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Perioperative fluids:

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17 papers 500 to 1000 followers
By Jason Mann No BS pulmonary critical care fellow
John H Boyd, Demetrios Sirounis, Julien Maizel, Michel Slama
BACKGROUND: In critically ill patients at risk for organ failure, the administration of intravenous fluids has equal chances of resulting in benefit or harm. While the intent of intravenous fluid is to increase cardiac output and oxygen delivery, unwelcome results in those patients who do not increase their cardiac output are tissue edema, hypoxemia, and excess mortality. Here we briefly review bedside methods to assess fluid responsiveness, focusing upon the strengths and pitfalls of echocardiography in spontaneously breathing mechanically ventilated patients as a means to guide fluid management...
September 4, 2016: Critical Care: the Official Journal of the Critical Care Forum
Rolando Claure-Del Granado, Ravindra L Mehta
BACKGROUND: Fluid overload is frequently found in acute kidney injury patients in critical care units. Recent studies have shown the relationship of fluid overload with adverse outcomes; hence, manage and optimization of fluid balance becomes a central component of the management of critically ill patients. DISCUSSION: In critically ill patients, in order to restore cardiac output, systemic blood pressure and renal perfusion an adequate fluid resuscitation is essential...
August 2, 2016: BMC Nephrology
Erin Frazee, Kianoush Kashani
BACKGROUND: Intravenous fluids (IVF) are frequently utilized to restore intravascular volume in patients with distributive and hypovolemic shock. Although the benefits of the appropriate use of fluids in intensive care units (ICUs) and hospitals are well described, there is growing knowledge regarding the potential risks of volume overload and its impact on organ failure and mortality. To avoid volume overload and its associated complications, strategies to identify fluid responsiveness are developed and utilized more often among ICU patients...
June 2016: Kidney Diseases
Fernando G Zampieri, Otavio T Ranzani, Luciano Cesar Pontes Azevedo, Izanio D S Martins, John A Kellum, Alexandre B Libório
OBJECTIVES: To assess the impact of the percentage of fluid infused as Lactated Ringer (%LR) during the first 2 days of ICU admission in hospital mortality and occurrence of acute kidney injury. DESIGN: Retrospective cohort. SETTING: Analysis of a large public database (Multiparameter Intelligent Monitoring in Intensive Care-II). PATIENTS: Adult patients with at least 2 days of ICU stay, admission creatinine lower than 5 mg/dL, and that received at least 500 mL of fluid in the first 48 hours...
August 5, 2016: Critical Care Medicine
Matthew W Semler, Todd W Rice
Sepsis is a common and life-threatening inflammatory response to severe infection treated with antibiotics and fluid resuscitation. Despite the central role of intravenous fluid in sepsis management, fundamental questions regarding which fluid and in what amount remain unanswered. Recent advances in understanding the physiologic response to fluid administration, and large clinical studies examining resuscitation strategies, fluid balance after resuscitation, colloid versus crystalloid solutions, and high- versus low-chloride crystalloids, inform the current approach to sepsis fluid management and suggest areas for future research...
June 2016: Clinics in Chest Medicine
Sumeet Reddy, Laurence Weinberg, Paul Young
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at Further information about the Annual Update in Intensive Care and Emergency Medicine is available from
2016: Critical Care: the Official Journal of the Critical Care Forum
Anders Winther Voldby, Birgitte Brandstrup
BACKGROUND: Perioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. This review aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice. RESULTS: Preoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well-being and muscular strength and to reduce insulin resistance...
2016: Journal of Intensive Care
J Wernerman, G H Sigurdsson
No abstract text is available yet for this article.
February 2016: Acta Anaesthesiologica Scandinavica
R Gupta, T J Gan
'Enhanced recovery after surgery' protocols implement a series of peri-operative interventions intended to improve recovery after major operations, one aspect of which is fluid management. The pre-operative goal is to prepare a hydrated, euvolaemic patient by avoiding routine mechanical bowel preparation and by encouraging patients to drink clear liquids up to two hours before induction of anaesthesia. The intra-operative goal is to achieve a 'zero' fluid balance at the end of uncomplicated surgery: goal-directed fluid therapy is recommended for poorly prepared or sick patients or those undergoing more complex surgery...
January 2016: Anaesthesia
Eduardo A Osawa, Andrew Rhodes, Giovanni Landoni, Filomena R B G Galas, Julia T Fukushima, Clarice H L Park, Juliano P Almeida, Rosana E Nakamura, Tania M V Strabelli, Brunna Pileggi, Alcino C Leme, Evgeny Fominskiy, Yasser Sakr, Marta Lima, Rafael A Franco, Raquel P C Chan, Marilde A Piccioni, Priscilla Mendes, Suéllen R Menezes, Tatiana Bruno, Fabio A Gaiotto, Luiz A Lisboa, Luiz A O Dallan, Alexandre C Hueb, Pablo M Pomerantzeff, Roberto Kalil Filho, Fabio B Jatene, Jose Otavio Costa Auler Junior, Ludhmila A Hajjar
OBJECTIVES: To evaluate the effects of goal-directed therapy on outcomes in high-risk patients undergoing cardiac surgery. DESIGN: A prospective randomized controlled trial and an updated metaanalysis of randomized trials published from inception up to May 1, 2015. SETTING: Surgical ICU within a tertiary referral university-affiliated teaching hospital. PATIENTS: One hundred twenty-six high-risk patients undergoing coronary artery bypass surgery or valve repair...
April 2016: Critical Care Medicine
Paul E Marik
No abstract text is available yet for this article.
October 2016: Critical Care Medicine
Michael L Moritz, Juan C Ayus
No abstract text is available yet for this article.
October 2015: New England Journal of Medicine
Lais Helena Camacho Navarro, Joshua A Bloomstone, Jose Otavio Costa Auler, Maxime Cannesson, Giorgio Della Rocca, Tong J Gan, Michael Kinsky, Sheldon Magder, Timothy E Miller, Monty Mythen, Azriel Perel, Daniel A Reuter, Michael R Pinsky, George C Kramer
BACKGROUND: Perioperative fluid therapy remains a highly debated topic. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. Maintaining effective circulating blood volume and pressure are key components of assuring adequate organ perfusion while avoiding the risks associated with either organ hypo- or hyperperfusion. Relative to perioperative fluid therapy, three inescapable conclusions exist: overhydration is bad, underhydration is bad, and what we assume about the fluid status of our patients may be incorrect...
2015: Perioperative Medicine
Michael A Dubick, Pang Shek, Charles E Wade
The objectives of this review are to assess the current state of hypertonic saline as a prehospital resuscitation fluid in hypotensive trauma patients, particularly after the 3 major Resuscitation Outcomes Consortium trauma trials in the US and Canada were halted due to futility. Hemorrhage and traumatic brain injury are the leading causes of death in both military and civilian populations. Prehospital fluid resuscitation remains controversial in civilian trauma, but small-volume resuscitation with hypertonic fluids is of utility in military scenarios with prolonged or delayed evacuation times...
June 2013: Clinics
Chrissy Guidry, Elizabeth Gleeson, Eric R Simms, Lance Stuke, Peter Meade, Norman E McSwain, Juan C Duchesne
BACKGROUND: High ratios of fresh frozen plasma:packed red blood cells in damage control resuscitation (DCR) are associated with increased survival. The impact of volume and type of resuscitative fluid used during high ratio transfusion has not been analyzed. We hypothesize a difference in outcomes based on the type and quantity of resuscitative fluid used in patients that received high ratio DCR. METHODS: A matched case control study of patients who received transfusions of ≥ four units of PRBC during damage control surgery over 4 1/2 y, was conducted at a Level I Trauma Center...
November 2013: Journal of Surgical Research
Zhi-Yong Peng, John A Kellum
PURPOSE OF REVIEW: There is significant controversy for perioperative fluid management. This review discusses the evidence from clinical studies, basic research, and systematic reviews to provide a summary of the current best practice in this area. RECENT FINDINGS: Recent evidence has challenged the long-held contention that use of colloids results in substantially less fluid volumes to achieve resuscitation endpoints. Meanwhile, evidence that hydroxyethyl starch does carry a risk of renal toxicity is now strong...
August 2013: Current Opinion in Critical Care
Daniel Chappell, Matthias Jacob, Klaus Hofmann-Kiefer, Peter Conzen, Markus Rehm
Replacement of assumed preoperative deficits, in addition to generous substitution of an unsubstantiated increased insensible perspiration and third space loss, plays an important role in current perioperative fluid regimens. The consequence is a positive fluid balance and weight gain of up to 10 kg, which may be related to severe complications. Because the intravascular blood volume remains unchanged and insensible perspiration is negligible, the fluid must accumulate inside the body. This concept brings into question common liberal infusion regimens...
October 2008: Anesthesiology
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