Early Fluid Resuscitation Research Articles

A prehospital approach to intravenous fluid therapy in patients with sepsis

Sepsis is a life-threatening, acute condition that can lead to septic shock and haemodynamic instability; it can be fatal if not treated. It is usually a complication of a viral, bacterial and fungal infection. Patients may have severe chest, kidney and abdominal infections. Hypovolaemia is common in patients with sepsis and may lead to a poorer outcome, and early fluid expansion is often the first step in treating these patients, in line with the Sepsis Six guidance. Paramedics are often the first practitioners to attend these patients so are well placed to provide live-saving fluid resuscitation. This article focuses on intravenous fluid therapy in the prehospital setting for critically ill patients with sepsis, including considerations regarding a need for early fluid resuscitation and the choice and administration of fluid, as well as monitoring and assessing the patient response to this.

S56 Perfusing the Pancreas: A Quality Improvement Project to Optimize Pancreatitis Management in a Tertiary Academic Center

Introduction: Acute pancreatitis (AP) is one of the leading gastrointestinal (GI) causes of hospitalization. Numerous studies have addressed the role of early fluid resuscitation and nutrition initiation in reducing the morbidity and length of stay associated with AP. Multiple GI societies have developed guidelines on the optimal management of AP. At our institution, we observed variations in the management of AP from current guidelines. We aim to identify the trends in the management of AP and the barriers to guideline adherence. We plan to use this data to enact systematic interventions that improve adherence to guideline recommendations. Methods: We evaluated all patients hospitalized with a diagnosis of acute or acute-on-chronic pancreatitis (ACP) from September to December 2021. Pre-intervention data on fluid resuscitation and initiation of oral diet/enteral feeding were collected. A survey was also developed and sent to hospital medicine and teaching teams to identify potential barriers. A Pareto chart showed that knowledge was not the primary barrier. Rather, there were clinical concerns that aggressive fluid resuscitation and early nutrition initiation could lead to potential complications of volume overload and worsening pancreatitis severity. Results: We reviewed data for 74 patients admitted with a diagnosis of AP or ACP. 93% of patients received intravenous fluids (IVF) within the first 24 hours, but only 8.5% received the recommended resuscitation rate of at least 250 cc/hr. With regards to nutrition, 46% of patients admitted with AP received oral/enteral nutrition within the first 24 hours. A Pareto chart of these responses identified that the biggest barriers to aggressive IVF resuscitation were concern for volume overload and patient co-morbidities, such as congestive heart failure and chronic kidney disease. A subsequent secondary analysis showed that the concern for CHF and CKD may not be valid, as 81% of patients admitted for AP did not have these co-morbidities. For early nutrition, the biggest barriers were concern for clinical worsening and PO intolerance. Conclusion: Our QI project aims to optimize pancreatitis management at our institution by improving adherence to early fluid resuscitation and oral/enteral nutrition initiation. A pro forma is in development to standardize management and will be distributed to clinical staff. Post-intervention data will be collected to assess for improvement.

Evidence-Based Approach to the Surgical Management of Acute Pancreatitis.

Background Acute pancreatitis is a significant challenge to health services. Remarkable progress has been made in the last decade in optimizing its management. Methods This review is a comprehensive assessment of 7 guidelines employed in current clinical practice with an appraisal of the underlying evidence, including 15 meta-analyses/systematic reviews, 16 randomized controlled trials, and 31 cohort studies. Results Key tenets of early management of acute pancreatitis include severity stratification based on the degree of organ failure and early goal-directed fluid resuscitation. Rigorous determination of etiology reduces the risk of recurrence. Early enteral nutrition and consideration of epidural analgesia have been pioneered in recent years with promising results. Indications for invasive intervention are becoming increasingly refined. The definitive indications for endoscopic retrograde cholangiopancreatography in acute pancreatitis are associated with cholangitis and common bile duct obstruction. The role of open surgical necrosectomy has diminished with the development of a minimally invasive step-up necrosectomy protocol. Increasing use of endoscopic ultrasound-guided intervention in the management of pancreatic necrosis has helped reduce pancreatic fistula rates and hospital stay. Conclusion The optimal approach to surgical management of complicated pancreatitis depends on patient physiology and disease anatomy, in addition to the available resources and expertise. This is best achieved with a multidisciplinary approach. This review provides a distillation of the recommendations of clinical guidelines and critical discussion of the evidence that informs them and presents an algorithmic approach to key areas of patient management.

COVID-19 presentation as acute pancreatitis

Rationale: The gastrointestinal manifestations of COVID-19 include anorexia, nausea, vomiting, abdominal pain, and diarrhea. However, pancreatitis as the presentation of COVID-19 is rarely reported. Patient’s Concern: A 63-year-old COVID-19 patient presented with complaints of abdominal pain and difficulty breathing for 5 d. Diagnosis: Contrast-enhanced computed tomography of the abdomen suggested acute interstitial pancreatitis without any biliary tract obstruction. Interventions: The patient was resuscitated with intravenous fluids based on dynamic parameters of fluid responsiveness. The patient was started on enteral feeding, analgesics, antibiotics, dexamethasone, low molecular weight heparin, and supportive therapy. Outcomes: The patient developed severe acute respiratory distress syndrome and died 6 days after admission. Lessons: Management of COVID-19 in the presence of pancreatitis is challenging. Adequate early fluid resuscitation is an important aspect of medical management for COVID-19 patients with pancreatitis and restrictive strategies must be followed. Increased liver enzymes and renal dysfunction in acute pancreatitis can also limit the use of specific therapies like remdesivir. Dexamethasone, even though it has shown a beneficial effect in treating COVID-19, can have an additive effect in causing hyperglycemia in these cases. Clinicians should be aware of this atypical presentation of COVID-19 with pancreatitis and adjust their management strategies, keeping in mind the considerations for both diseases.

406EMF Early Fluid Delivery by Emergency Medical Services for Sepsis Using a Novel Rapid Infusion Device

406EMF Early Fluid Delivery by Emergency Medical Services for Sepsis Using a Novel Rapid Infusion Device

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis

BackgroundEarly aggressive hydration is widely recommended for the management of acute pancreatitis, but evidence for this practice is limited.MethodsAt 18 centers, we randomly assigned patients who presented with acute pancreatitis to receive goal-directed aggressive or moderate resuscitation with lactated Ringer’s solution. Aggressive fluid resuscitation consisted of a bolus of 20 ml per kilogram of body weight, followed by 3 ml per kilogram per hour. Moderate fluid resuscitation consisted of a bolus of 10 ml per kilogram in patients with hypovolemia or no bolus in patients with normovolemia, followed by 1.5 ml per kilogram per hour in all patients in this group. Patients were assessed at 12, 24, 48, and 72 hours, and fluid resuscitation was adjusted according to the patient’s clinical status. The primary outcome was the development of moderately severe or severe pancreatitis during the hospitalization. The main safety outcome was fluid overload. The planned sample size was 744, with a first planned interim analysis after the enrollment of 248 patients.ResultsA total of 249 patients were included in the interim analysis. The trial was halted owing to between-group differences in the safety outcomes without a significant difference in the incidence of moderately severe or severe pancreatitis (22.1% in the aggressive-resuscitation group and 17.3% in the moderate-resuscitation group; adjusted relative risk, 1.30; 95% confidence interval [CI], 0.78 to 2.18; P=0.32). Fluid overload developed in 20.5% of the patients who received aggressive resuscitation and in 6.3% of those who received moderate resuscitation (adjusted relative risk, 2.85; 95% CI, 1.36 to 5.94, P=0.004). The median duration of hospitalization was 6 days (interquartile range, 4 to 8) in the aggressive-resuscitation group and 5 days (interquartile range, 3 to 7) in the moderate-resuscitation group.ConclusionsIn this randomized trial involving patients with acute pancreatitis, early aggressive fluid resuscitation resulted in a higher incidence of fluid overload without improvement in clinical outcomes. (Funded by Instituto de Salud Carlos III and others; WATERFALL ClinicalTrials.gov number, NCT04381169.)

An Automated Hardware-in-Loop Testbed for Evaluating Hemorrhagic Shock Resuscitation Controllers.

Hemorrhage remains a leading cause of death, with early goal-directed fluid resuscitation being a pillar of mortality prevention. While closed-loop resuscitation can potentially benefit this effort, development of these systems is resource-intensive, making it a challenge to compare infusion controllers and respective hardware within a range of physiologically relevant hemorrhage scenarios. Here, we present a hardware-in-loop automated testbed for resuscitation controllers (HATRC) that provides a simple yet robust methodology to evaluate controllers. HATRC is a flow-loop benchtop system comprised of multiple PhysioVessels which mimic pressure-volume responsiveness for different resuscitation infusates. Subject variability and infusate switching were integrated for more complex testing. Further, HATRC can modulate fluidic resistance to mimic arterial resistance changes after vasopressor administration. Finally, all outflow rates are computer-controlled, with rules to dictate hemorrhage, clotting, and urine rates. Using HATRC, we evaluated a decision-table controller at two sampling rates with different hemorrhage scenarios. HATRC allows quantification of twelve performance metrics for each controller configuration and scenario, producing heterogeneous results and highlighting the need for controller evaluation with multiple hemorrhage scenarios. In conclusion, HATRC can be used to evaluate closed-loop controllers through user-defined hemorrhage scenarios while rating their performance. Extensive controller troubleshooting using HATRC can accelerate product development and subsequent translation.

Benefits of esmolol in adults with sepsis and septic shock: An updated meta-analysis of randomized controlled trials.

Background:Sepsis affects millions of patients annually, resulting in substantial health and economic burdens globally. The role of esmolol potentially plays in the treatment of sepsis and septic shock in adult patients remains controversial.Methods:We undertook a systematic search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases from their inception to May 12, 2022, for randomized controlled trials that evaluated the efficacy of esmolol for sepsis and septic shock. A random-effects meta-analysis was performed. Two investigators independently screened articles, extracted data, and assessed the quality of included studies.Results:Eight studies from 7 randomized controlled trials were included in our meta-analysis of 503 patients with sepsis and/or septic shock. Compared with standard treatment, esmolol significantly decreased 28-day mortality (risk ratio 0.68, 95% confidence interval [CI] 0.52–0.88; P = .004), heart rate (standardized mean difference [SMD] −1.83, 95% CI −2.95 to −0.70, P = .001), tumor necrosis factor-a (SMD −0.48, 95% CI −0.94 to −0.02, P = .04), and the troponin I level (SMD −0.59, 95% CI −1.02 to −0.16, P = .008) 24 hours after treatment. No significant effect was found in terms of length of intensive care unit stay; mean arterial pressure, lactic acid, central venous pressure, or central venous oxygen saturation, interleukin 6, or white blood cell levels; stroke volume index; or the PaO2/FiO2 ratio.Conclusions:Esmolol treatment may be safe and effective in decreasing 28-day mortality, controlling heart rate, and providing cardioprotective function, but has no effect on lung injury in patients with sepsis or septic shock after early fluid resuscitation. Improvement in cardiac function may be related to changes in serum inflammatory mediators. No significant adverse effects on tissue perfusion and oxygen utilization were observed.

Effects of Different Types of Early Restrictive Fluid Resuscitation on Immune Function and Multiorgan Damage on Hemorrhagic Shock Rat Model in a Hypothermic Environment.

Objective This study was aimed at investigating the effects of different types of fluid restriction fluid resuscitation on the immune dysfunction and organ injury of hemorrhagic shock rats under a hypothermic environment. Methods SD rats were divided into sham operation group (SHAM), hemorrhagic shock model group (HS), crystal liquid limited resuscitation group (CRLLR), colloidal liquid limited resuscitation group (COLLR), and nonlimited resuscitation group (NLR); rats in each group were placed in a low-temperature environment of 0-5°C for 30 min, and then, a hemorrhagic shock rat model was prepared. Sodium lactate Ringer's restricted resuscitation solution, hydroxyethyl starch restricted resuscitation solution, and hydroxyethyl starch were used for resuscitation, and hemodynamic examination was performed. The mortality rate, inflammatory factors, oxidative stress factors, and immune function were detected by ELISA. The dysfunction and injury of the intestinal, lung, liver, and kidney were examined by histological methods. Results Hemorrhagic shock resulted in decreased immune function and activation of inflammation. Unrestricted fluid infusion further activated the inflammatory response. The crystalloid-restricted fluid infusion performed effectively to regulate inflammatory response, promote antioxidative activity, and reduce the immunosuppressive reaction. Rehydration could regulate the coagulation. The hydroxyethyl starch reduced the expression of platelet glycoproteins Ib and IIb/IIIa and blocked the binding of fibrinogen to activated platelets, thereby inhibiting intrinsic coagulation and platelet adhesion and aggregation. Rats in the CRLLR group showed to relieve the injury of the lung, liver, kidney, and intestine from hemorrhagic shock in low-temperature environment. Conclusion The early application of restrictive crystalloid resuscitation in hemorrhagic shock rats in hypothermic environment showed the best therapy results. Early LR-restrictive fluid replacement promotes the balance of inflammatory response and the recovery of immunosuppressive state, resists oxidative stress, stabilizes the balance of coagulation and fibrinolysis, improves coagulation function, and relieves organ injury.

Analysis of the Role of Ultrasound in Early Fluid Resuscitation of Patients with Severe Septic Shock

Analysis of the Role of Ultrasound in Early Fluid Resuscitation of Patients with Severe Septic Shock

Effect of goal-directed fluid therapy on renal function in critically ill patients: a systematic review and meta-analysis

Objective To evaluate whether goal-directed fluid therapy (GDFT) reduces the risk of renal injury in critical illness. Methods MEDLINE via PubMed, EMBASE, CENTRAL and CBM was searched from inception to 13 March 2022, for studies comparing the effect of GDFT with usual care on renal function in critically ill patients. GDFT was defined as a protocolized intervention based on hemodynamic and/or oxygen delivery parameters. A fixed or random effects model was applied to calculate the pooled odds ratio (OR) based on heterogeneity through the included studies. Results A total of 28 studies with 9,019 patients were included. The pooled data showed that compared with usual care, GDFT reduced the incidence of acute kidney injury (AKI) in critical illness (OR 0.62, 95% confidence interval (CI) 0.47 to 0.80, p< 0.001). Sensitivity analysis with only low risk of bias studies showed the same result. Subgroup analyses found that GDFT was associated with a lower AKI incidence in both postoperative and medical patients. The reduction was significant in GDFT aimed at dynamic indicators. However, no significant difference was found between groups in RRT support (OR 0.88, 95% CI 0.74 to 1.05, p= 0.17). GDFT tended to increase fluid administration within the first 6 h, decrease fluid administration after 24 h, and was associated with more vasopressor requirements. Conclusions This meta-analysis suggests that GDFT aimed at dynamic indicators may be an effective way to prevent AKI in critical illness. This may indicate a benefit from early adequate fluid resuscitation and the combined effect of vasopressors.

An interim analysis of the waterfall trial: A multicenter randomized controlled trial of early aggressive versus moderate goal-directed fluid resuscitation for acute pancreatitis

An interim analysis of the waterfall trial: A multicenter randomized controlled trial of early aggressive versus moderate goal-directed fluid resuscitation for acute pancreatitis

Prevention and Treatment of AKI during Various Disasters

Acute kidney injury (AKI) is frequent, and shows wide variation with regards to the spectrum, etio-pathogenesis and management strategies after natural (e.g., earthquakes) and man-made disasters (e.g., wars). The most important pathogenetic mechanisms in AKI during earthquakes are crush injury-related hypovolemia and myoglobinuria. Therefore, the most effective preventive measures are early and energetic fluid resuscitation (especially isotonic saline due to medical and logistic advantages) and also avoiding nephrotoxic medications. When preventive measures fail and intrarenal AKI develops, dialysis is lifesaving, with a preference towards intermittent hemodialysis due to medical and logistic advantages during disasters. During wars, the most important man-made disaster, prerenal, intrarenal and postrenal AKI may develop both at the battlefield and also in the field- or tertiary care-hospital setting. Overall, pathogenesis and management strategies of AKI in war victims are similar with those of AKI in general and in natural disasters. Logistic planning after disasters is vital for providing the most effective treatment. If patients cannot be coped with locally, either help should be asked from, or, alternatively, patients should be referred to, other regions or countries. Importantly, nephrology units in and around disaster-prone areas should be prepared for disasters for a sudden influx of AKI victims after disasters.

Efficacy analysis of inferior vena cava variability combined with difference of central venous-to-arterial partial pressure of carbon dioxide on guiding fluid resuscitation in patients with septic shock

To investigate the effect of inferior vena cava variability (IVCV) combined with difference of central venous-to-arterial partial pressure of carbon dioxide (Pcv-aCO2) on guiding fluid resuscitation in septic shock. Patients with septic shock admitted to the department of critical care medicine of Jiangxi Provincial People's Hospital from January 1, 2018 to December 31, 2020 were enrolled, and they were divided into control group and observation group according to random number table method. Patients in both groups were given fluid resuscitation according to septic shock fluid resuscitation guidelines. The patients in the control group received fluid resuscitation strictly according to the early goal-directed therapy (EGDT) strategy. Resuscitation target: central venous pressure (CVP) 12-15 cmH2O (1 cmH2O≈0.098 kPa), mean arterial pressure (MAP) > 65 mmHg (1 mmHg≈0.133 kPa), mean urine volume (UO) > 0.5 mL×kg-1×h-1, central venous oxygen saturation (ScvO2) > 0.70. In the observation group, the endpoint of resuscitation was evaluated by IVCV dynamically monitored by bedside ultrasound and Pcv-aCO2. Resuscitation target: fixed filling of inferior vena cava with diameter > 2 cm, IVCV < 18%, and Pcv-aCO2 < 6 mmHg. The changes in recovery indexes before and 6 hours and 24 hours of resuscitation of the two groups were recorded, and the 6-hour efficiency of fluid resuscitation, 6-hour lactate clearance rate (LCR) and 6-hour and 24-hour total volume of resuscitation were also recorded; at the same time, the duration of mechanical ventilation, length of intensive care unit (ICU) stay, 28-day mortality and the incidence of acute renal failure and acute pulmonary edema between the two groups were compared. A total of 80 patients were enrolled in the analysis, with 40 in the control group and 40 in the observation group. The MAP, CVP and ScvO2 at 6 hours and 24 hours of resuscitation in the two groups were significantly higher than those before resuscitation, while Pcv-aCO2 and blood lactic acid (Lac) were significantly decreased, and UO was increased gradually with the extension of resuscitation time, indicating that both resuscitation endpoint evaluation schemes could alleviate the shock state of patients. Compared with before resuscitation, IVCV at 6 hours and 24 hours of resuscitation in the observation group were decreased significantly [(17.54±4.52)%, (18.32±3.64)% vs. (27.49±10.56)%, both P < 0.05]. Compared with the control group, MAP and ScvO2 at 6 hours of resuscitation in the observation group were significantly increased [MAP (mmHg): 69.09±4.64 vs. 66.37±4.32, ScvO2: 0.666±0.033 vs. 0.645±0.035, both P < 0.05], 24-hour MAP was increased significantly (mmHg: 75.16±3.28 vs. 70.12±2.18, P < 0.05), but CVP was relatively lowered (cmH2O: 9.25±1.49 vs. 10.25±1.05, P < 0.05), indicating that the fluid resuscitation efficiency was higher in the observation group. Compared with the control group, 6-hour LCR in the observation group was significantly increased [(55.64±6.23)% vs. (52.45±4.52)%, P < 0.05], 6-hour and 24-hour total volume of resuscitation was significantly decreased (mL: 2 860.73±658.32 vs. 3 568.54±856.43, 4 768.65±1 085.65 vs. 5 385.34±1 354.83, both P < 0.05), the duration of mechanical ventilation was significantly shortened (days: 6.78±3.45 vs. 8.45±2.85, P < 0.05), while the incidence of acute pulmonary edema was significantly decreased [2.5% (1/40) vs. 20.0% (8/40), P < 0.05]. There was no significant difference in the length of ICU stay, 28-day mortality or incidence of acute renal failure between the two groups. Dynamic monitoring of IVCV and Pcv-aCO2 can effectively guide the early fluid resuscitation of patients with septic shock, and compared with EGDT, it can significantly shorten the duration of mechanical ventilation, reduce the amount of fluid resuscitation, and reduce the incidence of acute pulmonary edema. Combined with its non-invasive characteristics, it has certain clinical advantages.

Self-crosslinked chitosan/κ-carrageenan-based biomimetic membranes to combat diabetic burn wound infections

Diabetic wound infection often leads to compromised healing with frequent chances of sepsis, amputation and even death. Traditional patient care emphasized on early debridement and fluid resuscitation followed by intravenous antibiotics therapy. However, compromised vasculature often limit the systemic effect of antibiotics. Current study focused formulation of chitosan HCl, κ- carrageenan and PVA based physical cross-linked hydrogel membrane dressings loaded with cefotaxime sodium (CTX), for potential diabetic burn wound healing by adopting solvent casting method. Results of mechanical strength shows tensile strength and % elongation of 12.63 ± 0.25 and 48 ±3.05 respectively. Water vapor transmission rate (WVTR) depicts that despite of formulation KCP3 and KCP6, all hydrogel membranes have WVTR value in range of ideal dressing i.e., 2000–2500 g/m2/day. Whereas, all hydrogel membranes have oxygen permibility values more than 8.2 mg/ml. Bacterial penetration analysis confirms the barrier property of formulated membranes. Drug loaded hydrogel membrane showed control release up to 24 hr which provide protection against bacterial proliferation. Present study aims to constructs diabetic burn rat model which demonstrate that CTX loaded hydrogel membrane shown significantly rapid wound closure higher re-epithelization and numerous granulation tissue formation as compared to positive and negative control group. Conclusively, it is confirmed that formulated hydrogel membranes are beneficial and can be considered as a promising membrane dressing to treat diabetic burn wound.

Early goal directed therapy versus a protocolized resuscitation care in early management of septic shock

ABSTRACT Objective Multicenter studies showed that early goal directed therapy (EGDT) did not improve outcome in patients with septic shock compared with undefined usual care. The aim of this study was to evaluate the efficacy of a protocolized resuscitation care compared to traditional EGDT in early management of septic shock on short-term mortality. Design A randomized controlled trail. Setting Emergency Department and Critical Care Units of Alexandria main university hospital. Patients 100 adult patients of both genders with septic shock. Methods All patients received early fluid resuscitation, empirical broad-spectrum antibiotic therapy and mechanical ventilation if indicated. Then, they were randomly assigned into two groups: Early goal directed therapy (EGDT) group (n = 50) and Protocolized resuscitation care (PRC) group (n = 50). Results EGDT group showed 20% reduction in need for vasopressor than PRC group with significant difference (p = 0.001). PRC group showed lower mortality rate than EGDT group but with no significant difference (p = 0.405). There were no differences in ICU stay, mechanical ventilation days and duration of vasopressor (p= 0.091, 0.243, 0.372 respectively). Conclusion A Protocolized resuscitation care may be beneficial as compared to EGDT in early management of septic shock with a non-significant trend to decrease mortality.

Early Fluid Resuscitation of Burn Patients Based on High-Precision Weighing System

Correct and continuous weight measurement of a burn patient is important for fluid resuscitation. Generally, a body weight bed uses four sensors to obtain signals. However, owing to signals dynamic characteristics, the air fluidized therapy bed has a large error in this mode, which is difficult to reduce. In this study, we optimized the sensor configuration scheme and developed a set of signal processing and methods to evaluate noise reduction. Additionally, the wavelet neural network was used to improve the weighing accuracy. Furthermore, medical tools are located on different body parts of a patient to acquire weight characteristics to assist with the rehydration of patient. The average error of 183.33g is acceptable from a medical perspective. An average error of 250.21g in dynamic weight after using wavelet de-noising and wavelet neural network methods was obtained.

The effect of HES130/0.4 sodium chloride solution on kidney function following early fluid resuscitation in shock patients.

BackgroundDoctors often use a small dose of hydroxyethyl starch (HES) 130/0.4 sodium chloride solution in the emergency room; however, its effect on kidney function remains controversial. This study aimed to evaluate the effect of a small dose of HES130/0.4 sodium chloride solution on kidney function in shock patients during early fluid resuscitation.MethodsThis cohort study retrospectively analyzed the data of 129 shock patients requiring fluid resuscitation who had been admitted to the Emergency Department of the Affiliated Hospital of Nantong University from January 2019 to December 2020. Patients were divided into the observation group (n=40) and control group (n=89) according to the type of fluid resuscitation. In relation to the fluid resuscitation treatment, the observation group was treated with crystalloid solution, while the control group was treated with crystalloid and HES130/0.4 sodium chloride solution. To further explore the effect of a small dose of HES130/0.4 sodium chloride solution, the patients were further divided into the following 4 groups based on the specific fluid administered: (I) the HES(+), lactated Ringer’s (LR)(+) group (n=85); (II) the HES(+), LR(–) group (n=4); (III) the HES(–), LR(+) group (n=31); and (IV) the HES(–), LR(–) group (n=9). The outcomes were in-hospital mortality and changes in creatinine (CR) level after fluid resuscitation.ResultsThere were no significant differences in the in-hospital mortality rates between the observation and control groups (P=0.343). The CR levels of patients in the control and HES(+), LR(+) groups were reduced after fluid resuscitation (P=0.034; P=0.028). There was no significant change in patients’ CR levels in the HES(+), LR(–) group after fluid resuscitation (P=0.999).ConclusionsAdministering a small dose of HES 130/0.4 sodium chloride in patients with shock does not appear to affect kidney function and in-hospital mortality; however, these findings should be considered exploratory, and further studies should be conducted to confirm these results.

Fluid resuscitation strategy and efficacy evaluation in shock stage in severely burned children with different burn areas in different age groups

Fluid resuscitation strategy and efficacy evaluation in shock stage in severely burned children with different burn areas in different age groups

204 A Higher Initial VExUS Score Is Associated With Inferior Outcomes in Septic Emergency Department Patients

Early recognition, antibiotic therapy, and fluid resuscitation are integral components of the management of patients with sepsis and septic shock. Historically, emergency department (ED) management of these patients has been guided by the Surviving Sepsis guidelines, however, with advances in point-of-care ultrasound, more precise fluid management has become a realistic possibility. More recently, the venous excess ultrasound (VExUS) scoring system has been used to stratify intravascular volume status, but the prognostic value of VExUS scores has yet to be determined.