Intravascular Volume Replacement Research Articles

Fluid management in septic patients with pulmonary hypertension, review of the literature.

The management of sepsis in patients with pulmonary hypertension (PH) is challenging due to significant conflicting goals of management and complex hemodynamics. As PH progresses, the ability of right heart to perfuse lungs at a normal central venous pressure (CVP) is impaired. Elevated pulmonary vascular pressure, due to pulmonary vasoconstriction and vascular remodeling, opposes blood flow through lungs thus limiting the ability of right ventricle (RV) to increase cardiac output (CO) and maintain adequate oxygen delivery to tissue. In sepsis without PH, avoidance of volume depletion with intravascular volume replacement, followed by vasopressor therapy if hypoperfusion persists, remains the cornerstone of therapy. Intravenous fluid (IVF) resuscitation based on individualized hemodynamic assessment can help improve the prognosis of critically ill patients. This is accomplished by optimizing CO by maintaining adequate preload, afterload and contractility. Particular challenges in patients with PH include RV failure as a result of pressure and volume overload, gas exchange abnormalities, and managing IVF and diuretic use. Suggested approaches to remedy these difficulties include early recognition of symptoms associated with pressure and volume overload, intravascular volume management strategies and serial lab monitoring to assess electrolytes and renal function.

Geriyatrik cerrahi hastalarının intraoperatif sıvı yönetiminde pleth değişkenlik indeksinin potansiyel değeri

BACKGROUND: This study was designed to determine the effects of PVI-guided monitoring on the optimal intravascular volume replacement during hip and knee arthroplasty in geriatric patients, and whether using PVI could reduce blood transfusion and vasopressor requirements.
 METHODS: One-hundred geriatric patients who underwent elective hip and knee arthroplasty were included, assigned to either PVI group (volume replacement was PVI guided) or to a control group (volume replacement was based on traditional methods). Perioperative hemodynamic parameters, infusion rate of crystalloids, colloids, blood/blood products, ephedrine hydrochloride requirements and perioperative urine outputs were recorded. 
 RESULTS: Crystalloid infusion rate was higher (9.5 vs. 6.8 ml/kg/h, p

Hydroxyethyl Starch for Fluid Management in Patients Undergoing Major Abdominal Surgery: A Systematic Review With Meta-analysis and Trial Sequential Analysis.

In critically ill patients, warnings about a risk of death and acute kidney injury (AKI) with hydroxyethyl starch (HES) solutions have been raised. However, HES solutions may yet have a role to play in major abdominal surgery. This meta-analysis and trial sequential analysis (TSA) aimed to investigate the effect of HES intravascular volume replacement on the risk of AKI, intraoperative blood transfusion, and postoperative intra-abdominal complications compared to crystalloid intravascular volume replacement. In this meta-analysis and TSA, we searched for randomized controlled trials (RCTs) comparing intraoperative HES intravascular volume replacement to crystalloid intravascular volume replacement in adult patients undergoing major abdominal surgery. Primary outcome was 30-day AKI, defined as a binary outcome according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, combining stages 1, 2, and 3 into an AKI category versus no AKI category (stage 0). Secondary outcomes included rates of intraoperative blood transfusion and postoperative intra-abdominal complications. We used random effects models to calculate summary estimates. We used relative risk (RR) as summary measure for dichotomous outcomes, with corresponding 95% confidence intervals (CIs) for the primary outcome (P value <.05 was considered statistically significant) and 99% CI after Bonferroni correction for the secondary outcomes (P value <.01 was considered statistically significant). Seven RCTs including 2398 patients were included. HES intravascular volume replacement was not associated with an increased risk of 30-day AKI (RR = 1.22, 95% CI, 0.94-1.59; P = .13), when compared to crystalloid intravascular volume replacement. According to TSA, this analysis was underpowered. HES intravascular volume replacement was associated with higher rates of blood transfusion (RR = 1.57 99% CI, 1.10-2.25; P = .001), and similar rates of postoperative intra-abdominal complications (RR = 0.76 99% CI, 0.57-1.02; P = .02). In this meta-analysis to focus on HES intravascular volume replacement in major abdominal surgery, HES intravascular volume replacement was not associated with a higher risk of 30-day AKI when compared to crystalloid intravascular volume replacement. However, CI and TSA do not exclude harmful effects of HES intravascular volume replacement on the renal function.

Maintaining intravenous volume mitigates hypothermia-induced myocardial dysfunction and accumulation of intracellular Ca2.

What is the central question of this study? Detailed guidelines for volume replacement to counteract hypothermia-induced intravascular fluid loss are lacking. Evidence suggests colloids might have beneficial effects compared to crystalloids. Are central haemodynamic function and level of hypothermia-induced calcium overload, as a marker of cardiac injury, restored by fluid substitution during rewarming, and are colloids favourable to crystalloids? What is the main finding and its importance? Infusion with crystalloid or dextran during rewarming abolished post-hypothermic cardiac dysfunction, and partially mitigated myocardial calcium overload. The effects of volume replacement to support haemodynamic function are comparable to those using potent cardio-active drugs. These findings underline the importance of applying intravascular volume replacement to maintain euvolaemia during rewarming. Previous research exploring pathophysiological mechanisms underlying circulatory collapse after rewarming victims of severe accidental hypothermia has documented post-hypothermic cardiac dysfunction and hypothermia-induced elevation of intracellular Ca2+ concentration ([Ca2+ ]i ) in myocardial cells. The aim of the present study was to examine if maintaining euvolaemia during rewarming mitigates cardiac dysfunction and/or normalizes elevated myocardial [Ca2+ ]i . A total of 21 male Wistar rats (300g) were surface cooled to 15°C, then maintained at 15°C for 4h, and subsequently rewarmed to 37°C. The rats were randomly assigned to one of three groups: (1) non-intervention control (n=7), (2) dextran treated (i.v. 12ml/kg dextran 70; n=7), or (3) crystalloid treated (24ml/kg 0.9% i.v. saline; n=7). Infusions occurred during the first 30min of rewarming. Arterial blood pressure, stroke volume (SV), cardiac output (CO), contractility (dP/dtmax ) and blood gas changes were measured. Post-hypothermic changes in [Ca2+ ]i were measured using the method of radiolabelled Ca2+ (45 Ca2+ ). Untreated controls displayed post-hypothermic cardiac dysfunction with significantly reduced CO, SV and dP/dtmax . In contrast, rats receiving crystalloid or dextran treatment showed a return to pre-hypothermic control levels of CO and SV after rewarming, with the dextran group displaying significantly better amelioration of post-hypothermic cardiac dysfunction than the crystalloid group. Compared to the post-hypothermic increase in myocardial [Ca2+ ]i in non-treated controls, [Ca2+ ]i values with crystalloid and dextran did not increase to the same extent after rewarming. Volume replacement with crystalloid or dextran during rewarming abolishes post-hypothermic cardiac dysfunction, and partially mitigates the hypothermia-induced elevation of [Ca2+ ]i .

What's New in Shock? January 2021.

What's New in Shock? January 2021.

Crystalloids and colloids

Administration of intravenous fluid is like giving drugs, in that they have both beneficial and harmful effects. The composition of intravenous crystalloid and colloid fluids used for resuscitation is described in detail. The use of fluids for intravascular volume replacement is discussed as well as some of the controversies of this in haemorrhagic shock and septic shock.

Intravascular Volume Replacement Therapy with Synthetic Colloids: Is There an Influence on Renal Function?: Retraction

Intravascular Volume Replacement Therapy with Synthetic Colloids: Is There an Influence on Renal Function?: Retraction

Change in strong ion difference and metabolic acidosis after heart surgery

Introduction Metabolic acidosis is a common complication of cardiac surgery involving cardiopulmonary bypass (CPB) which is usually ascribed to tissue hypoperfusion. However, it may be related to the volume and content of the intravascular fluids (IV fluids) administered that cause haemodilution and a decrease in strong ion difference (SID) in the blood, so increasing the concentration of hydrogen ions (δ[H+]). Therefore, we hypothesized that the volume and content of IV fluids administered during cardiac surgery were associated with postoperative metabolic acidosis. The primary aim of this study was to measure the incidence of metabolic acidosis developed on arrival in the intensive care unit (ICU) by patients who had undergone cardiac surgery. Secondary aims were to explore the associations of the change in SID(δSID) and other blood concentrations with δ[H+] and between δSID with the content and volume of IV fluids administered. Methods The study design was a single centre, observational, prospective, cohort study. PlasmaLyte 148 was used to prime the CPB circuit and for intravascular volume replacement. Arterial blood samples were aspirated before induction of anaesthesia and on arrival to ICU and were analysed on a blood gas analyser. Changes in blood electrolytes, lactate concentrations (δlactate), δSID, anion gap, arterial carbon dioxide tension (δPaCO2) and bicarbonate ion concentration (δ[HCO3-]) as well as the total volume of IV fluids administered were then univariately correlated with δ[H+] using Pearson's coefficient. Independent variables that were significantly correlated with δ[H+] (p Results Fifty out of 85 patients (59%) had metabolic acidosis on arrival to ICU. The volume of IV fluids did not significantly correlate with δ[H+] (r= -0.13, p=0.24). A multivariate regression model (adjusted r2 = 0.51, F= 27.89, p Discussion Metabolic acidosis after cardiac surgery was weakly associated with a decrease in SID but not tissue hypoperfusion as estimated by lactate concentration nor effect of haemodilution. Interpretation of metabolic acidosis after cardiac surgery should include assessment of SID. δSID was used to summarize the effects of the change in concentration of individual strong ions on δ[H+] in the regression model. A much larger sample size would be needed to delineate the effects of the administration of specific strong ions contained in IV fluids on δ[H+].

New Light on Intravascular Volume Replacement Regimens: What Did We Learn from the Past Three Years?: Retraction.

New Light on Intravascular Volume Replacement Regimens: What Did We Learn from the Past Three Years?: Retraction.

Association of Vitamin D Deficiency with Profound Cardiogenic Shock in Patients Resuscitated From Sudden Cardiac Arrest.

Vitamin D deficiency is associated with various cardiovascular diseases, including sudden cardiac arrest (SCA). Profound cardiogenic shock is associated with morbidity and mortality in patients with SCA. This study investigated the association of vitamin D deficiency with profound cardiogenic shock in patients resuscitated from SCA. We enrolled patients who were successfully resuscitated from out-of-hospital cardiac arrests of a presumed cardiac cause. Profound cardiogenic shock was defined as refractory hypotension requiring high-dose vasopressor infusion (norepinephrine >0.5 mcg/kg/min) despite adequate intravascular volume replacement. Vitamin D levels were measured as plasma 25(OH)D concentrations and severe vitamin D deficiency was defined as 25(OH)D <10 ng/mL. A total of 237 subjects (179 men (76%), mean age 56.5 ± 16.5 years) were included in this study. The first monitored rhythm was shockable in 160 subjects (68%). Mean arrest time and CPR times were 25.6 ± 15.7 and 22.8 ± 15.0 min, respectively. Profound cardiogenic shock was observed in 100 subjects (42%). The mean vitamin D level was 12.3 ± 6.7 ng/mL, and vitamin D deficiency was diagnosed in 109 subjects (46%). In profound cardiogenic shock subjects, vitamin D levels were significantly lower (10.7 ± 7.0 vs. 13.4 ± 6.2 ng/mL, P = 0.002) and severe vitamin D deficiency was observed more frequently (63% vs. 34%, P < 0.001). Subjects with profound cardiogenic shock were likely to have longer arrest times (29.5 ± 17.0 vs. 22.7 ± 14.0 min, P = 0.001), left ventricular systolic dysfunction (LVEF < 40%, 73% vs. 38%, P < 0.001), and baseline renal dysfunction (65% vs. 37%, P < 0.001). Multivariate logistic analysis indicated that vitamin D deficiency was significantly associated with profound cardiogenic shock after SCA (OR 2.71, 95% CI 1.42-5.18, P = 0.003) after adjusting for confounding variables. Severe vitamin D deficiency was strongly associated with profound cardiogenic shock and mortality in patients resuscitated from SCA.

1638: IMPACT OF ALBUMIN ON INTRAVASCULAR VOLUME REPLACEMENT IN PATIENTS WITH SEPTIC SHOCK

Morton, Celia1; Bullard, Zackery2; Steelman, Joshua2; Zimmerman, Lisa Hall3 Author Information

Anaemia worsens early functional outcome after traumatic brain injury: a preliminary study

ABSTRACTObjective: To determine early effects on outcome from traumatic brain injury (TBI) induced by controlled cortical impact (CCI) associated with anaemia in mice.Hypothesis: Outcome from TBI with concomitant anaemia would be worse than TBI without anaemia.Methods: CCI was induced with electromagnetic impaction in four groups of C57BL/6J mice: sham, sham+anaemia; TBI; and TBI+anaemia. Anaemia was created by withdrawal of 30% of calculated intravascular blood volume and saline replacement of equal volume. Functional outcome was assessed by beam-walking test and open field test (after pre-injury training) on post-injury days 3 and 7. After functional assessment, brains removed from sacrificed animals were pathological reviewed with haematoxylin and eosin, cresyl violet, Luxol Fast Blue, and IBA-1 immunostains.Results: Beam-walking was similar between animals with TBI and TBI+anaemia (p = 0.9). In open field test, animals with TBI+anaemia walked less distance than TBI alone or sham animals on days 3 (p < 0.001) and 7 (p < 0.05), indicating less exploratory and locomotion behaviours. No specific pathologic differences could be identified.Conclusions: Anaemia associated with TBI from CCI is associated with worse outcome as measured by less distance travelled in the open field test at three days than if anaemia is not present.

Volume replacement during trauma resuscitation: a brief synopsis of current guidelines and recommendations.

Intravascular volume and fluid replacement are still cornerstones to correct fluid deficits during early trauma resuscitation, but optimum strategies remain under debate. A synopsis of best current knowledge with reference to the following guidelines and recommendations is presented: (1) The European Guideline on Management of Major Bleeding and Coagulopathy following Trauma (fourth edition), (2) S3 Guideline on Treatment of Patients with Severe and Multiple Injuries [English Version of the German Guideline S3 Leitlinie Polytrauma/Schwerverletzten-Behandlung/AWMF Register-Nr. 012/019 sponsored by the German Society for Trauma Surgery/Deutsche Gesellschaft für Unfallchirurgie (DGU)], and (3) S3 Guideline Intravascular Volume Treatment in the Adult [AWMF Register-Nr 001/020 sponsored by the German Society for Anesthesiology and Intensive Medicine/Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)]. Volume replacement at a reduced level in severely injured and bleeding trauma patients is advocated (permissive hypotension) until the bleeding is controlled. ATLS principles with Hb, BE, and/or lactate can assess perfusion, estimate/monitor the extent of bleeding/shock, and guide therapy. Isotonic crystalloid solutions are first-line and specific recommendations apply for patients with TBI.

Goal directed hemodynamic therapy based in esophageal Doppler flow parameters: A systematic review, meta-analysis and trial sequential analysis

BackgroundNumerous studies have compared perioperative esophageal Doppler monitoring (EDM) guided intravascular volume replacement strategies with conventional clinical volume replacement in surgical patients. The use of the EDM within hemodynamic algorithms is called ‘goal directed hemodynamic therapy’ (GDHT). MethodsMeta-analysis of the effects of EDM guided GDHT in adult non-cardiac surgery on postoperative complications and mortality using PRISMA methodology. A systematic search was performed in Medline, PubMed, EMBASE, and the Cochrane Library (last update, March 2015). Inclusion criteria: Randomized clinical trials (RCTs) in which perioperative GDHT was compared to other fluid management. Primary outcomes: Overall complications. Secondary outcomes: Mortality; number of patients with complications; cardiac, renal and infectious complications; incidence of ileus. Studies were subjected to quantifiable analysis, pre-defined subgroup analysis (stratified by surgery, type of comparator and risk); pre-defined sensitivity analysis and trial sequential analysis (TSA). ResultsFifty six RCTs were initially identified, 15 fulfilling the inclusion criteria, including 1368 patients. A significant reduction was observed in overall complications associated with GDHT compared to other fluid therapy (RR=0.75; 95% CI: 0.63–0.89; p=0.0009) in colorectal, urological and high-risk surgery compared to conventional fluid therapy. No differences were found in secondary outcomes, neither in other subgroups. The impact on preventing the development of complications in patients using EDM is high, causing a relative risk reduction (RRR) of 50% for a number needed to treat (NNT)=6. ConclusionsGDHT guided by EDM decreases postoperative complications, especially in patients undergoing colorectal surgery and high-risk surgery. However, no differences versus restrictive fluid therapy and in intermediate-risk patients were found.

Terapia hemodinámica guiada por objetivos basada en parámetros de flujo con Doppler esofágico: revisión sistemática, metaanálisis y análisis secuencial de ensayos

BackgroundNumerous studies have compared perioperative esophageal doppler monitoring (EDM) guided intravascular volume replacement strategies with conventional clinical volume replacement in surgical patients. The use of the EDM within hemodynamic algorithms is called ‘goal directed hemodynamic therapy’ (GDHT). MethodsMeta-analysis of the effects of EDM guided GDHT in adult non-cardiac surgery on postoperative complications and mortality using PRISMA methodology. A systematic search was performed in Medline, PubMed, EMBASE, and the Cochrane Library (last update, March 2015). Inclusion criteria: Randomized clinical trials (RCTs) in which perioperative GDHT was compared to other fluid management. Primary outcomes: Overall complications. Secondary outcomes: Mortality; number of patients with complications; cardiac, renal and infectious complications; incidence of ileus. Studies were subjected to quantifiable analysis, pre-defined subgroup analysis (stratified by surgery, type of comparator and risk); pre-defined sensitivity analysis and trial sequential analysis (TSA). ResultsFifty six RCTs were initially identified, 15 fulfilling the inclusion criteria, including 1,368 patients. A significant reduction was observed in overall complications associated with GDHT compared to other fluid therapy (RR=0.75; 95%CI: 0.63-0.89; P=0.0009) in colorectal, urological and high-risk surgery compared to conventional fluid therapy. No differences were found in secondary outcomes, neither in other subgroups. The impact on preventing the development of complications in patients using EDM is high, causing a relative risk reduction (RRR) of 50% for a number needed to treat (NNT)=6. ConclusionsGDHT guided by EDM decreases postoperative complications, especially in patients undergoing colorectal surgery and high-risk surgery. However, no differences versus restrictive fluid therapy and in intermediate-risk patients were found.

Hydroxyethyl Starch- Friend or Foe?

Resuscitation with intravenous fluid therapy is considered a corner stone in the management of critically ill patients in most acute conditions. In daily practice, the assessment of individual thresholds in order to optimize cardiac preload and avoid hypovolemia or deleterious fluid overload remains a challenge. The choice of fluids for intravascular volume replacement has been debated for decades. More recently, this debate has focused not only on colloids versus crystalloids, but more specifically on the choice of colloid solutions. Hydroxyethyl starch (HES) solutions, developed as less-expensive alternatives to albumin, are commonly employed for volume resuscitation in the perioperative period as well as in ICU patients. However, lately, the resuscitation with HES has become controversial due to its adverse effect regarding impaired coagulation, renal insufficiency and mortality. Therefore, a narrative review of recent literature was undertaken to establish the current utility and efficacy of HES in clinical practice. Prospective randomized controlled trials published between January 2008 and March 2015 with measures of outcome/mortality and adverse effects of HES administration were included. This review aims at increasing awareness amongst anesthetists and critical care specialist about correct and careful fluid administration. Review Article

Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Main Recommendations MR1. ESGE recommends immediate assessment of hemodynamic status in patients who present with acute upper gastrointestinal hemorrhage (UGIH), with prompt intravascular volume replacement initially using crystalloid fluids if hemodynamic instability exists (strong recommendation, moderate quality evidence). MR2. ESGE recommends a restrictive red blood cell transfusion strategy that aims for a target hemoglobin between 7 g/dL and 9 g/dL. A higher target hemoglobin should be considered in patients with significant co-morbidity (e. g., ischemic cardiovascular disease) (strong recommendation, moderate quality evidence). MR3. ESGE recommends the use of the Glasgow-Blatchford Score (GBS) for pre-endoscopy risk stratification. Outpatients determined to be at very low risk, based upon a GBS score of 0 – 1, do not require early endoscopy nor hospital admission. Discharged patients should be informed of the risk of recurrent bleeding and be advised to maintain contact with the discharging hospital (strong recommendation, moderate quality evidence). MR4. ESGE recommends initiating high dose intravenous proton pump inhibitors (PPI), intravenous bolus followed by continuous infusion (80 mg then 8 mg/hour), in patients presenting with acute UGIH awaiting upper endoscopy. However, PPI infusion should not delay the performance of early endoscopy (strong recommendation, high quality evidence). MR5. ESGE does not recommend the routine use of nasogastric or orogastric aspiration/lavage in patients presenting with acute UGIH (strong recommendation, moderate quality evidence). MR6. ESGE recommends intravenous erythromycin (single dose, 250 mg given 30 – 120 minutes prior to upper gastrointestinal [GI] endoscopy) in patients with clinically severe or ongoing active UGIH. In selected patients, pre-endoscopic infusion of erythromycin significantly improves endoscopic visualization, reduces the need for second-look endoscopy, decreases the number of units of blood transfused, and reduces duration of hospital stay (strong recommendation, high quality evidence). MR7. Following hemodynamic resuscitation, ESGE recommends early (≤ 24 hours) upper GI endoscopy. Very early ( MR8. ESGE recommends that peptic ulcers with spurting or oozing bleeding (Forrest classification Ia and Ib, respectively) or with a nonbleeding visible vessel (Forrest classification IIa) receive endoscopic hemostasis because these lesions are at high risk for persistent bleeding or rebleeding (strong recommendation, high quality evidence). MR9. ESGE recommends that peptic ulcers with an adherent clot (Forrest classification IIb) be considered for endoscopic clot removal. Once the clot is removed, any identified underlying active bleeding (Forrest classification Ia or Ib) or nonbleeding visible vessel (Forrest classification IIa) should receive endoscopic hemostasis (weak recommendation, moderate quality evidence). MR10. In patients with peptic ulcers having a flat pigmented spot (Forrest classification IIc) or clean base (Forrest classification III), ESGE does not recommend endoscopic hemostasis as these stigmata present a low risk of recurrent bleeding. In selected clinical settings, these patients may be discharged to home on standard PPI therapy, e. g., oral PPI once-daily (strong recommendation, moderate quality evidence). MR11. ESGE recommends that epinephrine injection therapy not be used as endoscopic monotherapy. If used, it should be combined with a second endoscopic hemostasis modality (strong recommendation, high quality evidence). MR12. ESGE recommends PPI therapy for patients who receive endoscopic hemostasis and for patients with adherent clot not receiving endoscopic hemostasis. PPI therapy should be high dose and administered as an intravenous bolus followed by continuous infusion (80 mg then 8 mg/hour) for 72 hours post endoscopy (strong recommendation, high quality evidence). MR13. ESGE does not recommend routine second-look endoscopy as part of the management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). However, in patients with clinical evidence of rebleeding following successful initial endoscopic hemostasis, ESGE recommends repeat upper endoscopy with hemostasis if indicated. In the case of failure of this second attempt at hemostasis, transcatheter angiographic embolization (TAE) or surgery should be considered (strong recommendation, high quality evidence). MR14. In patients with NVUGIH secondary to peptic ulcer, ESGE recommends investigating for the presence of Helicobacter pylori in the acute setting with initiation of appropriate antibiotic therapy when H. pylori is detected. Re-testing for H. pylori should be performed in those patients with a negative test in the acute setting. Documentation of successful H. pylori eradication is recommended (strong recommendation, high quality evidence). MR15. In patients receiving low dose aspirin for secondary cardiovascular prophylaxis who develop peptic ulcer bleeding, ESGE recommends aspirin be resumed immediately following index endoscopy if the risk of rebleeding is low (e. g., FIIc, FIII). In patients with high risk peptic ulcer (FIa, FIb, FIIa, FIIb), early reintroduction of aspirin by day 3 after index endoscopy is recommended, provided that adequate hemostasis has been established (strong recommendation, moderate quality evidence).

Indications and limitations for colloids in interventions and surgery

Over the last few decades colloids have played an important part in the stabilisation of patients with acute need of intravascular volume replacement. After the 6S and the CHEST trials were published in 2012 and the subsequent recommendations of the European Medicines Agency (EMA) and the Food and Drug Administration (FDA) there has been some uncertainty about the current clinical relevance and routine use of colloids. This article summarizes the current evidence and relevance of colloids in the perioperative environment and in the interventional setting on the basis of the recently published German S3-guidelines for volume therapy in adults. In situations of acute volume resuscitation colloids are still appropriate. Only colloids in balanced solutions should be used. Possible side effects, contraindications and the maximum daily dose have to be taken into consideration when administering colloids.

Resuscitative goals and new strategies in severe trauma patient resuscitation

Traumatic injuries represent a major health problem all over the world. In recent years we have witnessed profound changes in the paradigm of severe trauma patient resuscitation; new concepts regarding acute coagulopathy in trauma have been proposed; and there has been an expansion of specific commercial products related to hemostasis, among other aspects. New strategies in severe trauma management include the early identification of those injuries that are life threatening and require surgical hemostasis, tolerance of moderate hypotension, rational intravascular volume replacement, prevention of hypothermia, correction of acidosis, optimization of oxygen carriers, and identification of those factors required by the patient (fresh frozen plasma, platelets, tranexamic acid, fibrinogen, cryoprecipitates and prothrombin complex). However, despite such advances, further evidence is required to improve survival rates in severe trauma patients.

Effects of Intravascular Volume Replacement on Lung and Kidney Function and Damage in Nonseptic Experimental Lung Injury

Silva, Pedro L.; Güldner, Andreas; Uhlig, Christopher; Carvalho, Nadja; Beda, Allessandro; Rentzsch, Ines; Kasper, Michael; Wiedemann, Bärbel; Spieth, Peter M.; Koch, Thea; Capelozzi, Vera L.; Pelosi, Paolo; Rocco, Patricia R. M.; De Abreu, Marcelo Gama Author Information