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Hemodynamics fluids

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https://www.readbyqxmd.com/read/27879535/agreement-between-arterial-and-venous-lactate-in-emergency-department-patients-a-prospective-study-of-157-consecutive-patients
#1
Anne-Laure Paquet, Vanina Valli, Anne-Laure Philippon, Catherine Devilliers, Ben Bloom, Pierre Hausfater, Bruno Riou, Yonathan Freund
INTRODUCTION: In the emergency department (ED), lactate is routinely used for risk stratification. Whether venous or arterial lactate measured on blood gas is interchangeable is not known. We hypothesized that venous lactate can be used instead of arterial lactate for the evaluation of acute patients in the ED. PATIENTS AND METHODS: This was a prospective single-center study. All patients requiring a lactate measurement were enrolled and we simultaneously drew arterial and venous blood...
November 22, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/27908326/defining-and-diagnosing-sepsis
#2
REVIEW
Michael C Scott
Sepsis is a heterogeneous clinical syndrome that encompasses infections of many different types and severity. Not surprisingly, it has confounded most attempts to apply a single definition, which has also limited the ability to develop a set of reliable diagnostic criteria. It is perhaps best defined as the different clinical syndromes produced by an immune response to infection that causes harm to the body beyond that of the local effects of the infection.
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27908327/ready-for-prime-time-biomarkers-in-sepsis
#3
REVIEW
Brit Long, Alex Koyfman
Sepsis is a common condition managed in the emergency department. Current diagnosis relies on physiologic criteria and suspicion of a source of infection using history, physical examination, laboratory studies, and imaging studies. The infection triggers a host response with the aim to destroy the pathogen, and this response can be measured. A reliable biomarker for sepsis should assist with earlier diagnosis, improve risk stratification, or improve clinical decision making. Current biomarkers for sepsis include lactate, troponin, and procalcitonin...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27908328/the-new-usual-care
#4
REVIEW
Jared Radbel, Daniel Boutsikaris
Recent literature continues to refine which components of the early goal-directed therapy (EGDT) algorithm are necessary. Given it utilizes central venous pressure, continuous central venous oxygen saturation, routine blood transfusions, and inotropic medications, this algorithm can be timely, invasive, costly, and potentially harmful. New trials highlight early recognition, early fluid resuscitation, appropriate antibiotic treatment, source control, and the application of a multidisciplinary evidence-based approach as essential components of current sepsis management...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27908333/pitfalls-in-the-treatment-of-sepsis
#5
REVIEW
Lars-Kristofer N Peterson, Karin Chase
Sepsis is a challenging, dynamic, pathophysiology requiring expertise in diagnosis and management. Controversy exists as to the most sensitive early indicators of sepsis and sepsis severity. Patients presenting to the emergency department often lack complete history or clinical data that would point to optimal management. Awareness of these potential knowledge gaps is important for the emergency provider managing the septic patient. Specific areas of management including the initiation and management of mechanical ventilation, the appropriate disposition of the patient, and consideration of transfer to higher levels of care are reviewed...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27908338/fluid-resuscitation-in-severe-sepsis
#6
REVIEW
Rob Loflin, Michael E Winters
Since its original description in 1832, fluid resuscitation has become the cornerstone of early and aggressive treatment of severe sepsis and septic shock. However, questions remain about optimal fluid composition, dose, and rate of administration for critically ill patients. This article reviews pertinent physiology of the circulatory system, pathogenesis of septic shock, and phases of sepsis resuscitation, and then focuses on the type, rate, and amount of fluid administration for severe sepsis and septic shock, so providers can choose the right fluid, for the right patient, at the right time...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27908339/vasopressors-and-inotropes-in-sepsis
#7
REVIEW
Leeanne Stratton, David A Berlin, John E Arbo
Vasopressor and inotropes are beneficial in shock states. Norepinephrine is considered the first-line vasopressor for patients with sepsis-associated hypotension. Dobutamine is considered the first-line inotrope in sepsis, and should be considered for patients with evidence of myocardial dysfunction or ongoing signs of hypoperfusion. Vasopressor and inotrope therapy has complex effects that are often difficult to predict; emergency providers should consider the physiology and clinical trial data. It is essential to continually reevaluate the patient to determine if the selected treatment is having the intended result...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27908340/end-points-of-sepsis-resuscitation
#8
REVIEW
John C Greenwood, Clinton J Orloski
Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient's overall response to therapy...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28144392/vasopressin-use-in-critically-ill-cirrhosis-patients-with-catecholamine-resistant-septic-shock-the-cvicu-cohort
#9
Lukasz A Myc, Jonathan G Stine, Rinita Chakrapani, Alexandra Kadl, Curtis K Argo
AIM: To examine patient-centered outcomes with vasopressin (AVP) use in patients with cirrhosis with catecholamine-refractory septic shock. METHODS: We conducted a single center, retrospective cohort study enrolling adult patients with cirrhosis treated for catecholamine-resistant septic shock in the intensive care unit (ICU) from March 2011 through December 2013. Other etiologies of shock were excluded. Multivariable regression models were constructed for seven and 28-d mortality comparing AVP as a second-line therapy to a group of all other vasoactive agents...
January 18, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/27922879/the-changes-in-pulse-pressure-variation-or-stroke-volume-variation-after-a-tidal-volume-challenge-reliably-predict-fluid-responsiveness-during-low-tidal-volume-ventilation
#10
Sheila Nainan Myatra, Natesh R Prabu, Jigeeshu Vasishtha Divatia, Xavier Monnet, Atul Prabhakar Kulkarni, Jean-Louis Teboul
OBJECTIVES: Stroke volume variation and pulse pressure variation do not reliably predict fluid responsiveness during low tidal volume ventilation. We hypothesized that with transient increase in tidal volume from 6 to 8 mL/kg predicted body weight, that is, "tidal volume challenge," the changes in pulse pressure variation and stroke volume variation will predict fluid responsiveness. DESIGN: Prospective, single-arm study. SETTING: Medical-surgical ICU in a university hospital...
March 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28179016/shock-induced-endotheliopathy-shine-in-acute-critical-illness-a-unifying-pathophysiologic-mechanism
#11
REVIEW
PärIngemar Johansson, Jakob Stensballe, SisseRye Ostrowski
One quarter of patients suffering from acute critical illness such as severe trauma, sepsis, myocardial infarction (MI) or post cardiac arrest syndrome (PCAS) develop severe hemostatic aberrations and coagulopathy, which are associated with excess mortality. Despite the different types of injurious "hit", acutely critically ill patients share several phenotypic features that may be driven by the shock. This response, mounted by the body to various life-threatening conditions, is relatively homogenous and most likely evolutionarily adapted...
February 9, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28050897/fluid-resuscitation-in-human-sepsis-time-to-rewrite-history
#12
REVIEW
Liam Byrne, Frank Van Haren
Fluid resuscitation continues to be recommended as the first-line resuscitative therapy for all patients with severe sepsis and septic shock. The current acceptance of the therapy is based in part on long history and familiarity with its use in the resuscitation of other forms of shock, as well as on an incomplete and incorrect understanding of the pathophysiology of sepsis. Recently, the safety of intravenous fluids in patients with sepsis has been called into question with both prospective and observational data suggesting improved outcomes with less fluid or no fluid...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/27896148/plasma-lyte-148-a-clinical-review
#13
Laurence Weinberg, Neil Collins, Kiara Van Mourik, Chong Tan, Rinaldo Bellomo
AIM: To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine. METHODS: We performed an electronic literature search from Medline and PubMed (via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: "surgery", "anaesthesia", "anesthesia", "anesthesiology", "anaesthesiology", "fluids", "fluid therapy", "crystalloid", "saline", "plasma-Lyte", "plasmalyte", "hartmann's", "ringers" "acetate", "gluconate", "malate", "lactate"...
November 4, 2016: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27858374/prediction-of-fluid-responsiveness-an-update
#14
REVIEW
Xavier Monnet, Paul E Marik, Jean-Louis Teboul
In patients with acute circulatory failure, the decision to give fluids or not should not be taken lightly. The risk of overzealous fluid administration has been clearly established. Moreover, volume expansion does not always increase cardiac output as one expects. Thus, after the very initial phase and/or if fluid losses are not obvious, predicting fluid responsiveness should be the first step of fluid strategy. For this purpose, the central venous pressure as well as other "static" markers of preload has been used for decades, but they are not reliable...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27841822/vasopressin-versus-norepinephrine-in-patients-with-vasoplegic-shock-after-cardiac-surgery-the-vancs-randomized-controlled-trial
#15
Ludhmila Abrahao Hajjar, Jean Louis Vincent, Filomena Regina Barbosa Gomes Galas, Andrew Rhodes, Giovanni Landoni, Eduardo Atsushi Osawa, Renato Rosa Melo, Marcia Rodrigues Sundin, Solimar Miranda Grande, Fabio A Gaiotto, Pablo Maria Pomerantzeff, Luis Oliveira Dallan, Rafael Alves Franco, Rosana Ely Nakamura, Luiz Augusto Lisboa, Juliano Pinheiro de Almeida, Aline Muller Gerent, Dayenne Hianae Souza, Maria Alice Gaiane, Julia Tizue Fukushima, Clarice Lee Park, Cristiane Zambolim, Graziela Santos Rocha Ferreira, Tânia Mara Strabelli, Felipe Lourenco Fernandes, Ligia Camara, Suely Zeferino, Valter Garcia Santos, Marilde Albuquerque Piccioni, Fabio Biscegli Jatene, Jose Otavio Costa Auler, Roberto Kalil Filho
BACKGROUND: Vasoplegic syndrome is a common complication after cardiac surgery and impacts negatively on patient outcomes. The objective of this study was to evaluate whether vasopressin is superior to norepinephrine in reducing postoperative complications in patients with vasoplegic syndrome. METHODS: This prospective, randomized, double-blind trial was conducted at the Heart Institute, University of Sao Paulo, Sao Paulo, Brazil, between January 2012 and March 2014...
January 2017: Anesthesiology
https://www.readbyqxmd.com/read/27829180/changes-of-central-venous-oxygen-saturation-define-fluid-responsiveness-in-patients-with-septic-shock-a-prospective-observational-study
#16
Biao Xu, Xiaobo Yang, Chunyao Wang, Wei Jiang, Li Weng, Xiaoyun Hu, Jinmin Peng, Bin Du
PURPOSE: To evaluate whether the changes of central venous oxygen saturation (Scvo2) after fluid challenge can define fluid responsiveness in patients with septic shock. METHODS: In this prospective observational study, septic shock patients with invasive cardiac output monitoring requiring fluid challenge were included. Cardiac index (CI) and Scvo2 were measured before and after fluid challenges. The changes of CI (ΔCI) and the changes of Scvo2 (ΔScvo2) were calculated and analyzed using Pearson correlation...
April 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/27815151/right-atrial-pressure-in-the-critically-ill-how-to-measure-what-is-the-value-what-are-the-limitations
#17
REVIEW
Sheldon Magder
Right atrial pressure (Pra) is determined by the interaction of the function of the heart as a pump, called cardiac function, and the factors that determine the return of blood to heart, called return function. Thus, monitoring Pra or its surrogate, central venous pressure (CVP), can give important insights into mechanisms behind changes in hemodynamic status, responses to interventions, and the likelihood of diagnoses. Examination of the components of the Pra tracing, especially during the ventilator cycle, also can give information about right heart diastolic function, status of the tricuspid valve, volume responsiveness and the cardiac rhythm...
November 1, 2016: Chest
https://www.readbyqxmd.com/read/27787407/vasodilators-in-septic-shock-resuscitation-a-clinical-perspective
#18
Thiago Domingos Corrêa, Roberto Rabello Filho, Murillo Santucci Cesar Assunção, Eliézer Silva, Alexandre Lima
Microcirculatory abnormalities have been shown to be frequent in patients with septic shock despite "normalization" of systemic hemodynamics. Several studies have explored the impact of vasodilator therapy (prostacyclin, inhaled nitric oxide, topic acetylcholine, and nitroglycerin) on microcirculation and tissue perfusion, with contradictory findings.In this narrative review, we briefly present the pathophysiological aspects of microcirculatory dysfunction, and depict the evidence supporting the use of vasodilators and other therapeutic interventions (fluid administration, blood transfusion, vasopressors, and dobutamine) aiming to improve the microcirculatory flow in septic shock patients...
March 2017: Shock
https://www.readbyqxmd.com/read/27774825/optimum-treatment-of-vasopressor-dependent-distributive-shock
#19
Jean-Louis Vincent, Marc Leone
Distributive shock is associated with decreased systemic vascular resistance and altered oxygen extraction. Septic shock is the most frequent form of distributive shock. In shock states, duration of hypotension is associated with poor outcomes. The speed at which treatment to restore adequate perfusion pressure is initiated is, therefore, important to improve survival. Areas covered: This review presents an overview of the literature related to the management of vasopressor-dependent distributive shock, and in particular the relationship between arterial pressure and organ perfusion and function...
January 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/27749318/diagnostic-accuracy-of-the-inferior-vena-cava-collapsibility-to-predict-fluid-responsiveness-in-spontaneously-breathing-patients-with-sepsis-and-acute-circulatory-failure
#20
Sebastien Preau, Perrine Bortolotti, Delphine Colling, Florent Dewavrin, Vincent Colas, Benoit Voisin, Thierry Onimus, Elodie Drumez, Alain Durocher, Alban Redheuil, Fabienne Saulnier
OBJECTIVE: To investigate whether the collapsibility index of the inferior vena cava recorded during a deep standardized inspiration predicts fluid responsiveness in nonintubated patients. DESIGN: Prospective, nonrandomized study. SETTING: ICUs at a general and a university hospital. PATIENTS: Nonintubated patients without mechanical ventilation (n = 90) presenting with sepsis-induced acute circulatory failure and considered for volume expansion...
March 2017: Critical Care Medicine
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