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Pietro Caironi, Gianni Tognoni, Serge Masson, Roberto Fumagalli, Antonio Pesenti, Marilena Romero, Caterina Fanizza, Luisa Caspani, Stefano Faenza, Giacomo Grasselli, Gaetano Iapichino, Massimo Antonelli, Vieri Parrini, Gilberto Fiore, Roberto Latini, Luciano Gattinoni
BACKGROUND: Although previous studies have suggested the potential advantages of albumin administration in patients with severe sepsis, its efficacy has not been fully established. METHODS: In this multicenter, open-label trial, we randomly assigned 1818 patients with severe sepsis, in 100 intensive care units (ICUs), to receive either 20% albumin and crystalloid solution or crystalloid solution alone. In the albumin group, the target serum albumin concentration was 30 g per liter or more until discharge from the ICU or 28 days after randomization...
April 10, 2014: New England Journal of Medicine
Armand Mekontso Dessap, Sandrine Katsahian, Ferran Roche-Campo, Hugo Varet, Achille Kouatchet, Vinko Tomicic, Gaetan Beduneau, Romain Sonneville, Samir Jaber, Michael Darmon, Diego Castanares-Zapatero, Laurent Brochard, Christian Brun-Buisson
BACKGROUND: Pulmonary edema may alter alveolar bacterial clearance and infectivity. Manipulation of fluid balance aimed at reducing fluid overload may, therefore, influence ventilator-associated pneumonia (VAP) occurrence in intubated patients. The objective of the present study was to assess the impact of a depletive fluid-management strategy on ventilator-associated complication (VAC) and VAP occurrence during weaning from mechanical ventilation. METHODS: We used data from the B-type Natriuretic Peptide for the Fluid Management of Weaning (BMW) randomized controlled trial performed in nine ICUs across Europe and America...
July 2014: Chest
Maristella Santi, Sebastiano A G Lava, Pietro Camozzi, Olivier Giannini, Gregorio P Milani, Giacomo D Simonetti, Emilio F Fossali, Mario G Bianchetti, Pietro B Faré
BACKGROUND: Intravenous fluids are commonly prescribed in childhood. 0.9 % saline is the most-used fluid in pediatrics as resuscitation or maintenance solution. Experimental studies and observations in adults suggest that 0.9 % saline is a poor candidate for fluid resuscitation. Although anesthesiologists, intensive care specialists, perioperative physicians and nephrologists have been the most active in this debate, this issue deserves some physiopathological considerations also among pediatricians...
June 25, 2015: Italian Journal of Pediatrics
Karen S Powers
No abstract text is available yet for this article.
July 2015: Pediatrics in Review
P Guilabert, G Usúa, N Martín, L Abarca, J P Barret, M J Colomina
Since 1968, when Baxter and Shires developed the Parkland formula, little progress has been made in the field of fluid therapy for burn resuscitation, despite advances in haemodynamic monitoring, establishment of the 'goal-directed therapy' concept, and the development of new colloid and crystalloid solutions. Burn patients receive a larger amount of fluids in the first hours than any other trauma patients. Initial resuscitation is based on crystalloids because of the increased capillary permeability occurring during the first 24 h...
September 2016: British Journal of Anaesthesia
Anatole Harrois, Sophie Rym Hamada, Jacques Duranteau
PURPOSE OF REVIEW: To discuss the fluid resuscitation and the vasopressor support in severe trauma patients. RECENT FINDINGS: A critical point is to prevent a potential increase in bleeding by an overly aggressive resuscitative strategy. Indeed, large-volume fluid replacement may promote coagulopathy by diluting coagulation factors. Moreover, an excessive level of mean arterial pressure may induce bleeding by preventing clot formation. SUMMARY: Fluid resuscitation is the first-line therapy to restore intravascular volume and to prevent cardiac arrest...
December 2014: Current Opinion in Critical Care
Johan Mårtensson, Rinaldo Bellomo
PURPOSE OF REVIEW: To describe the harmful effects of intravenous fluids on kidney structure and function and summarize recent comparisons between different fluids and their effect on kidney outcome. RECENT FINDINGS: Administration of intravenous fluids may contribute to the development and sustention of acute kidney injury. In excess, fluids cause kidney interstitial edema and venous congestion, which prevents renal blood flow and glomerular filtration rate. In contrast to balanced crystalloids, chloride-rich solutions impair renal blood flow via autoregulatory mechanisms...
August 2015: Current Opinion in Critical Care
Sibylle A Kozek-Langenecker
PURPOSE OF REVIEW: Infusion therapy is essential in intravascular hypovolaemia and extravascular fluid deficits. Crystalloidal fluids and colloidal volume replacement affect blood coagulation when infused intravenously. The question remains if this side-effect of infusion therapy is clinically relevant in patients with and without bleeding manifestations, and if fluid-induced coagulopathy is a risk factor for anaemia, blood transfusion, and mortality, and a driver for resource use and costs...
August 2015: Current Opinion in Critical Care
Karthik Raghunathan, Patrick Nailer, Ryan Konoske
PURPOSE OF REVIEW: We discuss the importance of the composition of intravenous crystalloid solutions. On the basis of current physiologic principles, evidence from basic science and clinical experiments, recent observational studies, and clinical trials, we conclude that the 'ideal crystalloid' depends on clinical context. We make recommendations on solutions that may be used during critical illness, major surgery, and certain clinical situations. RECENT FINDINGS: The routine use of solutions with a supraphysiologic chloride content and a low strong ion difference (SID), such as isotonic saline solution, may be associated with adverse outcomes, especially among critically ill patients...
August 2015: Current Opinion in Critical Care
Shay McGuinness, Rachael Parke
PURPOSE OF REVIEW: The aim of this study was to review recent advances and evidence for the use of cardiac output monitors to guide perioperative haemodynamic therapy. RECENT FINDINGS: There are multiple different cardiac output monitoring devices available for clinical use which are coupled with many different intervention protocols to manipulate perioperative haemodynamics. There is little evidence to demonstrate superiority of any one device. Previous small studies and meta-analyses have suggested that perioperative haemodynamic therapy guided by cardiac output monitoring improves outcomes after major surgery...
August 2015: Current Opinion in Critical Care
Sweyn S Garrioch, Michael A Gillies
PURPOSE OF REVIEW: This review appraises recent evidence and provides clinical guidance on optimal perioperative fluid therapy. RECENT FINDINGS: Choice of perioperative intravenous fluid continues to be the source of much debate. Not all crystalloids are equivalent, and there is growing evidence that balanced solutions are superior to 0.9% saline in many situations. Recent evidence from the critical care population has highlighted risks associated with synthetic colloids; this and the absence of demonstrable benefit in the surgical population make it difficult to recommend their use in the perioperative period...
August 2015: Current Opinion in Critical Care
Ogbonna C Ogbu, David J Murphy, Greg S Martin
PURPOSE OF REVIEW: This review highlights the recent evidence describing the outcomes associated with fluid overload in critically ill patients and provides an overview of fluid management strategies aimed at preventing fluid overload during the resuscitation of patients with shock. RECENT FINDINGS: Fluid overload is a common complication of fluid resuscitation and is associated with increased hospital costs, morbidity and mortality. SUMMARY: Fluid management goals differ during the resuscitation, optimization, stabilization and evacuation phases of fluid resuscitation...
August 2015: Current Opinion in Critical Care
Pietro Caironi, Thomas Langer, Luciano Gattinoni
PURPOSE OF REVIEW: The use of albumin-containing solutions in critically ill patients has been recently revisited, following evidence on harmful effects of synthetic colloids, and novel randomized controlled trials (RCTs) in sepsis. Here, we review the most recent findings on albumin administration in acutely ill and septic patients. RECENT FINDINGS: The revision of Starling's theory on microvascular fluid dynamics has highlighted the role of albumin in preserving intravascular compartment volume...
August 2015: Current Opinion in Critical Care
Audrey A Avila, Eliezer C Kinberg, Nomi K Sherwin, Robinson D Taylor
Sepsis is a systemic inflammatory response to severe infection causing significant morbidity and mortality that costs the health care system $20.3 billion annually within the United States. It is well established that fluid resuscitation is a central component of sepsis management; however, to date there is no consensus as to the ideal composition of fluid used for resuscitation. In this review, we discuss the progression of clinical research comparing various fluids, as well as the historical background behind fluid selection for volume resuscitation...
March 10, 2016: Curēus
Daniel J Henning, Nathan I Shapiro
The Early Goal-Directed Therapy versus Standard Care for Sepsis trial by Rivers and colleagues in 2001 suggested that a significant mortality reduction may be realized through goal-directed interventions early in the care of patients with septic shock. However, the recent publication of the Protocol-Based Care for Early Septic Shock (ProCESS), Australasian Resuscitation in Sepsis Evaluation (ARISE), and Protocolised Management in Sepsis (ProMISE) trials did not demonstrate the superiority of early goal-directed therapy over usual care...
June 2016: Clinics in Chest Medicine
Jean Louis Vincent, Daniel De Backer, Christian J Wiedermann
Fluid administration is a key intervention in hemodynamic resuscitation. Timely expansion (or restoration) of plasma volume may prevent tissue hypoxia and help to preserve organ function. In septic shock in particular, delaying fluid resuscitation may be associated with mitochondrial dysfunction and may promote inflammation. Ideally, infused fluids should remain in the plasma for a prolonged period. Colloids remain in the intravascular space for longer periods than do crystalloids, although their hemodynamic effect is affected by the usual metabolism of colloid substances; leakage through the endothelium in conditions with increased permeability, such as sepsis; and/or external losses, such as with hemorrhage and burns...
October 2016: Journal of Critical Care
Carmen A Pfortmueller, Edith Fleischmann
INTRODUCTION: The concept of fluid resuscitation with balanced solutions containing acetate is relatively new. The knowledge about acetate mostly originates from nephrological research, as acetate was primarily used as a dialysis buffer where much higher doses of acetate are infused. The aim of this review is to give an overview of the advantages and disadvantages of an acetate-buffered crystalloid fluid when compared with other crystalloid infusates. METHODS: We report trials with the primary object of comparing an acetate-buffered infusion solute to another crystalloid infusate...
October 2016: Journal of Critical Care
Claudia Moeller, Carolin Fleischmann, Daniel Thomas-Rueddel, Vlasislav Vlasakov, Bram Rochwerg, Philip Theurer, Luciano Gattinoni, Konrad Reinhart, Christiane S Hartog
Gelatin is a widely used synthetic colloid resuscitation fluid. We undertook a systematic review and meta-analysis of adverse effects in randomized and nonrandomized studies comparing gelatin with crystalloid or albumin for treatment of hypovolemia. Multiple databases were searched systematically without language restrictions until August 2015. We assessed risk of bias of individual studies and certainty in evidence assessment by the Grading of Recommendations Assessment, Development, and Evaluation approach...
October 2016: Journal of Critical Care
Bruno Adler Maccagnan Pinheiro Besen, Leandro Utino Taniguchi
Fluid resuscitation plays a fundamental role in the treatment of septic shock. Administration of inappropriately large quantities of fluid may lead to volume overload, which is increasingly recognized as an independent risk factor for morbidity and mortality in critical illness. In the early treatment of sepsis, timely fluid challenges should be given to optimize organ perfusion, but continuous positive fluid balance is discouraged. In fact, achievement of a negative fluid balance during treatment of sepsis is associated with better outcomes...
July 21, 2016: Shock
Pedro Vitale Mendes, Fernando Godinho Zampieri, Marcelo Park
The use of fluid bolus infusion is the cornerstone for hemodynamic resuscitation of critically ill patients. Recently, the clinical use of colloids has lost strength with the publication of several trials suggesting no benefit, and possible harm of its use.On the other hand, the so called balanced solutions, with low chloride concentrations, have emerged as an alternative with potential physiological benefits over traditional saline solution. Normal saline carries a high amount of chloride which has been associated with an increased incidence of metabolic acidosis, renal vasoconstriction and reduced urine output...
July 21, 2016: Shock
2016-10-21 06:39:58
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