Choice Of Fluid Therapy Research Articles

Uso de fluidoterapia en la práctica clínica

The use of intravenous fluid therapy must meet a need that cannot be met by oral administration and is not free from risk. No perfectly physiological intravenous solution is currently available. Intravenous solutions are classified into crystalloids and colloids. For the majority of indications, optimal intravenous fluid therapy is based on the use of crystalloids. The choice of fluid therapy must be personalised based on the patient’s characteristics and prior medical history, the current clinical situation, the osmolality and association of hydroelectrolytic imbalances and the acid-base equilibrium. The use of synthetic colloids is subject to significant restrictions given their negative effects on health outcomes, mainly anaphylactic reactions.

Balanced Crystalloids versus Normal Saline in Children with Critical Asthma.

There is little known about the impact of maintenance fluid choice in children with critical asthma on clinical outcomes. Our primary study objectives were to determine the differences in the serum chloride and bicarbonate levels based on the receipt of 0.9% saline or a balanced solution. The secondary study objectives included differences in acute kidney injury (AKI) and intensive care unit (ICU)/hospital length of stay (LOS). In this retrospective cohort study, we included 1166 patients admitted to a quaternary children’s hospital with critical asthma between 2017 and 2019. The patients were stratified based on if they received 0.9% saline or a balanced solution (Lactated Ringer’s or Plasma-lyte) for maintenance therapy. The study outcomes were determined using independent sample t-tests, multivariable logistic regression, and negative binomial regression. The patients who received 0.9% saline maintenance therapy had a significantly higher increase in their serum chloride levels when compared to those who received balanced solutions (0.9% saline: +4 mMol/L, balanced: +2 mMol/L, p = 0.002). There was no difference in the decrease in the serum bicarbonate levels (0.9% saline: −0.4 mMol/L, balanced: −0.5 mMol/L, p = 0.830). After controlling for age, race, sex, and the Pediatric Logistic Organ Dysfunction (PELOD-2) score, there was no association between the type of fluid received and the development of AKI (OR 0.87, 95% CI: 0.46–1.63, p = 0.678). Additionally, there was no association between the type of fluid and hospital or ICU LOS. Thus, despite higher serum chloride levels in the patients that received 0.9% saline, the choice of fluid therapy did not have an impact on the serum bicarbonate values, the development of AKI or hospital and ICU LOS, suggesting there is little difference between 0.9% saline and balanced solutions as maintenance therapy in children with critical asthma.

Retraction Note to: Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence.

Volume replacement regimens are discussed very emotionally. Interpretation of the literature is difficult due to variations in study design, patient population, target for volume replacement, endpoints, and type of fluids. Meta-analyses may not be very helpful because all kinds of patients and very old studies are included. The principles and options for volume replacement were reviewed exclusively in trauma patients and studies from the literature focusing on this problem were analyzed. Using a MEDLINE search, volume replacement therapy in adult trauma patients published in the English language from 1985 to the end of 2002 were identified and analyzed. Studies on prehospital volume replacement, volume replacement in the emergency area or in the operating room, and volume therapy in trauma intensive care unit patients were included. The age-old crystalloid/colloid controvery has still not been resolved but has been enlarged to a colloid/colloid debate. It is now widely accepted that human albumin could easily be replaced by synthetic colloids for volume replacement in trauma patients. No superiority of a specific volume replacement strategy with regard to outcome was found. However, in several studies outcome was not the major endpoint. Although showing some promising results, the importance of hypertonic solutions for volume replacement in the trauma patient is not yet defined. The choice of fluid therapy in trauma patients engenders the most controversy and an examination of the body of literature on this subject results in confusion. It is imperative to continue the search for substances that are effective in avoiding the development of post-trauma multi-organ dysfunction syndrome without detrimental side-effects.

Essence Core: Fluid Management in Acute Kidney Injury.

Acute kidney injury (AKI) is a heterogeneous disorder characterized by sudden decrease in kidney functioning, with increased serum creatinine levels and impairment of vital kidney functions such as fluid, electrolyte, and acid-base homeostasis. The key to perioperative AKI management is accomplishing optimal intravenous fluid therapy, involving guided fluid resuscitation and fluid balance management including proper fluid removal. In the present review, we highlighted the importance of fluid-based management of AKI, which is a critical process, as both reduced and increased levels of body fluids can have detrimental effects on the patient. While fluid depletion is commonly the targeted approach for fluid management, fluid overload is also largely recognized as a major contributor to worsening the outcomes. With the wide range of available fluid types, such as colloids and crystalloids, detailed knowledge and role of each are necessary before making the choice of a treatment strategy to be employed. While each of these has associated pros and cons, crystalloids are largely accepted as the treatment of choice due to better outcomes and affordability. Nevertheless, the dose and choice of fluid therapy must be goal irected and customized based on the patient's condition, ruling out the confounding factors.

Summary of the Clinical Pharmacist’s Role in the Management of Acute Pancreatitis: A Clinical Review

Introduction: The role of the clinical pharmacist in the management of acute pancreatitis has not been researched extensively, and only a few published studies on the topic can be found. This clinical review presents all pertinent published data and serves as a guide for clinical pharmacists who participate in the management of patients with acute pancreatitis. Methods: An extensive literature search was conducted on PubMed from 1990 to 2021 to retrieve relevant studies focusing on the role of the clinical pharmacist in the treatment of acute pancreatitis. Results: An analysis of the medications that are associated with acute pancreatitis is presented, highlighting the responsibility of the pharmacist to conduct a thorough medication investigation in order to identify a possible drug-induced acute pancreatitis. Medical management of acute pancreatitis, mainly fluid therapy, is an area where a clinical pharmacist can appropriately intervene. Proper choice of fluid therapy and its rate, nutritional considerations, pain management and antibiotic use, are all important to consider for a successful treatment with minimal adverse effects. It is well documented in the literature that clinical pharmacists can decrease hospital costs. Discharge counseling performed by a clinical pharmacist has been shown to increase patient compliance and decrease both readmission rates and follow-up physician visits. Conclusion: The clinical pharmacist, as the primary drug expert, can identify medication-induced pancreatitis, diminish the use of unnecessary antibiotics, improve patient care and decrease the overall costs.

Place of Polygeline in Fluid Resuscitation: Focus on Hypovolemic Shock

Traumatic injury is a common cause of morbidity and mortality. Fluid resuscitation is an important component of treatment of haemorrhagic shock after trauma. In patients with major trauma, after the control of bleeding, the blood volume needs to be replenished. Blood and blood products, crystalloids and colloids are available options for increasing plasma volume. With the availability of several options, choice of fluid therapy in trauma patients creates a dilemma. The choice of intravenous fluid is based on its ability to increase intravascular volume, tissue perfusion and oxygenation and lesser risk of adverse effects. Blood and blood components are a precious commodity and need to be tested, typed and matched and often not readily available. Polygeline is an important option among other colloids which exerts clinically evident benefits, making it an appropriate choice for the management of hypovolemia due to trauma. For a better understanding of the current practices in trauma management, an expert group discussion was facilitated.

BALBUMIN: Encuesta sobre el uso de la albúmina en la reanimación del paciente gran quemado adulto

IntroductionIn the resuscitation of the severely burned patient (SBP) the aim is the correct replacement of intravascular volume to guarantee tissue perfusion, but the current levels of evidence do not make some aspects clear, such as the choice of fluid therapy, monitoring and the use of albumin. This has led to conflict among the physicians who attend to these patients. ObjectiveTo determine how the initial resuscitation of the SBP is carried out, and specifically, the use of albumin in the reference units of the Spanish territory (CSUR). MethodsA survey was conducted by e-mail to CSUR staff with questions about epidemiology, initial resuscitation, and use of albumin. ResultsThe majority (86%, 6/7) of the CSUR units have specific equipment and protocols to perform the initial resuscitation of the SBP. Resuscitation is based on the Parkland formula in 43% (3/7), the rest (4/7) combine the Parkland formula and therapeutic-guided resuscitation by transpulmonary thermodilution. Ringer lactate is the fluid of choice in 71% (5/7) of the units, although the Ringer acetate solution is used in 29% (2/7). The large majority of units (86%, 6/7) use albumin according to their specific protocol, as an initial replacement colloid. ConclusionsThe results of this survey have allowed us to know the current situation on the initial resuscitation and the use of albumin in the SBP in the CSUR, detecting new trends and points of conflict in this regard.

Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock.

Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently edema. Fluid resuscitation is a mainstay in the initial treatment of sepsis, but the choice of fluid is unclear. The ideal resuscitative fluid is one that restores intravascular volume while minimizing edema; unfortunately, edema and edema-related complications are common consequences of current resuscitation strategies. Crystalloids are recommended as first-line therapy, but the type of crystalloid is not specified. There is increasing evidence that normal saline is associated with increased mortality and kidney injury; balanced crystalloids may be a safer alternative. Albumin is similar to crystalloids in terms of outcomes in the septic population but is costlier. Hydroxyethyl starches appear to increase mortality and kidney injury in the critically ill and are no longer indicated in these patients. In the trauma population, the shift to plasma-based resuscitation with decreased use of crystalloid and colloid in the treatment of hemorrhagic shock has led to decreased inflammatory and edema-mediated complications. Studies are needed to determine if these benefits also occur with a similar resuscitation strategy in the setting of sepsis.

Systemic inflammatory response during cardiac surgery: a pilot study.

There is a growing body of evidence indicating that perioperative fluid management during cardiac surgery influences patient care and outcome. The choice of fluid therapy and the degree of systemic inflammatory response triggered during surgery control the effects of tissue edema formation and end-organ function. As such, "goal-directed" fluid resuscitation protocols that measure colloid osmotic pressure (COP) may promote improvements in patient morbidity and mortality. Thirty patients scheduled for primary coronary artery bypass grafting were prospectively randomized for perioperative fluid treatment under COP guidance [albumin (ALB), n = 17] or conventional fluid protocols without COP support (control, n = 13). Whole-blood samples were drawn at four different time intervals including (A) anesthesia induction, (B) 10 minutes after the initiation of cardiopulmonary bypass, (C) at the completion of sternal skin approximation, and (D) 3 hours after admission to the cardiac intensive care unit. Interleukin 6 (IL-6) and IL-8 were measured by immunometric, enzyme-linked immunosorbent assays as well as C-reactive protein. Colloid osmotic pressure values were measured using a colloid osmometer. As compared with conventional fluid protocols, the patients treated in the intervention (ALB) group received significantly less total perioperative fluid [7893.6 (1874.5) vs 10,754.8 (2403.9), P = 0.001], and this relationship remained after controlling for age, sex, and The Society of Thoracic Surgeons risk score (β = -0.5, t = -3.1, P = 0.005). Colloid osmotic pressure values were significantly higher in the ALB group at time point D after surgery (P = 0.03). There were no significant differences in IL-6, IL-8, and C-reactive protein values between the groups at any of the time blood draw intervals. Perioperative outcomes were evaluated by treatment group. For both groups, the incidence of perioperative morbidity was low and did not differ by treatment group. The use of COP-guided fluid resuscitation was associated with a significant reduction in perioperative fluid demand. However, patients prescribed to COP-guided fluid therapy did not experience a reduction in whole-body inflammation or improved surgical outcome as compared with conventional fluid management techniques.

Fluid therapy in calves

Choice of fluid therapy in calves depends on acid–base status of the calf and the degree of dehydration. Evaluation of acid–base status involves measuring blood parameters, assessing the clinical state of the calf and assumptions based on age. Use of homemade fluids for intravenous fluid therapy is often recommended as they are more suitable than commercially available preparations and cost effective. Oral fluid therapy is essential and early instigation can avoid the need for parenteral fluids. Various products are available with more recent alternatives having benefits for gut health. Whichever solution is chosen it is important to re-start milk feeding as soon as possible.

Choice of fluid therapy in patients of craniopharyngioma in the perioperative period: A hospital-based preliminary study.

Background:Electrolyte imbalance and acute diabetes insipidus (DI) are the most common complications in patients undergoing craniopharyngioma surgery. Improper management of water and electrolyte imbalance is common cause of morbidity and mortality. Data is sparse and controversial regarding the choice of fluid therapy in this population during perioperative period.Methods:In this retrospective-prospective study involving 73 patients (58 retrospective), the type of fluid therapy was correlated with occurrence of hypernatremia, hyponatremia, DI, morbidity, and mortality. In the retrospective study, 48 patients received normal saline and 10 received mixed fluids as per the prevailing practice. In the prospective group, five patients each received normal saline, half normal saline, and 5% dextrose randomly.Results:The sodium values were significantly higher in first 48 h in the group that received normal saline compared with other groups (P < 0.001). The use of normal saline was associated with higher incidence of hypernatremia, DI, and mortality (P = 0.05), while the group that received 5% dextrose was associated with hyponatremia, hypoglycemia, and seizures. There was no perioperative hypotension with use of any of the fluids.Conclusion:Our results indicate half normal saline was fluid of choice with diminished incidence of water and electrolyte abnormalities without increase in mortality during postoperative period.

Type of resuscitation fluid—it does matter!

2012 saw the publication of four important trials investigating the choice of fluid therapy in patients suffering from critical illness or undergoing major surgery. These studies pave the way for more evidence-based administration of fluid in such patients.

Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence.

Volume replacement regimens are discussed very emotionally. Interpretation of the literature is difficult due to variations in study design, patient population, target for volume replacement, endpoints, and type of fluids. Meta-analyses may not be very helpful because all kinds of patients and very old studies are included. The principles and options for volume replacement were reviewed exclusively in trauma patients and studies from the literature focusing on this problem were analyzed. Using a MEDLINE search, volume replacement therapy in adult trauma patients published in the English language from 1985 to the end of 2002 were identified and analyzed. Studies on prehospital volume replacement, volume replacement in the emergency area or in the operating room, and volume therapy in trauma intensive care unit patients were included. The age-old crystalloid/colloid controvery has still not been resolved but has been enlarged to a colloid/colloid debate. It is now widely accepted that human albumin could easily be replaced by synthetic colloids for volume replacement in trauma patients. No superiority of a specific volume replacement strategy with regard to outcome was found. However, in several studies outcome was not the major endpoint. Although showing some promising results, the importance of hypertonic solutions for volume replacement in the trauma patient is not yet defined. The choice of fluid therapy in trauma patients engenders the most controversy and an examination of the body of literature on this subject results in confusion. It is imperative to continue the search for substances that are effective in avoiding the development of post-trauma multi-organ dysfunction syndrome without detrimental side-effects.

Small animal fluid therapy 2. Solutions and monitoring

ABSTRACTThis review outlines the importance of considering other aspects of treatment for underlying conditions, and other nursing measures, when fluid therapy is employed in small animal patients. The choice of fluid therapy should be based on rationally defined therapeutic targets and not following a strict set of procedures. Monitoring should also be a constant feature during fluid therapy so that adjustments can be made according to a patient's response to the treatment.

Pulmonary capillary pressure and permeability

An appreciation of the "state of the art" of pulmonary capillary pressure and permeability must necessarily form an important part of the basis of a rational choice of fluid therapy. The present state of the understanding of pulmonary transcapillary fluid exchange is developed. Laboratory data are used in conjunction with clinical evidence to construct and support the physiological concepts set forth.