Fluid Resuscitation In Patients Research Articles

The application of Picco technology -guided fluid resuscitation in patients with ketoacidosis in ICU

The application of Picco technology -guided fluid resuscitation in patients with ketoacidosis in ICU

Effects of dynamic versus static parameter-guided fluid resuscitation in patients with sepsis: A randomized controlled trial

Effects of dynamic versus static parameter-guided fluid resuscitation in patients with sepsis: A randomized controlled trial

Precursors to oliguria during major burn resuscitation: An analysis of a prospective observational trial at 5 major US burn centers

Currently, urine output is the leading variable used to tailor fluid resuscitation in patients with large TBSA burns. However, this metric often lags with respect to resuscitation. Our group sought to identify derangements in variables that precede development of oliguria (<30 cc/hr) that we hypothesize will aid in more efficient resuscitation. We performed a retrospective analysis of 146 adult patients admitted within 4 h of a large TBSA (>20%) burn. We then divided them into two cohorts: those who developed oliguria within 6 h of admission and those who did not. Patients who experienced early oliguria had a higher incidence of invasive SBP < 90 (p = 0.02) or DBP < 40 (p = 0.009), lower minimum bicarbonate level (p = 0.04), more full thickness burns (p = 0.004), and higher TBSA (p = 0.01). More female patients were found in the oliguric group (p = 0.003). Multivariate analysis was used to develop a model to predict development of oliguria. When evaluated together, minimum DBP, sex, TBSA (or percent full thickness burn), and maximum base deficit constituted the most parsimonious model that significantly predicted oliguria (AUC = 0.92). Interestingly, the model lost significance when DBP was omitted, highlighting the importance of diastolic pressure in the development of oliguria.

Assessment of Outcomes in Patients with Heart Failure and End-Stage Kidney Disease after Fluid Resuscitation for Sepsis and Septic Shock

BackgroundSepsis fluid resuscitation is controversial, especially for patients with volume overload risk. The Surviving Sepsis Campaign recommends a 30-mL/kg crystalloid fluid bolus for patients with sepsis-induced hypoperfusion. Criticism of this approach includes excessive fluid resuscitation in certain patients. ObjectiveThe aim of this study was to assess the efficacy and safety of guideline-concordant fluid resuscitation in patients with sepsis and heart failure (HF) or end-stage kidney disease (ESKD). MethodsA retrospective cohort study was conducted in patients with sepsis who qualified for guideline-directed fluid resuscitation and concomitant HF or ESKD. Those receiving crystalloid fluid boluses of at least 30 mL/kg within 3 h of sepsis diagnosis were placed in the concordant group and all others in the nonconcordant group. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) and hospital length of stay (LOS); vasoactive medications and net volume over 24 h; new mechanical ventilation, new or increased volume removal, and acute kidney injury within 48 h; and shock-free survival at 7 days. ResultsOne hundred twenty-five patients were included in each group. In-hospital mortality was 34.4% in the concordant group and 44.8% in the nonconcordant group (p = 0.1205). The concordant group had a shorter ICU LOS (7.6 vs. 10.5 days; p = 0.0214) and hospital LOS (12.9 vs. 18.3 days; p = 0.0163), but increased new mechanical ventilation (37.6 vs. 20.8%; p = 0.0052). No differences in other outcomes were observed. ConclusionsReceipt of a 30-mL/kg fluid bolus did not affect outcomes in a cohort of patients with mixed types of HF and sepsis-induced hypoperfusion.

Robust output-feedback control of fluid resuscitation with absolute stability guarantee against uncertain physiology and therapeutic responsiveness

This paper presents a robust closed-loop control approach to fluid resuscitation in patients with hemorrhagic blood loss. A unique strength of the proposed approach is its robustness against uncertain and time-varying patient physiology and therapeutic effectiveness. First, we adopted an observer-based control architecture that can fulfill set point tracking and disturbance rejection objectives. Second, we determined the control gains to achieve adequate transient response performance using the linear quadratic regulator design. Third, we determined the observer gains as a solution to a set of linear matrix inequalities so that the overall closed-loop fluid resuscitation control system is (i) robust against the variability in patient physiology and (ii) absolutely stable against unknown therapeutic effectiveness. We demonstrated the initial proof-of-concept of the proposed approach by conducting rigorous in silico testing using a large number of physiologically plausible virtual patients, while ascertaining the absolute stability via the circle criterion analysis. The results suggested that the proposed approach to closed-loop control of fluid resuscitation is a promising option to advance automation of fluid resuscitation armed with stability against a large variability in patient physiology and therapeutic effectiveness as well as adequate performance in set point tracking and disturbance rejection.

Comparison of balanced and unbalanced crystalloids as resuscitation fluid in patients treated for cardiogenic shock

BackgroundThe efficacy and safety of saline versus balanced crystalloid solutions in ICU-patients remains complicated by exceptionally heterogenous study population in past comparative studies. This study sought to compare saline and balanced crystalloids for fluid resuscitation in patients with cardiogenic shock with or without out-of-hospital cardiac arrest (OHCA).MethodsWe retrospectively analyzed 1032 propensity score matched patients with cardiogenic shock from the Munich University Hospital from 2010 to 2022. In 2018, default resuscitation fluid was changed from 0.9% saline to balanced crystalloids. The primary endpoint was defined as 30-day mortality rate.ResultsPatients in the saline group (n = 516) had a similar 30-day mortality rate as patients treated with balanced crystalloids (n = 516) (43.1% vs. 43.0%, p = 0.833), but a higher incidence of new onset renal replacement therapy (30.2% vs 22.7%, p = 0.007) and significantly higher doses of catecholamines. However, OHCA-patients with a lactate level higher than 7.4 mmol/L had a significantly lower 30-day mortality rate when treated with saline (58.6% vs. 79.3%, p = 0.013). In addition, use of balanced crystalloids was independently associated with a higher mortality in the multivariate cox regression analysis after OHCA (hazard ratio 1.43, confidence interval: 1.05–1.96, p = 0.024).ConclusionsIn patients with cardiogenic shock, use of balanced crystalloids was associated with a similar all-cause mortality at 30 days but a lower rate of new onset of renal replacement therapy. In the subgroup of patients after OHCA with severe shock, use of balanced crystalloids was associated with a higher mortality than saline.Trial registration: LMUshock registry (WHO International Clinical Trials Registry Platform Number DRKS00015860).

Fluid Resuscitation in Patients With Traumatic Brain Injury: A Comprehensive Review.

Patients with traumatic brain injury (TBI) or head trauma present challenges for emergency physicians and neurosurgeons. Traumatic brain injury is currently a community health issue. For the best possible care, it is crucial to understand the various helpful therapy techniques in the pre-operative and pre-hospital phases. The initial rapid infusion of large volumes of mannitol and a hypertonic crystalloid solution to restore blood pressure and blood volume is the current standard of care for people with combined hemorrhagic shock (HS) and traumatic brain injury. The selection and administration of fluids to trauma and traumatic brain injury patients may be especially helpful in preventing subsequent ischemic brain damage because of the hemodynamic stabilizing effects of these fluids in hypovolemic shock. Traumatic brain injury is an essential factor that may lead to disability and death in a patient. Traumatic brain damage can develop either as a direct result of the trauma or as a result of the initial harm. Significant neurologic problems, such as cranial nerve damage, dementia, seizures, and Alzheimer's disease, can develop after a traumatic brain injury. The comorbidity of the victims may also be significantly increased by additional psychiatric problems such as psychological diseases and other behavioral and cognitive sequels. We review the history of modern fluid therapy, complications after traumatic brain injury, and the use of fluid treatment for decompressive craniectomy and traumatic brain injury.

Ultrasound-guided fluid resuscitation versus usual care guided fluid resuscitation in patients with septic shock: a systematic review and meta-analysis

Ultrasound-guided fluid resuscitation versus usual care guided fluid resuscitation in patients with septic shock: a systematic review and meta-analysis

Protocol for a systematic review and meta-analysis assessing conservative versus liberal intravenous fluid administration in patients with sepsis or septic shock at risk of fluid overload

IntroductionIntravenous crystalloid fluid resuscitation forms a crucial part of the early intervention bundle for sepsis and septic shock, with the Surviving Sepsis Campaign guidelines recommending a 30 mL/kg fluid bolus...

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.

Initial fluid resuscitation guided by the Parkland formula leads to high fluid volumes in the first 72 h, increasing mortality and the risk for kidney injury

BackgroundOur Burn center has used the Parkland formula (4 ml/kg/TBSA%) adjusted by physiological parameters to guide fluid resuscitation in burn patients. Our main objective was to examine fluid resuscitation in patients with major burn injury and its effect on mortality, need for renal replacement therapy (RRT) and the length of stay (LOS) in the Intensive Care Unit (ICU). Further aims were to determine which factors were associated with fluid resuscitation volumes during the first 24 h, and whether these fluid volumes had an association with the volumes infused during the next 48 h. MethodsThis retrospective observational study accrued patients (N = 46) admitted to the Helsinki Burn Center between 2016 and 2018 with burn injuries ≥ 20% TBSA. The national intensive care registry and the electronic patient record system provided data on fluid infusions, urine output, laboratory measurements, presence of inhalation injury, surgical procedures within 72 h from injury, patient demographics, need for renal replacement therapy and mortality. Patients were divided into groups based on infused fluid volumes and univariate regressions were performed to identify factors associated with fluid volumes. Results48% of the patients received fluids more than 6 ml/kg/TBSA% during the first 24 h. 35% of the patients received fluid volumes exceeding the Ivy index (250 ml/kg/d) and was associated with higher TBSA%, SOFA and SAPS scores as well as increased mortality and need for RRT. Higher lactate and lower base excess were associated with higher fluid volumes. Urine output had no association with the resuscitation volumes. Larger resuscitation volumes during the first 24 h were associated with larger fluid volumes given also during the next 48 h. Higher cumulative fluid volume in 0–72 h resulted in increased need of RRT and higher ICU mortality. ConclusionUsing the Parkland formula and adjusting the infusion based on physiological parameters leads to over resuscitation in many of the patients. It seems that the more fluids are given during the initial resuscitation phase, the more fluids are also administered during the subsequent phase. Higher cumulative fluid volumes are associated with RRT requirements and higher mortality. We postulate that starting fluid resuscitation with a lower infusion rate could be beneficial, as it may lead to smaller cumulative fluid volumes during the first 72 h, leading to reduced mortality and kidney injury.

Review article: Practical considerations for fluid resuscitation in cirrhosis.

Standard clinical methods of assessing volume and providing resuscitation are not always applicable to patients with advanced or decompensated cirrhosis. Despite this being well known from a clinical perspective, there remains relatively little evidence to guide clinicians though fluid management in patients with cirrhosis and, often, multi-organ system dysfunction. This review summarises the current understanding of the circulatory dysfunction in cirrhosis, modalities for assessing volume status, and considerations for fluid selection. It additionally provides a practical approach to fluid resuscitation. We review current literature on cirrhosis pathophysiology in steady-state and shock, clinical implications of fluid resuscitation, and strategies to assess intravascular volume. Literature reviewed here was identified by the authors through PubMed search and review of selected papers' references. Clinical management of resuscitation in advanced cirrhosis remains relatively stagnant. Although several trials have attempted to establish the superior resuscitative fluid, the lack of improvement in hard clinical outcomes leaves clinicians without clear guidance. The absence of consistent evidence for fluid resuscitation in patients with cirrhosis limits our ability to produce a clearly evidence-based protocol for fluid resuscitation in cirrhosis. However, we propose a preliminary practical guide to managing fluid resuscitation in patients with decompensated cirrhosis. Further studies are needed to develop and validate volume assessment tools in the specific context of cirrhosis, while randomised clinical trials of protocolized resuscitation may improve care of this patient population.

Shock Index in predicting fluid resuscitation in patients with hypovolemic shock

Introduction: Hypovolemic shock is diagnosed by the signs of hemodynamic instability and when the source of volume loss is obvious. Among various types, hypovolemic shock is the most common which results either from the loss of blood from hemorrhage or from the loss of plasma alone due to extravascular fluid sequestration or gastrointestinal, urinary, and insensible losses. The objective of this research was to find the use of shock index in predicting fluid resuscitation in patients with hypovolemic shock. Methods: An analytical cross-sectional study was conducted among 120 patients with hypovolemic shock visiting to the Emergency department of College of Medical Sciences and Teaching Hospital from July 2022 to September 2022. Data was collected from patients and checked for completeness, accuracy and then entered and analyzed using SPSS-20. Data was analyzed using descriptive and inferential statistical tools. P-value &lt;0.05 was considered as statistically significant. Results: Out of 120 patients, majority of the patients were &gt;50 years. Minority of the patients only required blood transfusion. Among total patients 60% of the patients were admitted in ICU, 25% of them were admitted in ward and 4.17% of them were expired. In 60% cases shock index was &lt;1 while in 40% case shock index was ≥1. The number of patients receiving blood transfusion at ER increased with increase in shock index and that the number of patients with hypovolemic shock are admitted in hospital more in shock index category ≥1 as compared to shock index &lt;1 (p-value &lt;0.05). Conclusions: This study reveals that shock index is accurate in predicting the amount of fluid. The risk of all clinical complication is increased with increase in shock index.

Central blood gases versus lactate level for assessment of initial resuscitation success in patients with sepsis in critical care

ABSTRACT Background Central blood gas and lactate levels serve as goals for fluid resuscitation. Objective To evaluate the role of blood gases [the ratio of P(v-a)CO2/C(a-v)O2 and P(v-a)CO2)] and lactate clearance as indicators of initial fluid resuscitation in patients diagnosed with sepsis. Study design This study included three groups of patients according to the resuscitation effective predictors. Patients A total of 120 patients were divided into 3 groups, 40 patients in each. Group (A): ratio P(v-a)CO2/C(a-v)O2, group (B):: of Lactate clearance (LC), and group (C): P(v-a)co2. Interventions Variables were measured at the start of ICU arrival (T0) and after 8 hours of resuscitation (T8). Main outcome measures The ratio P(v-a)CO2/C(a-v)O2, difference of P(v-a)co2 and Lactate level and clearance (LC) recorded and calculated, a dose of dobutamine required, packed RBCs, length of stay, mortality, and any recorded complication. Measured at T0 and T8 time points Results In group A, the ratio of P(v-a)CO2/C(a-v)O2 was improved significantly at T8 when compared with values at baseline. Lactate (group B) showed a significantly lower level at T8 than at T0. In group C, the gradient of P(v-a)CO2 did not differ significantly at T8. After 28 days, group C had a higher mortality rate (55% in group C vs 25% in group A and 30% in group B). Conclusion The ratio of P(v-a)CO2/C(a-v)O2 calculation may be as good as, if not better than, lactate as an indicator of initial resuscitation success of patients with sepsis, this can improve the outcome and reduce mortality. Unfortunately, the P(v-a)CO2 gradient alone is not

Abstract 10085: Troponin Release is Associated With Mortality and Poor Fluid Resuscitation in Patients With Sepsis

Introduction: Septic patients are predisposed to myocardial injury manifested as cardiac troponin release (TnR). Prognostic significance and management implications of TnR in this setting has not been fully elucidated. We aimed to determine the impact of admission TnR and fluid resuscitation on outcomes of patients with sepsis admitted to intensive care units (ICU). Methods: A total of 24,778 patients with sepsis from eICU-CRD (n=11,992), MIMIC-III (n=6,638) and MIMIC-IV (n=6,148) databases were examined for mortality and 1-year survival by multivariable logistic, Cox regression analysis, or Kaplan-Meier survival analysis with overlap weighting adjustment, as well as generalized additive models for fluid resuscitation. Results: TnR on admission was associated with higher in-hospital mortality [adjusted odds ratios (aOR)=1.33; 95% confidence interval (CI)=1.23-1.43; p&lt; 0.001 in unweighted analysis and aOR=1.39; 95% CI=1.29-1.50; p&lt; 0.001 with overlap weighting]. One-year survival was lower in patients with admission TnR (Kaplan-Meier survival analysis; p=0.002). A trend was noted for association between admission TnR and 1-year mortality [aOR=1.16; 95% CI, 0.99-1.37; p = 0.067 in unweighted analysis] while the association was statistically significant after overlap weighting (aOR=1.25; 95% CI=1.06-1.47; p=0.008). We also found that patients with admission TnR were less likely to benefit from more liberal fluid resuscitation. Adequate fluid resuscitation within a range of 70 to 90 ml/kg in the first 24 hours of ICU stay was associated with lower in-hospital mortality in septic patients without TnR but not in those with admission TnR. Conclusions: Admission TnR was significantly associated with higher in-hospital mortality and worse 1-year survival among septic patients. Adequate fluid resuscitation improved in-hospital mortality in septic patients without but not with admission TnR.

WITHDRAWN: I'll have a HIPEC, but please hold the fluid!?

In this issue of American Journal of Surgery, Thampy and authors discuss the utility of practicing restrictive intraoperative fluid resuscitation in patients undergoing cytoreductive surgery and HIPEC in decreasing in-hospital morbidity and decreased ICU length of stay.1 This article has further contributed to the ever evolving and innovative research topic of interest in surgical oncology and will continue to shape the way we practice intraoperative resuscitation in the future.

Bicarbonated Ringer’s solution improves L-arg-induced acute pancreatitis in rats via the NF-κB and Nrf2 pathways

Objective Bicarbonated Ringer’s solution (BRS), as a new generation of crystalline fluid, has been widely used for intravenous fluid resuscitation in patients with shock diseases. The purpose of our study is to investigate the intervention effects and potential mechanisms of BRS on L-arg-induced AP in rats. Methods The AP model was induced by intraperitoneal injection of 20% L-arg. BRS was infused immediately following the previous L-arg injection. The pancreatic tissue was harvested for histological examination. The serum levels of amylase and lipase activity, lactic acid, proinflammatory and anti-inflammatory cytokines were determined. The peroxide and antioxidant activities in the pancreatic tissue were measured. The protein and mRNA levels of nuclear factor-κB, TNF-α, nuclear factor erythroid 2-related Factor 2 and heme oxygenase-1 were determined by Western blot and quantitative reverse transcription PCR analysis. Results Pancreatic tissue injuries were obviously alleviated, with a significant increase in normal acinar cells after BRS treatment. The serum levels of amylase, lipase, lactic acid, IL-1β and TNF-α were significantly decreased, while IL-10 was obviously increased by inhibiting the NF-κB pathway and TNF-α. Moreover, Nrf2 pathway and HO-1 were promoted by BRS treatment, which resulted in significantly reduced malondialdehyde and reactive oxygen species levels. In contrast, antioxidant activities, including glutathione peroxidase and so on, were markedly increased after BRS treatment. Conclusions Bicarbonated Ringer’s solution improves L-arg-induced acute pancreatitis in rats through the NF-κB and Nrf2 pathways, indicating that BRS holds promise as a priority in fluid resuscitation to treat acute pancreatitis.

CORRELATION BETWEEN INFERIOR VENA CAVA DIAMETER AND CENTRAL VENOUS PRESSURE DURING RESUSCITATION IN CRITICALLY ILL PATIENTS WITH SHOCK.

Introduction: Shock is one of the most common presentations to emergency departments.Depending on the etiology of shock the management principles vary and using ultrasound in such patients is now widely accepted.Determination of the inferior vena cava diameter can indicate the volume status of the patient and further guide the management of shock in critically ill patients. Methods: In this prospective study we identified 50 patients in whom central venous pressure has been correlated with inferior vena cava diameter and their response to fluid resuscitation has been studied. Hypovolemic shock patients were included and other causes of shock were excluded. Results: We found statistically significant correlation between inferior vena cava diameter and central venous pressure response to fluid resuscitation with p value of &lt; 0.01. Conclusion: Inferior vena cava diameter measurement can be used as a non invasive method to guide in fluid resuscitation in patients with hypovolemic shock.

The Application of PiCCO-guided Fluid Resuscitation in Patients With Traumatic Shock.

The aim of this study was to evaluate the application of pulse contour cardiac output (PiCCO) in patients with traumatic shock. Seventy-eight patients with traumatic shock were included and grouped. The control group (CG, n = 39) underwent fluid resuscitation through transthoracic echocardiography (TTE) monitoring, and the research group (RG, n = 39) received PiCCO-guided fluid resuscitation. The mechanical ventilation time, duration of vasoactive drug use, and duration of stay in the intensive care unit were lower in the RG compared to the CG (P < .05). At 72h after fluid resuscitation, the mean arterial pressure and central venous pressure in the RG were higher than those in the CG (P < .05). The stroke volume variation and distensibility index of the inferior vena cava were lower at 72h after fluid resuscitation, but the levels of extravascular lung water, global end-diastolic volume index, and intrathoracic blood volume index were higher in the RG (P < .05). The levels of endothelial 1, nitrogen monoxide, tumor necrosis factor-α, procalcitonin, C-reactive protein, and partial pressure of carbon dioxide at 72h after fluid resuscitation in the RG were lower than those in the CG (P < .05). PiCCO-guided liquid resuscitation may help to accurately evaluate the volumetric parameters, alleviate symptoms of ischemia and hypoxia, regulate hemodynamics and blood gas analysis, reduce inflammatory reactions, improve endothelial functions, and effectively guide the usage of vascular active drugs.

Clinical study of fluid resuscitation guided by peripheral perfusion index in patients with septic shock

To explore the guiding effect of peripheral perfusion index (PI) on fluid resuscitation in patients with septic shock. Sixty-five patients with septic shock who were diagnosed according to relevant criteria of septic shock and admitted to the department of critical care medicine of the Affiliated Hospital of Hangzhou Normal University from September 2017 to December 2020 were included. Patients were divided into the conventional treatment group (30 cases) and PI guidance group (35 cases) by random number method. Both groups of patients were treated with the bundle according to clinical guidelines. Sputum, urine and blood were collected for pathogenic microorganism culture before the application of antibiotics, and vasoactive drugs were given. Both groups need to achieve all the following resuscitation goals within 6 hours: urine output > 0.5 mL×kg-1×h-1, mean arterial pressure (MAP) ≥ 65 mmHg (1 mmHg ≈ 0.133 kPa), central venous pressure (CVP) was 8-12 mmHg, and central venous oxygen saturation (ScvO2) ≥ 0.70. There was no further resuscitation in the conventional treatment group after the goals were achieved. In addition to these four goals, the PI guidance group was expected to achieve PI ≥ 1.4. Heart rate (HR), CVP, MAP, ScvO2, blood lactic acid (Lac), the time of fluid negative balance, intensive care unit (ICU) mortality and 28-day mortality between the two groups were compared before and after 6 hours of fluid resuscitation. Before fluid resuscitation, there were no statistically significant differences in all indicators between two groups. After 6 hours fluid resuscitation, the four treatment goals in PI guidance group were slightly lower than those of the conventional treatment group [HR (times/min): 96.5±12.1 vs. 97.7±7.9, MAP (mmHg): 83.2±6.2 vs. 82.1±7.5, ScvO2: 0.661±0.077 vs. 0.649±0.051, CVP (mmHg): 10.8±2.7 vs. 10.4±2.1], there were no statistically significant differences between the two groups (all P > 0.05); the Lac level of the PI guidance group after resuscitation was lower than that of the conventional treatment group, and the difference was statistically significant (mmol/L: 4.8±1.3 vs. 5.9±1.4, P < 0.05); the duration of fluid negative balance in the PI guidance group was earlier than that in the conventional treatment group [days: 3.0 (2.0, 3.0) vs. 3.5 (3.0, 4.0), P < 0.05]. The ICU mortality and 28-day mortality in the PI guidance group were lower than those in the conventional treatment group [ICU mortality rate: 37.1% (13/35) vs. 50.0% (15/30), 28-day mortality rate: 57.1% (20/35) vs. 60.0% (18/30)], but the differences were not statistically significant (both P > 0.05). The peripheral PI can be used as an important indicator of fluid resuscitation in patients with septic shock. PI guiding fluid resuscitation in patients with septic shock can reduce Lac levels, shorten the duration of fluid negative balance and reduce the risk of fluid overload.