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RANDOMIZED CONTROLLED TRIAL
François Jardot, Robert G Hahn, Dominique Engel, Christian M Beilstein, Patrick Y Wuethrich
BACKGROUND: Volume replacement with crystalloid fluid is the conventional treatment of hemorrhage. We challenged whether a standardized amount of 5% or 20% albumin could be a viable option to maintain the blood volume during surgery associated with major hemorrhage. Therefore, the aim of this study was to quantify and compare the plasma volume expansion properties of 5% albumin, 20% albumin, and Ringer-lactate, when infused during major surgery. METHODS: In this single-center randomized controlled trial, fluid replacement therapy to combat hypovolemia during the hemorrhagic phase of cystectomy was randomly allocated in 42 patients to receive either 5% albumin (12 mL/kg) or 20% albumin (3 mL/kg) over 30 min at the beginning of the hemorrhagic phase, both completed by a Ringer-lactate replacing blood loss in a 1:1 ratio, or Ringer-lactate alone to replace blood loss in a 3:1 ratio...
February 5, 2024: Critical Care: the Official Journal of the Critical Care Forum
#2
JOURNAL ARTICLE
Muhammad Ashir Shafique, Noman Adil Shaikh, Abdul Haseeb, Abdullah Mussarat, Muhammad Saqlain Mustafa
BACKGROUND: The choice of fluid resuscitation in Traumatic Hemorrhagic shock (THS) remains a critical aspect of patient management. Bicarbonated Ringers solution (BRS) has shown promise due to its composition resembling human Extracellular Fluid and its potential benefits on hemodynamics. OBJECTIVE: To evaluate the efficacy, mortality rates, hemodynamic effects, and adverse outcomes of Sodium Bicarbonate Ringer's Solution in the treatment of hemorrhagic shock, as compared to other relevant interventions...
February 2024: American Journal of Emergency Medicine
#3
REVIEW
Muralie Vignarajah, Annie Berg, Zahra Abdallah, Naman Arora, Arshia Javidan, Tyler Pitre, Shannon M Fernando, Jessica Spence, John Centofanti, Bram Rochwerg
BACKGROUND: The evidence regarding optimal crystalloid use in the perioperative period remains unclear. As the primary aim of this study, we sought to summarise the data from RCTs examining whether use of balanced crystalloids compared with 0.9% saline (saline) leads to differences in patient-important outcomes. METHODS: We searched Ovid MEDLINE, Embase, the Cochrane library, and Clinicaltrials.gov, from inception until December 15, 2022, and included RCTs that intraoperatively randomised adult participants to receive either balanced fluids or saline...
September 2023: British Journal of Anaesthesia
#4
REVIEW
Fernando G Zampieri, Sean M Bagshaw, Matthew W Semler
IMPORTANCE: Approximately 20% to 30% of patients admitted to an intensive care unit have sepsis. While fluid therapy typically begins in the emergency department, intravenous fluids in the intensive care unit are an essential component of therapy for sepsis. OBSERVATIONS: For patients with sepsis, intravenous fluid can increase cardiac output and blood pressure, maintain or increase intravascular fluid volume, and deliver medications. Fluid therapy can be conceptualized as 4 overlapping phases from early illness through resolution of sepsis: resuscitation (rapid fluid administered to restore perfusion); optimization (the risks and benefits of additional fluids to treat shock and ensure organ perfusion are evaluated); stabilization (fluid therapy is used only when there is a signal of fluid responsiveness); and evacuation (excess fluid accumulated during treatment of critical illness is eliminated)...
June 13, 2023: JAMA
#5
JOURNAL ARTICLE
Francesco Gavelli, Rui Shi, Jean-Louis Teboul, Danila Azzolina, Xavier Monnet
BACKGROUND: We performed a systematic review and meta-analysis of studies assessing the end-expiratory occlusion test (EEXPO test)-induced changes in cardiac output (CO) measured by any haemodynamic monitoring device, as indicators of preload responsiveness. METHODS: MEDLINE, EMBASE and Cochrane Database were screened for original articles. Bivariate random-effects meta-analysis determined the Area under the Summary Receiver Operating Characteristic (AUSROC) curve of EEXPO test-induced changes in CO to detect preload responsiveness, as well as pooled sensitivity and specificity and the best diagnostic threshold...
May 24, 2020: Annals of Intensive Care
#6
JOURNAL ARTICLE
Alexandra Beurton, Jean-Louis Teboul, Francesco Gavelli, Filipe Andre Gonzalez, Valentina Girotto, Laura Galarza, Nadia Anguel, Christian Richard, Xavier Monnet
BACKGROUND: A passive leg raising (PLR) test is positive if the cardiac index (CI) increased by > 10%, but it requires a direct measurement of CI. On the oxygen saturation plethysmographic signal, the perfusion index (PI) is the ratio between the pulsatile and the non-pulsatile portions. We hypothesised that the changes in PI could predict a positive PLR test and thus preload responsiveness in a totally non-invasive way. METHODS: In patients with acute circulatory failure, we measured PI (Radical-7) and CI (PiCCO2) before and during a PLR test and, if decided, before and after volume expansion (500-mL saline)...
January 18, 2019: Critical Care: the Official Journal of the Critical Care Forum
#7
JOURNAL ARTICLE
Lisa Raia, Paul Gabarre, Vincent Bonny, Tomas Urbina, Louai Missri, Pierre-Yves Boelle, Jean-Luc Baudel, Bertrand Guidet, Eric Maury, Jeremie Joffre, Hafid Ait-Oufella
BACKGROUND: Capillary refill time (CRT) is a valuable tool for triage and to guide resuscitation. However, little is known about CRT kinetics after fluid infusion. METHODS: We conducted a prospective observational study in a tertiary teaching hospital. First, we analyzed the intra-observer variability of CRT. Next, we monitored fingertip CRT in sepsis patients during volume expansion within the first 24 h of ICU admission. Fingertip CRT was measured every 2 min during 30 min following crystalloid infusion (500 mL over 15 min)...
August 13, 2022: Annals of Intensive Care
#8
REVIEW
Jean-Louis Vincent, James A Russell, Matthias Jacob, Greg Martin, Bertrand Guidet, Jan Wernerman, Ricard Ferrer, Stuart A McCluskey, Luciano Gattinoni
Albumin solutions have been used worldwide for the treatment of critically ill patients since they became commercially available in the 1940s. However, their use has become the subject of criticism and debate in more recent years. Importantly, all fluid solutions have potential benefits and drawbacks. Large multicenter randomized studies have provided valuable data regarding the safety of albumin solutions, and have begun to clarify which groups of patients are most likely to benefit from their use. However, many questions remain related to where exactly albumin fits within our fluid choices...
July 16, 2014: Critical Care: the Official Journal of the Critical Care Forum
#9
RANDOMIZED CONTROLLED TRIAL
Tine S Meyhoff, Peter B Hjortrup, Jørn Wetterslev, Praleene Sivapalan, Jon H Laake, Maria Cronhjort, Stephan M Jakob, Maurizio Cecconi, Marek Nalos, Marlies Ostermann, Manu Malbrain, Ville Pettilä, Morten H Møller, Maj-Brit N Kjær, Theis Lange, Christian Overgaard-Steensen, Björn A Brand, Marie Winther-Olesen, Jonathan O White, Lars Quist, Bo Westergaard, Andreas B Jonsson, Carl J S Hjortsø, Nick Meier, Thomas S Jensen, Janus Engstrøm, Lars Nebrich, Nina C Andersen-Ranberg, Jacob V Jensen, Neeliya A Joseph, Lone M Poulsen, Louise S Herløv, Christoffer G Sølling, Susan K Pedersen, Kurt K Knudsen, Therese S Straarup, Marianne L Vang, Helle Bundgaard, Bodil S Rasmussen, Søren R Aagaard, Thomas Hildebrandt, Lene Russell, Morten H Bestle, Martin Schønemann-Lund, Anne C Brøchner, Claes F Elvander, Søren K L Hoffmann, Michael L Rasmussen, Yvonne K Martin, Fredrik F Friberg, Herman Seter, Tayyba N Aslam, Sigrid Ådnøy, Philipp Seidel, Kristian Strand, Bror Johnstad, Eva Joelsson-Alm, Jens Christensen, Christian Ahlstedt, Carmen A Pfortmueller, Martin Siegemund, Massimiliano Greco, Jaroslav Raděj, Miroslav Kříž, Doug W Gould, Kathy M Rowan, Paul R Mouncey, Anders Perner
BACKGROUND: Intravenous fluids are recommended for the treatment of patients who are in septic shock, but higher fluid volumes have been associated with harm in patients who are in the intensive care unit (ICU). METHODS: In this international, randomized trial, we assigned patients with septic shock in the ICU who had received at least 1 liter of intravenous fluid to receive restricted intravenous fluid or standard intravenous fluid therapy; patients were included if the onset of shock had been within 12 hours before screening...
June 30, 2022: New England Journal of Medicine
#10
RANDOMIZED CONTROLLED TRIAL
Simon Finfer, Sharon Micallef, Naomi Hammond, Leanlove Navarra, Rinaldo Bellomo, Laurent Billot, Anthony Delaney, Martin Gallagher, David Gattas, Qiang Li, Diane Mackle, Jayanthi Mysore, Manoj Saxena, Colman Taylor, Paul Young, John Myburgh
BACKGROUND: Whether the use of balanced multielectrolyte solution (BMES) in preference to 0.9% sodium chloride solution (saline) in critically ill patients reduces the risk of acute kidney injury or death is uncertain. METHODS: In a double-blind, randomized, controlled trial, we assigned critically ill patients to receive BMES (Plasma-Lyte 148) or saline as fluid therapy in the intensive care unit (ICU) for 90 days. The primary outcome was death from any cause within 90 days after randomization...
March 3, 2022: New England Journal of Medicine
#11
RANDOMIZED CONTROLLED TRIAL
Mahesh Ramanan, Antony Attokaran, Lauren Murray, Neeraj Bhadange, David Stewart, Gokulnath Rajendran, Raju Pusapati, Melissa Petty, Peter Garrett, Peter Kruger, Sandra Peake, Laurent Billot, Balasubramanian Venkatesh
PURPOSE: To determine whether treatment with Plasmalyte-148 (PL) compared to sodium chloride 0.9% (SC) results in faster resolution of diabetic ketoacidosis (DKA) and whether the acetate in PL potentiates ketosis. METHODS: We conducted a cluster, crossover, open-label, randomized, controlled Phase 2 trial at seven hospitals in adults admitted to intensive care unit (ICU) with severe DKA with hospital randomised to PL or SC as fluid therapy. The primary outcome, DKA resolution, was defined as a change in base excess to ≥ - 3 mEq/L at 48 h...
November 2021: Intensive Care Medicine
#12
REVIEW
Peter Bentzer, Donald E Griesdale, John Boyd, Kelly MacLean, Demetrios Sirounis, Najib T Ayas
IMPORTANCE: Fluid overload occurring as a consequence of overly aggressive fluid resuscitation may adversely affect outcome in hemodynamically unstable critically ill patients. Therefore, following the initial fluid resuscitation, it is important to identify which patients will benefit from further fluid administration. OBJECTIVE: To identify predictors of fluid responsiveness in hemodynamically unstable patients with signs of inadequate organ perfusion. DATA SOURCES AND STUDY SELECTION: Search of MEDLINE and EMBASE (1966 to June 2016) and reference lists from retrieved articles, previous reviews, and physical examination textbooks for studies that evaluated the diagnostic accuracy of tests to predict fluid responsiveness in hemodynamically unstable adult patients who were defined as having refractory hypotension, signs of organ hypoperfusion, or both...
September 27, 2016: JAMA
#13
JOURNAL ARTICLE
Fernando G Zampieri, Flávia R Machado, Rodrigo S Biondi, Flávio G R Freitas, Viviane C Veiga, Rodrigo C Figueiredo, Wilson J Lovato, Cristina P Amêndola, Ary Serpa-Neto, Jorge L R Paranhos, Marco A V Guedes, Eraldo A Lúcio, Lúcio C Oliveira-Júnior, Thiago C Lisboa, Fábio H Lacerda, Israel S Maia, Cintia M C Grion, Murillo S C Assunção, Airton L O Manoel, João M Silva-Junior, Péricles Duarte, Rafael M Soares, Tamiris A Miranda, Lucas M de Lima, Rodrigo M Gurgel, Denise M Paisani, Thiago D Corrêa, Luciano C P Azevedo, John A Kellum, Lucas P Damiani, Nilton Brandão da Silva, Alexandre B Cavalcanti
IMPORTANCE: Intravenous fluids are used for almost all intensive care unit (ICU) patients. Clinical and laboratory studies have questioned whether specific fluid types result in improved outcomes, including mortality and acute kidney injury. OBJECTIVE: To determine the effect of a balanced solution vs saline solution (0.9% sodium chloride) on 90-day survival in critically ill patients. DESIGN, SETTING, AND PARTICIPANTS: Double-blind, factorial, randomized clinical trial conducted at 75 ICUs in Brazil...
August 10, 2021: JAMA
#14
EDITORIAL
D P Southall, M P Samuels
No abstract text is available yet for this article.
October 2011: Archives of Disease in Childhood
#15
RANDOMIZED CONTROLLED TRIAL
Kathryn Maitland, Sarah Kiguli, Robert O Opoka, Charles Engoru, Peter Olupot-Olupot, Samuel O Akech, Richard Nyeko, George Mtove, Hugh Reyburn, Trudie Lang, Bernadette Brent, Jennifer A Evans, James K Tibenderana, Jane Crawley, Elizabeth C Russell, Michael Levin, Abdel G Babiker, Diana M Gibb
BACKGROUND: The role of fluid resuscitation in the treatment of children with shock and life-threatening infections who live in resource-limited settings is not established. METHODS: We randomly assigned children with severe febrile illness and impaired perfusion to receive boluses of 20 to 40 ml of 5% albumin solution (albumin-bolus group) or 0.9% saline solution (saline-bolus group) per kilogram of body weight or no bolus (control group) at the time of admission to a hospital in Uganda, Kenya, or Tanzania (stratum A); children with severe hypotension were randomly assigned to one of the bolus groups only (stratum B)...
June 30, 2011: New England Journal of Medicine
#16
JOURNAL ARTICLE
Bo Hu, Joy C Y Chen, Yue Dong, Ryan D Frank, Melissa Passe, Erica Portner, Zhiyong Peng, Kianoush Kashani
BACKGROUND: Fluid resuscitation has become the cornerstone of early septic shock management, but the optimal fluid rate is still not well studied. The goal of this investigation is to examine the relationship between fluid resuscitation rate and septic shock resolution. METHOD: We retrospectively studied adult (≥ 18 years) patients with septic shock, defined based on sepsis III definition, from January 1, 2006, through May 31, 2018, in the medical intensive care unit (MICU) of Mayo Clinic Rochester...
April 7, 2020: Critical Care: the Official Journal of the Critical Care Forum
#17
REVIEW
Niels Van Regenmortel, Lynn Moers, Thomas Langer, Ella Roelant, Tim De Weerdt, Pietro Caironi, Manu L N G Malbrain, Paul Elbers, Tim Van den Wyngaert, Philippe G Jorens
PURPOSE: Iatrogenic fluid overload is a potential side effect of intravenous fluid therapy in the hospital. Little attention has been paid to sodium administration as a separate cause of harm. With this narrative review, we aim to substantiate the hypothesis that a considerable amount of fluid-induced harm is caused not only by fluid volume, but also by the sodium that is administered to hospitalized patients. METHODS: We show how a regular dietary sodium intake is easily surpassed by the substantial amounts of sodium that are administered during typical hospital stays...
May 17, 2021: Annals of Intensive Care
#18
REVIEW
Jan Bakker
PURPOSE OF REVIEW: Current goals of resuscitation in septic shock are mainly a fixed volume of fluids and vasopressors to correct hypotension and improve tissue perfusion indicated by decreasing lactate levels. RECENT FINDINGS: Abnormal peripheral perfusion by objective and subjective parameters are associated with increased mortality in various phases of the treatment of critically ill patients including patients with septic shock. Ongoing resuscitation in septic shock patients with normal peripheral perfusion is not associated with improved outcome, rather with increased mortality...
June 1, 2021: Current Opinion in Critical Care
#19
REVIEW
Thomas G V Cherpanath, Alexander Hirsch, Bart F Geerts, Wim K Lagrand, Mariska M Leeflang, Marcus J Schultz, A B Johan Groeneveld
OBJECTIVE: Passive leg raising creates a reversible increase in venous return allowing for the prediction of fluid responsiveness. However, the amount of venous return may vary in various clinical settings potentially affecting the diagnostic performance of passive leg raising. Therefore we performed a systematic meta-analysis determining the diagnostic performance of passive leg raising in different clinical settings with exploration of patient characteristics, measurement techniques, and outcome variables...
May 2016: Critical Care Medicine
#20
RANDOMIZED CONTROLLED TRIAL
Ryan M Brown, Li Wang, Taylor D Coston, Nathan I Krishnan, Jonathan D Casey, Jonathan P Wanderer, Jesse M Ehrenfeld, Daniel W Byrne, Joanna L Stollings, Edward D Siew, Gordon R Bernard, Wesley H Self, Todd W Rice, Matthew W Semler
Rationale: Administration of intravenous crystalloid solutions is a fundamental therapy for sepsis, but the effect of crystalloid composition on patient outcomes remains unknown. Objectives: To compare the effect of balanced crystalloids versus saline on 30-day in-hospital mortality among critically ill adults with sepsis. Methods: Secondary analysis of patients from SMART (Isotonic Solutions and Major Adverse Renal Events Trial) admitted to the medical ICU with an International Classification of Diseases, 10th Edition, Clinical Modification System code for sepsis, using multivariable regression to control for potential confounders...
December 15, 2019: American Journal of Respiratory and Critical Care Medicine
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