Effects Of Fluid Resuscitation Research Articles

An Unusual Case of Lower Gastrointestinal Hemorrhage

Question: A 53-year-old woman, who was in good health, presented with hematochezia for more than 20 days. Examination was unremarkable, with stable vital signs. Laboratory tests revealed a hemoglobin of 78 g/L (normal 120–160 g/L), and the rest of the laboratory tests were normal. Colonoscopy revealed multiple masses with a cobblestone appearance, obvious mucosal congestion, and edema in the junction of sigmoid and rectum (Figure A). Colonic biopsy precipitated active bleeding that required various measures to stop bleeding. Ice-cold saline solution and 8% norepinephrine (8 mg norepinephrine in 100 mL saline solution) was used to rinse the bleeding site repeatedly and to constrict the vessels, but failed to stop the bleeding. Titanium clip was then used to clamp the vessels, but blood still exudated. Lauromacrogol was injected to stop the bleeding eventually (Figure A). She recovered following fluid resuscitation, acid suppression and somatostatin therapy. Contrast-enhanced computed tomography (CT) of the abdomen and pelvis is shown in Figure B–E. Three days later, she developed massive hematochezia with a hemoglobin level of 45 g/L. Owing to effective fluid resuscitation and blood transfusion, her blood pressure was relatively stable.

Restrictive resuscitation in patients with sepsis and mortality: A systematic review and meta-analysis with trial sequential analysis.

Although fluid resuscitation is recommended by the Society of Critical Care Medicine Surviving Sepsis Campaign Guidelines, risks of volume overload persist.The objective of this systematic review is to assess the effects of a restrictive fluid resuscitation approach in the septic patient both during and after the initial resuscitation period (30 ml/kg). A systematic review and meta-analysis with trial sequential analysis (TSA) of randomized controlled trials was conducted. Two blinded reviewers independently assessed and included studies that evaluated adult patients with sepsis involving a comparator group with an effective restrictive fluid resuscitation approach. The primary outcome was mortality. Secondary outcomes included rates of acute kidney injury (AKI), renal replacement therapy (RRT), ventilator days, intensive care unit (ICU) and hospital length of stay (LOS), duration of vasopressor therapy, and limb (or digital) ischemia. PubMed and Medline databases were queried for the search. A total of eight trials in 2375 patients were included. Effective restrictive fluid resuscitation compared with standard of care. The risk of bias was high in six studies and low in two studies, and all studies implemented fluid restriction after a 30-ml/kg infusion of fluids. Fluid restriction did not significantly reduce mortality in all studies compared to usual care (37% vs. 40% with usual care; risk ratio [RR] 0.90, 95% confidence interval [CI] 0.76-1.06, p=0.23, I2 =24%) or by TSA findings. There were no significant differences in rates of AKI or RRT (5 studies), LOS in ICU (4 studies) or hospital (3 studies), duration of vasopressor therapy (6 studies), or incidence of limb or digital ischemia (3 studies). However, fluid restriction significantly reduced ventilator days as evaluated in seven studies (mean difference - 1.25 days, 95% CI -1.92 to -0.58 days, p=0.0003, I2 =90%). This study demonstrated that a restrictive resuscitation strategy in sepsis resulted in no difference in mortality but may reduce ventilator days. Larger randomized trials are required to determine the optimal management of fluids in patients with sepsis.

276 Relationship Between Fluid Administration in the First Three Hours of Sepsis Resuscitation and Mortality

Timely and effective fluid resuscitation is vital for stabilizing sepsis while avoiding volume overload. Therefore, our study assessed the impact of administering a 30 mL/kg bolus fluid to patients with sepsis within 3 h of clinical outcomes.

Clinical effect of fluid resuscitation guided by intra-abdominal pressure and oxygenation index for severe acute pancreatitis patients

To investigate the effect of the liquid resuscitation therapy strategy using intra-abdominal pressure (IAP) and oxygenation index (PaO2/FiO2) as the end point in patients with severe acute pancreatitis (SAP). A retrospective study was performed, including 84 patients with SAP in emergency intensive care unit of Qingzhou Hospital Affiliated to Shandong First Medical University from January 2018 to August 2021. According to the status of fluid balance at admission, all patients were divided into the positive fluid balance group (43 cases) and the negative fluid balance group (41 cases). The clinical data including gender, age, etiology, underlying disease, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) of all patients were collected. Fluid balance, PaO2/FiO2, IAP, compliance rate, new mechanical ventilation rate and overall hospital stay of 1 week after admission were recorded and compared between the two groups. After 72 hours of treatment, the cumulative fluid balance was (5 219.5±1 038.4) mL in the positive fluid balance group; IAP was higher than that before treatment [mmHg (1 mmHg ≈ 0.133 kPa): 11.9±2.0 vs. 11.7±2.1], but no significant difference was found (P > 0.05); PaO2/FiO2 was significantly higher than that before treatment (mmHg: 299.8±51.4 vs. 220.5±50.4, P < 0.05). After 72 hours of treatment, the cumulative fluid balance in negative fluid balance group was (-3 542.4±1 310.6) mL; IAP was significantly lower than before treatment (mmHg: 11.4±1.8 vs. 15.2±1.9, P < 0.05); PaO2/FiO2 was significantly higher than that before treatment (mmHg: 309.9±50.9 vs. 215.4±49.7, P < 0.05). In the fluid resuscitation goals, after 72 hours of treatment, the compliance rate in the negative fluid balance group was significantly higher than that in the positive fluid balance group [82.93% (34/41) vs. 62.79% (27/43), P < 0.05]; 1 week after admission, the new mechanical ventilation rate in the negative fluid balance group was significantly lower than that in the positive fluid balance group [21.95% (9/41) vs. 41.86% (18/43), P < 0.05]; however, there was no significant difference in overall hospital stay between the two groups (days: 41.2±10.9 vs. 39.1±11.5, P > 0.05). After treatment, 70 patients survived and 14 patients died (including 9 cases in the positive fluid balance group and 5 cases in the negative fluid balance group). Using IAP and PaO2/FiO2 to guide liquid therapy could result in effective fluid resuscitation in SAP. The treatment strategy effectively improved prognosis of patients with SAP.

Geriatric Burn Injuries: Prevalence, Management and Clinical Outcome

Burns are a significant public health issue that result in more than 180 000 fatalities annually. For specialized burn care, the geriatric burn population is a sensitive and usually challenging group. Despite the fact that all age groups have shown advances in burn care, geriatrics still have worse survival rates. Burn severity, treatment, and outcomes are impacted in geriatrics because of the physiological differences between them and younger adult burn patients. The atrophic skin of the elderly results in deeper burns, or a higher ratio of full-thickness total body surface area compared to younger patients, but it also hinders the healing of both donor sites and burns. The purpose of this research is to review the available information about geriatric burn injuries: prevalence, management and clinical outcome. Elderly people are more susceptible to complications such pneumonia, congestive heart failure, and pulmonary edema. The morbidity and mortality seen in geriatric burn patients are also attributed to altered immunological and inflammatory response driven by age leading to increased hospital stays and more severe complications. Management of geriatric burn patients involves two concepts. the revolutionary theory of eschar excision and wound closure within the first week of hospitalization, and the conventional strategy of reducing physiologic stress by delaying surgery in the early post-burn stage while the development of effective fluid resuscitation protocols, which has most significantly boosted patient survival, is one of the pillars of modern burn care. The epidemiology of burn injuries in geriatrics is quite variable and demands further research.

Künt Karın Travmasına Bağlı Solid Organ Yaralanmalarında Non operatif Tedavi-Dalak Yaralanmaları

Introduction: Non-operative management (NOM) is the current approach in patients with solid organ injury caused by blunt abdominal trauma. In recent years, conservative treatment is successfully employed by advances in imaging modalities, interventional radiology and intensive care management. However, there is no consensus on follow-up of trauma patients undergoing NOM. In this study, we aimed to highlight controversial issues in trauma patients undergoing NOM. Materials and methods: In this study, we retrospectively assessed with splenic injury after blunt abdominal trauma. Criteria for conversion to laparotomy include hemodynamic instability despite adequate resuscitation and presence of peritoneal irritation findings. The patients were classified as those with NOM success and those with NOM failure requiring laparotomy. Groups were compared regarding demographic characteristics, mechanism of injury, additional trauma, hemodynamic status at admission, severity of injury on CT scan, transfusion need for blood and blood products, need for laparotomy, length of hospital stay, need for ICU admission, change in hemoglobin/hematocrit value and leukocyte count, and initiation time of oral intake Results: In 72 cases with splenic injury after blunt abdominal trauma that was managed by NOM. In 10 patients, NOM was failed and the patients underwent laparotomy. All patients underwent CT scan during initial diagnostic workshop. Conclusion: Imaging modalities should be used in the follow-up of patients with ≥grade 3 injury. Higher grades of injury result in increased costs and prolonged hospitalization. NOM failure is increased in high grade injuries. Another factor in NOM failure is perforation of non-solid organs. Close hemodynamic monitorization, frequent physical examination and effective fluid resuscitation are essential in patients undergoing NOM. It should be kept in mind that complications such as re-bleeding and splenic abscess may occur at early period after discharge.

1278-PUB: Acid-Base Alterations after Isotonic Fluid Resuscitation of Patients in Suspected DKA in the Pediatric Emergency Department

Introduction: Pediatric patients presenting to the emergency department (ED) for diabetic ketoacidosis (DKA) often present with dehydration, with admission to the intensive care unit (ICU) dependent on measures of dehydration and acidosis. Objective: The objective of this study was to assess the effect of fluid resuscitation in the ED on patient disposition to the ICU or floor based on changes in markers of dehydration and acidosis. Methods: This investigation was a single-center, retrospective study of patients 6 to 18 years old presenting to the ED for concern of DKA from 2016-2019. Patients with pre-bolus and post-bolus venous blood gas (VBG) were included. Each pre-bolus and post-bolus VBG was classified as meeting ICU or floor criteria. Based on the protocol developed at Rainbow Babies and Children’s Hospital, ICU criteria were pH &amp;lt; 7.3 and/or bicarbonate (HCO3) &amp;lt; 15 (on VBG or renal function panel). Dehydration was assessed using heart rate and blood urea nitrogen (BUN), adjusted by age. Continuous variables were analyzed using Kruskal-Wallis test, and categorical variables were analyzed with the chi-square test or Fisher’s exact test. Results: In this study, 187 patients met inclusion criteria. Post-bolus pH was increased in 52%, decreased in 41%, and unchanged in 7%. Post-bolus bicarbonate was increased in 44%, decreased in 53%, and unchanged in 2%. Of 145 patients with initial disposition to the ICU, 26 (17.9%) met floor criteria post-bolus, and no marker for dehydration distinguished this cohort (p=0.054 for heart rate, p=0.93 for BUN). Of 40 patients with initial disposition to the floor, 7 (17.5%) met ICU criteria post-bolus, and no marker for dehydration distinguished this cohort (p=0.68 for heart rate and p=1 for BUN). Conclusion: Patients presenting to the ED in DKA may have a decrease in pH or HCO3 following a normal saline bolus. In patients initially meeting criteria for the floor, up to 17.5% may change disposition to the ICU after a normal saline bolus. Disclosure S. Gera: None. S. P. Sheth: None. K. A. Kutney: None. S. Malay: None.

Effect of fluid resuscitation on cerebral integrity: A prospective randomised porcine study of haemorrhagic shock.

The treatment of haemorrhagic shock is a challenging task. Colloids have been regarded as standard treatment, but their safety and benefit have been the subject of controversial debates. Negative effects, including renal failure and increased mortality, have resulted in restrictions on their administration. The cerebral effects of different infusion regimens are largely unknown. The current study investigated the impact of gelatine-polysuccinate, hydroxyethyl starch (HES) and balanced electrolyte solution (BES) on cerebral integrity, focusing on cerebral inflammation, apoptosis and blood flow in pigs. Randomised experimental study. University-affiliated large animal research unit. Twenty-four juvenile pigs aged 8 to 12 weeks. Haemorrhagic shock was induced by controlled arterial blood withdrawal to achieve a combination of relevant blood loss (30 to 40 ml kg-1) and haemodynamic deterioration. After 30 min of shock, fluid resuscitation was started with either gelatine-polysuccinate, HES or BES. The animals were then monitored for 4 h. Cerebral perfusion and diffusion were measured via arterial-spin-labelling MRI. Peripheral tissue perfusion was evaluated via white light spectroscopy. Cortical and hippocampal samples were collected at the end of the experiment. The numbers of cerebral cell nuclei were counted and mRNA expression of markers for cerebral apoptosis [glucose transporter protein type 1 (SLC2A), lipocalin 2 (LCN-2), aquaporin-4 (AQP4)] and inflammation [IL-6, TNF-α, glial fibrillary acidic protein (GFAP)] were determined. The three fluid protocols all stabilised the macrocirculation. Fluid resuscitation significantly increased the cerebral perfusion. Gelatine-polysuccinate and HES initially led to a higher cardiac output but caused haemodilution. Cerebral cell counts (as cells μm-2) were lower after colloid administration in the cortex (gelatine-polysuccinate, 1.8 ± 0.3; HES, 1.9 ± 0.4; each P < 0.05 vs. BES, 2.3 ± 0.2) and the hippocampus (gelatine-polysuccinate, 0.8 ± 0.2; HES, 0.9 ± 0.2; each P < 0.05 vs. BES, 1.1 ± 0.1). After gelatine-polysuccinate, the hippocampal SLC2A and GFAP were lower. After gelatine-polysuccinate, the cortical LCN-2 and TNF-α expression levels were increased (each P < 0.05 vs. BES). In a porcine model, fluid resuscitation by colloids, particularly gelatine-polysuccinate, was associated with the occurrence of cerebral injury. 23 177-07/G 15-1-092; 01/2016.

Effect of fluid resuscitation on acute lung injury in a rat model of sepsis.

Sepsis is a systemic infection reaction and intravascular volume therapy plays a crucial role in it's treatment. Acute respiratory distress syndrome (ARDS) occurs in the lungs, the most affected organ. This study aimed to investigate the different effects of fluid therapy on ARDS caused by sepsis. To form a sepsis model, cecal ligation and puncture (CLP) procedure were performed on 44 adult rats. Divided into six groups; normal, CLP group, those treated with 40 ml/kg 0.9 % NaCl, 3 % NaCl (hypertonic saline), Ringer Lactate and Hydroxyethyl starch. After 24 hours treatments, histopathological examination of the lungs were done, and the plasma levels of CRP, TNF-α and IL-6 and paO2 were measured. The scores of all histological parameters of the group treated with hypertonic saline were significantly lower than of the other groups (p < 0.001). Likewise, according to the arterial blood gas results, paO2 was significantly higher (p < 0.01) in the hypertonic saline group compared to the other groups, and paCO2 was significantly lower (p < 0.01). CRP, TNF-α and IL-6 levels of inflammatory markers were also significantly lower in hypertonic saline groups compared to other groups (p < 0.001). Our study shows that treatment with hypertonic saline reduces the progression of ARDS in sepsis (Tab. 3, Fig. 4, Ref. 49).

Abstract 362: Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury

Introduction: The Prehospital TBI Guidelines (PTGs) are intended for both isolated and multisystem TBI (ITBI/MTBI). However, uncontrolled hemorrhage and potential detrimental effects of fluid resuscitation in MTBI may lead to differential effectiveness compared to ITBI. Methods: Preplanned subgroup analysis of PTG effectiveness in ITBI and MTBI from EPIC (before/after system study; 133 agencies, &gt;11,000 trained; NIH R01NS071049). Interventions: Prevention/treatment of hypoxia, hypotension, hyperventilation. Inclusion: Barell Matrix 1; 1/07-6/15. Severity subgroups [Head Region Severity Score (HRSS; AIS equivalent)]: Moderate = 1-2; Severe = 3-4; Critical = 5-6. Definitions: ITBI: TBI with no other RSS ≥3 injury. MTBI: TBI plus non-head region RSS ≥3 injuries. Pre (P1) and post-implementation (P3) cohorts were compared using logistic regression. Results: Cases: 21,852; median age 45 (IQR 24, 66); 67% male. ITBI: 16,663 (76.3%); P1 = 11,602, P3 = 5061. MTBI: 5189 (23.7%); P1 = 3626, P3 = 1563]. Hypotension occurred much more frequently in MTBI (15.8%) than ITBI (4.5%; OR = 3.9 (3.5, 4.4); p&lt;0.0001) and, after PTG implementation, MTBI patients were much more likely to receive a fluid bolus (10.7%; 167/1563) than ITBI (5.3%; 267/5061; p&lt;0.0001). There was highly significant improvement in aOR for survival in severe (HRSS 3-4) ITBI and MTBI (Fig 1). Furthermore, the severe ITBI and MTBI patients who were intubated or who received any positive pressure ventilation (PPV; basic or advanced) also improved dramatically (Fig 2). Conclusions: PTG implementation was independently associated with improved odds of survival in severe ITBI and MTBI. Despite a rate of hypotension 4 times higher in MTBI, survival improvement was at least as strong as for ITBI. Since the MTBI cohort was much more likely to receive fluid resuscitation, these findings support the PTG recommendation for aggressive treatment of hypotension in TBI even in patients with potential ongoing hemorrhage.

500 Intracranial Injuries and the Effect of Fluid Resuscitation in Burn Patients

Abstract Introduction Few studies exist that describe the neurologic injuries seen in patients admitted to the burn ICU. Patients who have sustained a severe thermal injury undergo complex metabolic, hemodynamic, and inflammatory changes and require aggressive fluid resuscitation. The neurologic consequences of burn-associated resuscitation may have clinical implications. The purpose of this study was to evaluate the intracranial neurologic injuries and how they relate to volume of burn-related resuscitation fluids administered. Methods We performed a retrospective analysis of all patients admitted to the Burn ICU at a single facility between January 2003 and June 2017. Patients were included if they were admitted within 24 hours of their burn injury and obtained head computed tomography (CT) for any indication in the first 96 hours of hospitalization. Results Of a total 5176 patients admitted, 439 met the inclusion criteria. An acute intracranial process was identified in 41 cases. 27 patients received 0–150 cc/kg of IV fluids, while 11 received &amp;gt;200 cc/kg during the first 24 hours. The most common injuries in the former were hemorrhage (subarachnoid, intraparenchymal) and edema (7/27 for each), while ischemia/infarction (4/11) was the most frequent in those receiving &amp;gt;200 cc/kg. Follow up imaging was more likely to be worse in the &amp;gt;200 cc/kg group (5/11) than in the &amp;lt; 150 cc/kg group (2/27). Conclusions Of patients admitted to the Burn ICU within 24 hours of injury and who received a head CT within the first 96 hours, an acute intracranial abnormality was found in 8% of patients. The most common diagnosis was hemorrhage in those receiving &amp;lt; 150 cc/kg of IV resuscitation, while ischemic/infarction was more common in those receiving &amp;gt;200 cc/kg. Follow up imaging in those receiving more IV fluids was more likely to demonstrate worsening, which could suggest that increased resuscitation leads to worsening intracerebral outcomes. Applicability of Research to Practice Having a high index of suspicion for intracranial complications related to resuscitation improves the multi-disciplinary team’s ability to prevent, identify early and treat appropriately in order to improve patient outcomes.

Application and Nursing of Pulse Index Continuous Cardiac Output (PiCCO) Volume Monitoring in Early Fluid Resuscitation in Patients with Septic Shock

Background: Septic shock is a rapidly changing and fatal syndrome that can cause comprehensive deterioration of cardiopulmonary and renal function and multiple organ failure. At the same time, septic shock has the complex clinical manifestations and hemodynamics. PiCCO can accurately monitor blood flow, physical and volume indicators, and active and effective fluid resuscitation are important measures to reduce the fatality rate of septic shock and improve the prognosis of patients. Objectives: To explore the application and nursing of PiCCO in early fluid resuscitation in patients with septic shock. Methods: This was a retrospective observational study. The observation group and the control group each had 30 cases. The observation group used PiCCO to guide fluid resuscitation; the control group used conventional methods to guide fluid resuscitation. The changes in CVP, HR, MAP, and urine volume per hour were observed in the two groups. The changes of various indicators before and after fluid resuscitation, the length of stay in ICU and the mortality rate were compared between the two groups. All the outcomes were collected from the electronic medical case system after patients’ discharge from the hospital. Results: APACHE II, CVP, HR, MAP were compared between the observation group and the control group, and the differences were statistically significant (P 0.05). The blood volume of patients in the observation group was significantly improved after fluid supplementation (P 0.05). Compared with the control group, the length of stay in ICU in the observation group was significantly shorter, and the mortality rate was also significantly reduced (P 0.05). Conclusion: PiCCO can be better used in early fluid resuscitation of patients with septic shock.

Effects of Fluid Resuscitation on Organ Failure and Mortality in Patients with Acute Pancreatitis and Systemic Inflammatory Response Syndrome: A Retrospective Cohort Study

Acute pancreatitis (AP), or inflammation of the pancreas, is a common gastrointestinal condition sometimes associated with systemic inflammatory response syndrome...

Fluid resuscitation in patients with end-stage renal disease on hemodialysis presenting with severe sepsis or septic shock: A case control study

Due to the potential risk of volume overload, physicians are hesitant to aggressively fluid-resuscitate septic patients with end-stage renal disease (ESRD) on hemodialysis (HD). Primary objective: To calculate the percentage of ESRD patients on HD (Case) who received ≥30 mL/Kg fluid resuscitation within the first 6 h compared to non-ESRD patients (Control) that presented with severe sepsis (SeS) or septic shock (SS). Secondary objectives: Effect of fluid resuscitation on intubation rate, need for urgent dialysis, hospital length of stay (LOS), intensive care unit (ICU) admission and LOS, need for vasopressors, and hospital mortality. Medical records of 715 patients with sepsis, SeS, SS, and ESRD were reviewed. We identified 104 Case and 111 Control patients. In the Case group, 23% of patients received ≥30 mL/Kg fluids compared to 60% in the Control group (p < 0.001). There was no significant difference in in-hospital mortality, need for urgent dialysis, intubation rates, ICU LOS, or hospital LOS between the two groups. Subgroup analysis between ESRD patients who received ≥30 mL/Kg (N = 80) vs those who received <30 mL/Kg (N = 24) showed no significant difference in any of the secondary outcomes. Compliance with 30 mL/Kg fluids was low for all patients but significantly lower for ESRD patients. Aggressive fluid resuscitation appears to be safe in ESRD patients.

2816 Mortality of Different Etiologies of Acute Pancreatitis and Effect of Aggressive vs. Non-Aggressive Fluid Resuscitation

INTRODUCTION: Acute pancreatitis (AP) is a common cause of GI-related hospitalization. AP can be classified into mild AP, moderately severe AP and severe AP. Severe acute pancreatitis (SAP) and necrotizing pancreatitis (NP) or localized complications with infections account for &gt; 40% of pancreatitis related mortality. Common etiologies include acute biliary pancreatitis (ABP) and alcohol ( AAP). We aimed to study the mortality rate and effect of fluid resuscitation in AP (SAP, NP). METHODS: Patients with SAP and NP who received PEG-J were collected retrospectively from a single tertiary care center by utilizing ICD-9 and ICD-10 codes (International Classification of Diseases). Each case was confirmed by manual review. SAP and NP were defined per the 2012 revised Atlanta classification. Descriptive analysis was done by Excel. Fluid resuscitation was defined as aggressive hydration (AH) infusion of crystalloids given at a rate of at least 3.0 mL/kg/h after a bolus of 10-20 mL/kg within 24 hours of presentation. RESULTS: Seventy-nine patients with SAP or NP underwent PEG-J placement. Demographics, labs and comorbidities (Table 1). Etiologies of pancreatitis were alcohol 30% (24), biliary 39%, idiopathic 23%. Distribution based on Atlanta classification (Table 2). All-cause mortality of the patients was 12 (15%) and among this group 7 (9%) were related to pancreatitis related complications whereas 4 (5%) patients opted for palliative care and 1 was found to have pancreatic cancer. Among AAP, 4 patients died from reasons not related to pancreatitis, as compared to 4 patients (13%) who died in ABP group which were all related to pancreatitis. In ABP, 28 (90%) patients had data available for fluid. 8 (29%) received AH within first 24 hours and none of them died. 20 (71%) did not receive AH and 3 of them died. This was not significant at P &lt; 0.05 using Fisher exact test. In AAP, 21 (87.5%) had data for fluid. Six (29%) received AH and none of them died. Fifteen (71%) did not receive AH and 3 of them died but the deaths were not related to pancreatitis. Average ICU stay of the overall subjects was 8 days and median hospital stay was 12 days. Average duration of hospital stay in AAP was 19.8 days compared to 20.5 days in ABP. Average ICU stay was 9 days in both groups. CONCLUSION: ABP carries higher mortality and more LOS related to pancreatitis compared with AAP. The AH is associated with decreased mortality in ABP but was not statistically significant perhaps due to small sample size.

Intracranial Injuries in the Burn ICU and Effect of Fluid Resuscitation (S2.008)

Intracranial Injuries in the Burn ICU and Effect of Fluid Resuscitation (S2.008)

Resuscitation fluids.

Intravenous fluid administration is a fundamental therapy in critical care, yet key questions remain unanswered regarding optimal fluid composition and dose. This review evaluates recent evidence regarding the effects of fluid resuscitation on pathophysiology, organ function, and clinical outcomes for critically ill patients. Recent findings suggest that intravenous fluid composition affects risk of kidney injury and death for critically ill adults. Generally, the risk of kidney injury and death appears to be greater with semisynthetic colloids compared with crystalloids, and with 0.9% sodium chloride compared with balanced crystalloids. Whether a liberal, restrictive, or hemodynamic responsiveness-guided approach to fluid dosing improves outcomes during sepsis or major surgery remains uncertain. As evidence on fluid resuscitation evolves, a reasonable approach would be to use primarily balanced crystalloids, consider 2-3 l for initial fluid resuscitation of hypovolemic or distributive shock, and use measures of anticipated hemodynamic response to guide further fluid administration.

The Effects of Fluid Resuscitation on Renal and Cardiac Mitochondrial Function in a Severely Burned Swine Model

Severe burn injury covering over 30% of the total body surface area (TBSA) results in a systemic inflammatory response which can lead to multi organ dysfunction (MOD). Intravenous (IV) fluid resuscitation is a key component in the acute phase of burn treatment, however the volumes and types of fluids used (e.g., crystalloids vs. colloids) remain controversial. While previous studies have shown mitochondrial damage in organs such as heart and kidneys post‐burn, the effects of IV fluids on mitochondrial function have not been studied. The purpose of this study is to determine the effects of small volumes of crystalloid or colloid fluids on mitochondrial function following severe burns in a swine model. Anesthetized Yorkshire swine (n=14) sustained 40% TBSA full‐thickness contact burns with brass probes heated to 100°C placed in contact with the skin for 30 seconds. Animals were allowed to recover in metabolic cages and were given IV fluids (15 mL/kg/day) as either crystalloids (n=7) or colloids (n=7). Five non‐burned swine served as control. After 48 h, heart and kidney tissue were harvested and mitochondrial function was analyzed by high resolution respirometry. Substrates were added to determine the maximum oxidative phosphorylation (OXPHOS). Then the ATP synthase inhibitor, oligomycin was added to determine Leak respiration. Mitochondrial efficiency was defined as the coupling control ratio (OXPHOS/Leak). Citrate synthase (CS) assay was used for normalization of the data, and statistical significance was set at p&lt;0.05. Mitochondrial abundance was significantly lower in swine kidney given colloid vs crystalloid (13.87 ± 2.35 vs 22.03 ± 1.68 nmol CS/ml/s, p&lt;0.05, respectively) and control (23.77 ± 3.55 nmol CS/ml/s, p&lt;0.05). Leak respiration per mitochondrion in heart tissues was significantly higher in burned swine given colloids than crystalloids (672.3 ± 82.74 vs 334.4 ± 50.27 pmol O2/mg/s/CS, p&lt;0.01) and non‐burned controls (254.1 ± 57.77 pmol O2/mg/s/CS, p&lt;0.01), indicating higher O2 respiration without ATP synthesis. We found heart mitochondria in swine given colloids were significantly less efficient than controls (54% ± 6 vs 76% ± 5, p&lt;0.05, respectively), which was not true after IV crystalloids (67% ± 7). This was also found in renal mitochondria where colloid (but not crystalloid‐treated) swine showed less ATP producing efficiency in the kidney than non‐burned controls (55% ± 6 vs 73% ± 5, p&lt;0.05, respectively). For the first time, our study examined the effects of different IV fluids on mitochondrial function following severe burns. Our data suggest that resuscitation with crystalloids may be protective of mitochondrial abundance and function within the first 48 h following severe burns. Future studies to address timing and volume of resuscitation fluid administration are needed.Support or Funding InformationThis study was supported by Military Burn Research Program Award# W81XWH‐16‐2‐0041.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Lactated Ringer' Solution may be Superior to Saline-Based 6% Hydroxyethyl Starch 130/0.4 for Early Resuscitation within 12 hours from Hemorrhagic Shock

ABSTRACTPurpose: To compare the effects of fluid resuscitation with lactated Ringer's solution (LR) and saline-based 6% hydroxyethyl starch 130/0.4 (HES) on the inflammatory response and oxidative stress in the small intestine as well as on bacterial translocation to the liver. Methods: Sprague–Dawley rats were subjected to blood pressure-controlled hemorrhagic shock and then resuscitated with LR or HES. At 1, 3, 6, 12, and 24 hr after resuscitation, liver tissues were collected to count the bacterial colonies, and small intestines were harvested to analyze the levels of inflammatory (TNF-α and HO-1) and oxidative stress (MPO) mediators as well as the intestinal injury by immunohistochemistry, colorimetry and hematoxylin & eosin staining, respectively. Results: The expression level of TNF-α in the LR group was stable from 1 to 6 hr but decreased at 12 hr and then abruptly increased at 24 hr. The expression level of TNF-α in the LR group was significantly lower than that in the HES group, especially during the first 12 hr post-fluid infusion. MPO activity decreased to its lowest level at 3 hr but increased from 6 to 12 hr, with no difference at 24 hr between the two groups. Although a decreasing tendency was observed from 6 hr, HO-1 expression levels remained higher in the LR group than in the HES group at 12 and 24 hr, particularly at 12 hr. During the initial 12 hr, the LR group exhibited significantly lower colony-forming units in the liver tissues than the HES group. Chiu's score in the intestine decreased regardless of which resuscitative fluids were used. Conclusions: During early resuscitation (within 12 hr), LR may be superior to HES in reducing intestinal injuries by suppressing inflammatory and oxidative mediators.

不同晶胶比液体复苏对重症急性胰腺炎比格犬血流动力学的影响

不同晶胶比液体复苏对重症急性胰腺炎比格犬血流动力学的影响