitation fluids, has been causally linked to increased vascular barrier permeability (VBP) resulting in tissue edema. In nontraumatic hemorrhagic shock (NTHS), it remains questionable whether glycocalyx degradation in itself results in an alteration of VBP. The composition of fluids can also have a modulatory effect on glycocalyx shedding and VBP. We hypothesized that the shedding of the glycocalyx during NTHS has little effect on VBP and that the composition of fluids can modulate these effects...
November 16, 2018: Anesthesia and Analgesia
Alexandre Joosten, Amélie Delaporte, Julien Mortier, Brigitte Ickx, Luc Van Obbergh, Jean-Louis Vincent, Maxime Cannesson, Joseph Rinehart, Philippe Van der Linden
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: The authors recently demonstrated that administration of balanced hydroxyethyl starch solution as part of intraoperative goal-directed fluid therapy was associated with better short-term outcomes than administration of a balanced crystalloid solution in patients having major open abdominal surgery. In the present study, a 1-yr follow-up of renal and disability outcomes in these patients was performed...
November 9, 2018: Anesthesiology
Matthew W Semler, John A Kellum
Intravenous fluid therapy is the most common intervention received by acutely ill patients. Historically, saline (0.9% sodium chloride) has been the most frequently administered intravenous fluid, especially in North America. Balanced crystalloid solutions (e.g., lactated Ringer's, Plasma-Lyte) are an increasingly used alternative to saline. Balanced crystalloids have a sodium, potassium, and chloride content closer to that of extra-cellular fluid and, when given intravenously, have fewer adverse effects on acid-base balance...
November 8, 2018: American Journal of Respiratory and Critical Care Medicine
Myung-Soo Jang, Jin-Hee Han, SangHo Lee, Sung-Eun Kim
STUDY DESIGN: Retrospective analysis. OBJECTIVE: The objective of this study was to investigate the effects of intraoperative balanced 6% hydroxyethyl starch (HES) 130/0.4 on postoperative blood loss and the coagulation profile. SUMMARY OF BACKGROUND DATA: The safety of colloid versus crystalloid transfusion for bleeding and coagulation during major spine surgery remains controversial and only a few studies exist. Thus, we compared the effects of balanced 6% HES 130/0...
October 16, 2018: Clinical Spine Surgery
K Bhaskaran, Ganapathy Arumugam, P V Vinay Kumar
Context and Aims: Off-pump coronary artery bypass graft (OPCABG) is a form of CABG surgery. It is performed without the use of cardiopulmonary bypass machine as a surgical treatment for coronary heart disease. Acute kidney injury (AKI) is one of the common postoperative complications of OPCABG. Previous studies suggest important differences related to intravenous fluid (IVF) chloride content and renal function. We hypothesize that perioperative use of chloride restricted IVFs may decrease incidence and severity of postoperative AKI in patients undergoing OPCABG...
October 2018: Annals of Cardiac Anaesthesia
Xiaoming Wang, Zhou Yuan, Qihong Chen, Jiangquan Yu, Ruiqiang Zheng
OBJECTIVE: To compare the effect of 0.9% NaCl solution, Ringer solution, and acetate sodium potassium magnesium calcium glucose solution (ASPMCG solution) on internal environment in patients with septic shock receiving early fluid resuscitation. METHODS: A prospective randomized controlled trial was conducted. From June 2016 to January 2018, a total of 280 patients with septic shock admitted to intensive care unit (ICU) of Northern Jiangsu People's Hospital were enrolled...
September 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Luke A Gatta, Evelyn L Lockhart, Andra H James
A critical tool in the successful management of patients with abnormal placentation is an established massive transfusion protocol designed to rapidly deliver blood products in obstetrical and surgical hemorrhage. Spurred by trauma research and an understanding of consumptive coagulopathy, the past 2 decades have seen a shift in volume resuscitation from an empiric, crystalloid-based method to balanced, targeted transfusion therapy. The present article reviews patient blood management in abnormal placentation, beginning with optimizing the patient's status in the antenatal period to the laboratory assessment and transfusion strategy for blood products at the time of hemorrhage...
December 2018: Clinical Obstetrics and Gynecology
Shuyan Wei, Lillian S Kao, Henry E Wang, Ronald Chang, Jeanette Podbielski, John B Holcomb, Charles E Wade
Background: Septic shock is a public health problem with high mortality. There remains a knowledge gap regarding the optimal resuscitation fluid to improve clinical outcomes, and the underlying mechanism by which fluids exert their effect. Shock-induced endotheliopathy (SHINE) is thought to be a shared pathophysiologic mechanism associated with worsened outcomes in critically ill trauma and sepsis patients. SHINE is characterized by breakdown of the glycocalyx-a network of membrane-bound proteoglycans and glycoproteins that covers the endothelium...
2018: Trauma surgery & acute care open
Chao Liu, Zhi Mao, Pan Hu, Xin Hu, Hongjun Kang, Jie Hu, Zhifang Yang, Penglin Ma, Feihu Zhou
Objective: The aim of this study was to compare the effectiveness of different fluids on critically ill patients who need fluid resuscitation through a systematic review and network meta-analysis (NMA). Data sources: Electronic databases were searched up to March 2018 for randomized controlled trials comparing the effectiveness of different fluids in critically ill patients. The primary outcome was mortality, and the secondary outcomes were the incident of acute kidney injury (AKI) and risk of receiving renal replacement therapy (RRT)...
2018: Therapeutics and Clinical Risk Management
Jonathan D Casey, Ryan M Brown, Matthew W Semler
PURPOSE OF REVIEW: Intravenous fluid administration is a fundamental therapy in critical care, yet key questions remain unanswered regarding optimal fluid composition and dose. This review evaluates recent evidence regarding the effects of fluid resuscitation on pathophysiology, organ function, and clinical outcomes for critically ill patients. RECENT FINDINGS: Recent findings suggest that intravenous fluid composition affects risk of kidney injury and death for critically ill adults...
December 2018: Current Opinion in Critical Care
Daniel Martin, Panagis M Lykoudis, Gabriel Jones, David Highton, Alan Shaw, Sarah James, Qiang Wei, Giuseppe Fusai
BACKGROUND: The impact of perioperative intravenous fluid administration on surgical outcomes has been documented in literature, but not specifically studied in the context of hepato-pancreato-biliary (HPB) surgery. This study aimed to investigate the impact of postoperative intravenous fluid administration on intensive care unit (ICU), in this subgroup of patients. METHODS: A single-center retrospective cohort of 241 HPB patients was assessed, focusing on intravenous fluid administration in ICU, during the first 24 h...
October 2018: Hepatobiliary & Pancreatic Diseases International: HBPD INT
Ankita Dey, S Adinarayanan, Prasanna Udupi Bidkar, Rakesh K Bangera, V Balasubramaniyan
Background: The choice of fluid is important in neurosurgical patients, who may be dehydrated due to the administration of diuretics in order to reduce cerebral edema. Normal saline, the infused fluid routinely used in neurosurgical patients, can cause hyperchloremic metabolic acidosis. A balanced crystalloid (BC) may help to maintain the metabolic status more favorably in these patients, without adversely affecting brain relaxation. Methods: We conducted a prospective, randomized controlled trial on patients undergoing elective craniotomy for supratentorial tumor resection under general anesthesia...
September 2018: Neurology India
Andrew Friederich, Natalie Martin, Morgan B Swanson, Brett A Faine, Nicholas M Mohr
STUDY OBJECTIVE: The purpose of this study is to test the hypothesis that balanced crystalloids improve quality of recovery more than normal saline solution (0.9% sodium chloride) in stable emergency department (ED) patients. Secondary outcomes measured differences in health care use. METHODS: A single-site, participant- and evaluator-blinded, 2-arm parallel allocation (1:1), comparative effectiveness, randomized controlled trial allocated adults receiving intravenous fluids in the ED before discharge to receive 2 L of lactated Ringer's solution or normal saline solution...
August 23, 2018: Annals of Emergency Medicine
Yazan Z M Zayed, Ahmed M Y Aburahma, Mahmoud O Barbarawi, Kewan Hamid, Momen R N Banifadel, Laith Rashdan, Ghassan I Bachuwa
Objectives: Intravenous fluids are one of the most used medical therapy for patients, especially critically ill patients. We conducted a meta-analysis comparing between balanced crystalloids and normal saline in critically ill patients and its effect on various clinical outcomes. Design: Meta-analysis and systematic review of randomized clinical trials (RCTs). Methods and data source: Electronic search was performed using PubMed, Cochrane library, and clinical trials...
2018: Journal of Intensive Care
Michael J Lanspa, Rebecca E Burk, Emily L Wilson, Eliotte L Hirshberg, Colin K Grissom, Samuel M Brown
Objective: Echocardiography is often used to guide septic shock resuscitation, but without evidence for efficacy. We conducted an intensive care unit (ICU)-based randomized controlled feasibility trial comparing echocardiography-guided septic shock resuscitation (ECHO) with early goal-directed therapy (EGDT). Methods: We conducted a single center, randomized controlled feasibility trial at a 468-bed academic tertiary care center in Utah, USA. Adult patients with early septic shock were assessed and treated at defined intervals over 6 h using an echocardiogram-guided resuscitation protocol or a slightly modified EGDT protocol...
2018: Journal of Intensive Care
T G Kampmeier, P H Arnemann, M Hessler, K Bockbreder, A Wald, A Morelli, S W Rehberg, C Ertmer
BACKGROUND: Colloid solutions have been associated with kidney dysfunction in septic animals and humans. The present study investigated the influence of resuscitation with human albumin (HA) 5%, hydroxyethyl starch (HES) 130/0.4 6%, and balanced crystalloids on ultrastructural kidney damage, kidney function, and survival in a model of ovine septic shock. METHODS: After induction of peritoneal septic shock, animals were randomised to one of the following groups: (1) HA 5%, (2) HES 130/0...
September 2018: British Journal of Anaesthesia
A González-Castro, M Ortiz-Lasa, J C Rodriguez-Borregan, P Escudero-Acha, E Chicote, B Suberviola, C Blanco, Y Peñasco, A Jiménez Alfonso, J Llorca, T Dierssen-Soto
INTRODUCTION AND OBJECTIVE: To evaluate, by means of a meta-analysis, the effect of normal saline on mortality in intensive care patients, when compared with the use of balanced crystalloids. MATERIAL AND METHOD: Published controlled clinical trials, randomised and sequential prospective studies in time, evaluating the mortality when physiological saline was used in patients admitted to intensive care units. Electronic search was performed in Medline, Embase, Cochrane Library, ISI Proceedings, and Web of Science, as well as a manual search of selected references...
August 9, 2018: Revista Española de Anestesiología y Reanimación
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