Colloids For Fluid Resuscitation Research Articles

Expert Consensus on the Use of Human Serum Albumin in Adult Cardiac Surgery.

Expert Consensus on the Use of Human Serum Albumin in Adult Cardiac Surgery.

Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS

ObjectiveTo describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS.MethodsThis was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice.ResultsOn the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only.ConclusionOur results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.

The effects of colloids or crystalloids on acute respiratory distress syndrome in swine (&lt;em&gt;Sus scrofa&lt;/em&gt;) models with severe sepsis: analysis on extravascular lung water, IL-8, and VCAM-1

Background: Acute respiratory distress syndrome (ARDS) is a fatal complication of severe sepsis. Due to its higher molecular weight, the use of colloids in fluid resuscitation may be associated with fewer cases of ARDS compared to crystalloids. Extravascular lung water (EVLW) elevation and levels of interleukin-8 (IL-8) and vascular cell adhesion molecule-1 (VCAM-1) have been studied as indicators playing a role in the pathogenesis of ARDS. The aim of the study was to determine the effects of colloid or crystalloid on the incidence of ARDS, elevation of EVLW, and levels of IL-8 and VCAM-1, in swine models with severe sepsis.Methods: This was a randomized trial conducted at the Laboratory of Experimental Surgery, School of Veterinary Medicine, IPB, using 22 healthy swine models with a body weight of 8 to 12 kg. Subjects were randomly allocated to receive either colloid or crystalloid fluid resuscitation. After administration of endotoxin, clinical signs of ARDS, EVLW, IL-8, and VCAM-1 were monitored during sepsis, severe sepsis, and one- and three hours after fluid resuscitation. Analysis of data using the Wilcoxon test , Kolmogorov-Smirnov test, Mann-Whitney test, unpaired t test.Results: Mild ARDS was more prevalent in the colloid group, while moderate ARDS was more frequent in the crystalloid group. EVLW elevation was lower in the colloid compared to the crystalloid group. There was no significant difference in IL-8 and VCAM-1 levels between the two groups.Conclusion: The use of colloids in fluid resuscitation does not decrease the probability of ARDS events compared to crystalloids. Compared to crystalloids, colloids are associated with a lower increase in EVLWI, but not with IL-8 or VCAM-1 levels.

Fluid resuscitation in severe sepsis and septic shock: Shifting goalposts.

Fluid resuscitation in severe sepsis and septic shock: Shifting goalposts.

Evidence-based medicine: Do we need gelatins and starches?

AbstractFor more than a decade, systematic reviews have questioned the value of colloids in fluid resuscitation. A Cochrane review that was updated in early 2012 found no mortality advantage relative to crystalloids across a range of conditions for gelatins [risk ratio (RR) 0.91, 95% confidence interval (CI): 0.49–1.72], albumin (RR 1.01, 95% CI: 0.93–1.10), or hydroxyethyl starch (RR 1.10, 95% CI: 0.91–1.32.) Subsequent to that review, two further high-quality randomised controlled trials [Crystalloid vs Hydroxyethyl Starch Trial (CHEST) and Scandinavian Starch for Severe Sepsis/Septic Shock (6S) trial also failed to demonstrate a mortality benefit and raised concerns about renal harm.This overview looks at the evolution of evidence on colloid use. The issue of what constitutes sufficient evidence to pronounce on lack of benefit is raised, and two further EBM conundrums are explored. Firstly, is it appropriate to continue collecting patient data on harms in the absence of clear evidence of benefit? Secon...

Warning against colloids in fluid resuscitation

Warning against colloids in fluid resuscitation

Perioperatives Flüssigkeitsmanagement - Welches Volumen für welchen Patienten?

There is a renewed discussion about the role of crystalloids and natural as well as synthetic colloids in fluid resuscitation. Based on the currently available evidence the choice of fluid replacement does not influence mortality. However, there is increasing evidence that due to unwarranted organ effects of the specific replacement fluids, individual subgroups of patients may be preferentially treated either with cristalloids or colloids.

Place of the colloids in fluid resuscitation of the traumatized patient

The examination of the recent literature aimed at analysing the most recent data that could affect decisions regarding the use of colloids in trauma resuscitation. Animal data have generally shown a beneficial effect of colloids in trauma resuscitation, with improvements in capillary leak demonstrated in lung, intestine and brain. In most studies, hydroxyethyl starch resuscitation was more effective than crystalloid and decreased markers of inflammatory processes were observed. Brain injury in animals was attenuated with colloids. In uncontrolled haemorrhage, resuscitation with colloid increased bleeding and mortality.Human studies have also failed to confirm the suggestion that albumin resuscitation may be associated with a worse outcome in head injury. However, there is a strong suggestion that aggressive prehospital resuscitation, particularly with colloid, may be harmful. Studies in burns have consistently shown an improvement in the tendency to fluid overload with the inclusion of colloid in the resuscitation strategy, but so far no outcome benefit has been shown.Two studies of general trauma resuscitation have shown apparent benefit from the use of HES in early resuscitation with reductions in mortality and in renal injury. Recent trauma studies provide ongoing, but not conclusive, evidence of a benefit from colloid resuscitation in trauma.

Crystalloid or Colloid for Fluid Resuscitation in Paediatrics?

Crystalloid or Colloid for Fluid Resuscitation in Paediatrics?

Choice of fluids for resuscitation in children with severe infection and shock: systematic review

Objective To systemically review the evidence from clinical trials comparing the use of crystalloids and colloids for fluid resuscitation in children with severe infection.Data sources Medline (1950-2008), PubMed, the Cochrane...

CRYSTALLOIDS VERSUS COLLOIDS FOR FLUID RESUSCITATION IN CRITICALLY-ILL PATIENTS

The choice of crystalloid or colloid for fluid resuscitation has been debated for the last few years. Although colloids seems to be more interesting when taking into account their physiological properties, their effect on mortality is not better than crystalloids if they are used in an adequate amount.Moreover, colloids’ side effects are far more important than those of crystalloids. Several randomised studies pointed out the renal effects of colloids including acute renal injury with an increased need of renal replacement therapy. An unacceptably high rate of renal side effects has resulted in premature termination of some clinical trials. In addition, homeostatic and anaphylactoid effects of colloids on coagulation and on anaphylaxis may increase the risk of death associated with their use. Finally, colloids are much more expensive than crystalloids. For all these reasons, we conclude that crystalloids should be preferred to colloids for fluid resuscitation.

Fluid management and diuretic therapy in acute renal failure

Acute renal failure (ARF) is a common problem in critical care; therefore, nurses should consider it to be a potential issue for all of their patients. Fluid management and diuretic therapy are important in these patients. The aim of this study is to review the use of these interventions in patients in acute renal failure. Initially, the paper will review renal physiology and discuss some of the causes of acute renal failure. This will be followed by a critical examination of the evidence surrounding the use of crystalloids and colloids for fluid resuscitation, as well as the role of diuretics in patients with acute renal failure. The paper concludes by identifying approaches for developing future practice in this area.

Albumin vs. non-protein colloids for fluid resuscitation: does it matter?

Albumin vs. non-protein colloids for fluid resuscitation: does it matter?

Albumin vs. non-protein colloids for fluid resuscitation: does it matter?

Objective: Albumin is an effective plasma volume expander (PVE); however, the cost and frequent shortages of albumin have led hospitals to adopt guidelines for the use of alternative colloid PVE's.Many of these guidelines recommend the use of crystalloids as a first line of therapy as well as the substitution of albumin by less expensive non-protein colloids. These alternatives have demonstrated efficacy similar to that of albumin in many clinical indications. However, while the administration of crystalloids and finite amounts of non-protein colloids is usually safe, their safety has been questioned in some patient subgroups as well as when large doses are administered. The objective of this paper is to discuss albumin and alternative PVE's to highlight clinical situations where they are preferred. Data source: Published original research articles, review articles, textbooks, abstracts in both English and non-English have been reviewed. Study selection: Studies on the use of albumin and non-protein volum...

Crystalloids or colloids for fluid resuscitation – is that the question?

Fluid resuscitation is the most commonly applied treatment to critically ill patients and both crystalloids and colloids have saved thousands of lives. The debate of all crystalloids versus all colloids is increasingly irrelevant and misguided. Colloids are enormously variable and meta-analyses putting all colloids together into one group versus crystalloids are misleading. Critically ill patients form a very heterogeneous group and evidence is mounting which supports early subdivision into clinical entities and a more individualized treatment approach. All patients with hypovolaemia need water and salt, but when, how much and in what concentration? We should match the fluids used to the patient's condition. In patients with evidence of systemic capillary leak syndrome, modern medium molecular weight hydroxyethyl starches have shown definite advantages over albumin and low-molecular-weight gelatines.

Extracellular fluid variations during a fluid challenge: a comparison of normal saline (NS) and hydroxyethyl starch (HES) in stressed patients

The controversy regarding the use of crystaloids or colloids for fluid resuscitation of critically ill patients continues. Fluid remaining in the vascular compartment would have an obvious advantage. We used bioimpedance, a technique allowing assessment of body cell mass and extracellular water, to compare NS and HES, a relatively new colloid.

Comparison of Emergency Resuscitation with Colloids and Crystalloids

Clinical management is exceedingly difficult to evaluate in emergency patients because resuscitation is often chaotic, disorderly, and frantic. Resuscitation depends upon many factors: the primary illness or injury, the amount of blood and fluid losses, the patient's age, the prior state of health, the associated medical conditions, the time delay in instituting therapy, the volume and rate of fluids administered, and, finally, the choice of fluids given. Although it is difficult to control the effects of these complex interrelated factors, their influence may be evaluated by stratifying patients and then comparing the direct effects and outcome measures within each stratum.There has been persistent controversy over the relative merits of crystalloids and colloids in fluid resuscitation. We studied reviews of fluid management of all hypotensive patients seen in the adult surgical section of the Emergency Department (ED) during a 2½ year period, to compare the conventional crystalloid resuscitation which had been standard for this busy university-run county hospital with a fluid management protocol consisting of about 1/4 A colloids depending on age, cardiac history, and CVP.