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Fluids questioning medicine podcast

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By Andrew Buelt Questioningmedicine, intern in residency
Erin Frazee, Kianoush Kashani
BACKGROUND: Intravenous fluids (IVF) are frequently utilized to restore intravascular volume in patients with distributive and hypovolemic shock. Although the benefits of the appropriate use of fluids in intensive care units (ICUs) and hospitals are well described, there is growing knowledge regarding the potential risks of volume overload and its impact on organ failure and mortality. To avoid volume overload and its associated complications, strategies to identify fluid responsiveness are developed and utilized more often among ICU patients...
June 2016: Kidney Diseases
J Lee, E de Louw, M Niemi, R Nelson, R G Mark, L A Celi, K J Mukamal, J Danziger
OBJECTIVE: Although the consequences of chronic fluid retention are well known, those of iatrogenic fluid retention that occurs during critical illness have not been fully determined. Therefore, we investigated the association between fluid balance and survival in a cohort of almost 16,000 individuals who survived an intensive care unit (ICU) stay in a large, urban, tertiary medical centre. DESIGN: Longitudinal analysis of fluid balance at ICU discharge and 90-day post-ICU survival...
April 2015: Journal of Internal Medicine
João M Silva, Amanda Maria Ribas Rosa de Oliveira, Fernando Augusto Mendes Nogueira, Pedro Monferrari Monteiro Vianna, Marcos Cruz Pereira Filho, Leandro Ferreira Dias, Vivian Paz Leão Maia, Cesar de Souza Neucamp, Cristina Prata Amendola, Maria José Carvalho Carmona, Luiz M Sá Malbouisson
INTRODUCTION: In some studies including small populations of patients undergoing specific surgery, an intraoperative liberal infusion of fluids was associated with increasing morbidity when compared to restrictive strategies. Therefore, to evaluate the role of excessive fluid infusion in a general population with high-risk surgery is very important. The aim of this study was to evaluate the impact of intraoperative fluid balance on the postoperative organ dysfunction, infection and mortality rate...
2013: Critical Care: the Official Journal of the Critical Care Forum
John H Boyd, Jason Forbes, Taka-aki Nakada, Keith R Walley, James A Russell
OBJECTIVE: To determine whether central venous pressure and fluid balance after resuscitation for septic shock are associated with mortality. DESIGN: We conducted a retrospective review of the use of intravenous fluids during the first 4 days of care. SETTING: Multicenter randomized controlled trial. PATIENTS: The Vasopressin in Septic Shock Trial (VASST) study enrolled 778 patients who had septic shock and who were receiving a minimum of 5 μg of norepinephrine per minute...
February 2011: Critical Care Medicine
J A Myburgh
The administration of intravenous fluids for resuscitation is the most common intervention in acute medicine. There is increasing evidence that the type of fluid may directly affect patient-centred outcomes. There is a lack of evidence that colloids confer clinical benefit over crystalloids and they may be associated with harm. Hydroxyethyl starch preparations are associated with increased mortality and use of renal replacement therapy in critically ill patients, particularly those with sepsis; albumin is associated with increased mortality in patients with severe traumatic brain injury...
January 2015: Journal of Internal Medicine
Bram Rochwerg, Waleed Alhazzani, Anees Sindi, Diane Heels-Ansdell, Lehana Thabane, Alison Fox-Robichaud, Lawrence Mbuagbaw, Wojciech Szczeklik, Fayez Alshamsi, Sultan Altayyar, Wang-Chun Ip, Guowei Li, Michael Wang, Anna Wludarczyk, Qi Zhou, Gordon H Guyatt, Deborah J Cook, Roman Jaeschke, Djillali Annane
BACKGROUND: Fluid resuscitation is the cornerstone of sepsis treatment. However, whether balanced or unbalanced crystalloids or natural or synthetic colloids confer a survival advantage is unclear. PURPOSE: To examine the effect of different resuscitative fluids on mortality in patients with sepsis. DATA SOURCES: MEDLINE, EMBASE, ACP Journal Club, CINAHL, HealthSTAR, the Allied and Complementary Medicine Database, and the Cochrane Central Register of Controlled Trials through March 2014...
September 2, 2014: Annals of Internal Medicine
Janice L Zimmerman, Michael C Shen
Rhabdomyolysis is a well-known clinical syndrome of muscle injury associated with myoglobinuria, electrolyte abnormalities, and often acute kidney injury (AKI). The pathophysiology involves injury to the myocyte membrane and/or altered energy production that results in increased intracellular calcium concentrations and initiation of destructive processes. Myoglobin has been identified as the primary muscle constituent contributing to renal damage in rhabdomyolysis. Although rhabdomyolysis was first described with crush injuries and trauma, more common causes in hospitalized patients at present include prescription and over-the-counter medications, alcohol, and illicit drugs...
September 2013: Chest
Vance Beck, Dan Chateau, Gregory L Bryson, Amarnath Pisipati, Sergio Zanotti, Joseph E Parrillo, Anand Kumar
INTRODUCTION: Despite recent advances in the management of septic shock, mortality remains unacceptably high. Earlier initiation of key therapies including appropriate antimicrobials and fluid resuscitation appears to reduce the mortality in this condition. This study examined whether early initiation of vasopressor therapy is associated with improved survival in fluid therapy-refractory septic shock. METHODS: Utilizing a well-established database, relevant information including duration of time to vasopressor administration following the initial documentation of recurrent/persistent hypotension associated with septic shock was assessed in 8,670 adult patients from 28 ICUs in Canada, the United States of America, and Saudi Arabia...
May 12, 2014: Critical Care: the Official Journal of the Critical Care Forum
Farid Sadaka, Mayrol Juarez, Soophia Naydenov, Jacklyn O'Brien
PURPOSE: To determine whether progressively increasing fluid balance after initial fluid resuscitation for septic shock is associated with increased mortality. METHODS: A retrospective review of the use of intravenous fluids in patients with septic shock in a large university affiliated hospital with 56 medical-surgical intensive care unit beds. We analyzed the data of 350 patients with septic shock who were managed according to the Surviving Sepsis Campaign guidelines...
July 2014: Journal of Intensive Care Medicine
Sarah J Lee, Kannan Ramar, John G Park, Ognjen Gajic, Guangxi Li, Rahul Kashyap
BACKGROUND: The surviving sepsis guidelines recommend early aggressive fluid resuscitation within 6 h of sepsis onset. Although rapid fluid administration may offer benefit, studies on the timing of resuscitation are lacking. We hypothesized that there is an association between quicker, adequate fluid resuscitation and patient outcome from sepsis onset time. METHODS: This is a retrospective cohort study of consecutive adults with severe sepsis and septic shock admitted to a quaternary care medical ICU between January 2007 and December 2009...
October 2014: Chest
Vaishnaavi Gnanasampanthan, Lauren Porten, Ian Bissett
BACKGROUND: This study aims to measure whether the introduction of a multifaceted, evidence-based, educational intervention will improve both intravenous (i.v.) fluids prescribed by doctors and administrated by nurses. METHODS: A daily baseline audit of i.v. fluid prescription and administration for colorectal inpatients was carried out at two Auckland teaching hospitals over 4 weeks. The educational intervention was then administered at hospital 1, while at hospital 2 nurses and junior doctors were merely informed of the audit...
December 2014: ANZ Journal of Surgery
Niels Van Regenmortel, Philippe G Jorens, Manu L N G Malbrain
PURPOSE OF REVIEW: Fluid management is regarded as a cornerstone of successful perioperative care, but fluid prescription is not always treated that way. New insights and guidelines have become available very recently. RECENT FINDINGS: Although most of the recent scientific attention went to resuscitation fluids and the place of hydroxyethyl starches, recent guidelines also emphasize the importance of fluid prescription in a maintenance and a replacement setting...
August 2014: Current Opinion in Critical Care
Karthik Raghunathan, Andrew Shaw, Brian Nathanson, Til Stürmer, Alan Brookhart, Mihaela S Stefan, Soko Setoguchi, Chris Beadles, Peter K Lindenauer
OBJECTIVE: Isotonic saline is the most commonly used crystalloid in the ICU, but recent evidence suggests that balanced fluids like Lactated Ringer's solution may be preferable. We examined the association between choice of crystalloids and in-hospital mortality during the resuscitation of critically ill adults with sepsis. DESIGN: A retrospective cohort study of patients admitted with sepsis, not undergoing any surgical procedures, and treated in an ICU by hospital day 2...
July 2014: Critical Care Medicine
Armand Mekontso Dessap, Sandrine Katsahian, Ferran Roche-Campo, Hugo Varet, Achille Kouatchet, Vinko Tomicic, Gaetan Beduneau, Romain Sonneville, Samir Jaber, Michael Darmon, Diego Castanares-Zapatero, Laurent Brochard, Christian Brun-Buisson
BACKGROUND: Pulmonary edema may alter alveolar bacterial clearance and infectivity. Manipulation of fluid balance aimed at reducing fluid overload may, therefore, influence ventilator-associated pneumonia (VAP) occurrence in intubated patients. The objective of the present study was to assess the impact of a depletive fluid-management strategy on ventilator-associated complication (VAC) and VAP occurrence during weaning from mechanical ventilation. METHODS: We used data from the B-type Natriuretic Peptide for the Fluid Management of Weaning (BMW) randomized controlled trial performed in nine ICUs across Europe and America...
July 2014: Chest
Byron Alexander Foster, Dina Tom, Vanessa Hill
OBJECTIVE: To determine whether the use of hypotonic vs isotonic maintenance fluids confers an increased risk of hyponatremia in hospitalized children. STUDY DESIGN: A search of MEDLINE (1946 to January 2013), the Cochrane Central Registry (1991 to December 2012), Cumulative Index for Nursing and Allied Health Literature (1990 to December 2012), and Pediatric Academic Societies (2000-2012) abstracts was conducted using the terms "hypotonic fluids/saline/solutions" and "isotonic fluids/saline/solutions," and citations were reviewed using a predefined protocol...
July 2014: Journal of Pediatrics
Annemieke Smorenberg, Can Ince, Ab Johan Groeneveld
OBJECTIVE: In this narrative review, an overview is given of the pros and cons of various crystalloid fluids used for infusion during initial resuscitation or maintenance phases in adult hospitalized patients. Special emphasis is given on dose, composition of fluids, presence of buffers (in balanced solutions) and electrolytes, according to recent literature. We also review the use of hypertonic solutions. METHODS: We extracted relevant clinical literature in English specifically examining patient-oriented outcomes related to fluid volume and type...
August 6, 2013: Perioperative Medicine
Jingjing Wang, Erdi Xu, Yanfeng Xiao
OBJECTIVE: To assess evidence from randomized controlled trials (RCTs) on the safety of isotonic versus hypotonic intravenous (IV) maintenance fluids in hospitalized children. METHODS: We searched PubMed, Embase, Cochrane Library, and (up to April 11, 2013) for RCTs that compared isotonic to hypotonic maintenance IV fluid therapy in hospitalized children. Relative risk (RR), weighted mean differences, and 95% confidence intervals (CIs) were calculated based on the effects on plasma sodium (pNa)...
January 2014: Pediatrics
Djillali Annane, Shidasp Siami, Samir Jaber, Claude Martin, Souheil Elatrous, Adrien Descorps Declère, Jean Charles Preiser, Hervé Outin, Gilles Troché, Claire Charpentier, Jean Louis Trouillet, Antoine Kimmoun, Xavier Forceville, Michael Darmon, Olivier Lesur, Jean Reignier, Jean Régnier, Fékri Abroug, Philippe Berger, Christophe Clec'h, Christophe Cle'h, Joël Cousson, Laure Thibault, Sylvie Chevret
IMPORTANCE: Evidence supporting the choice of intravenous colloid vs crystalloid solutions for management of hypovolemic shock remains unclear. OBJECTIVE: To test whether use of colloids compared with crystalloids for fluid resuscitation alters mortality in patients admitted to the intensive care unit (ICU) with hypovolemic shock. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, randomized clinical trial stratified by case mix (sepsis, trauma, or hypovolemic shock without sepsis or trauma)...
November 6, 2013: JAMA: the Journal of the American Medical Association
Perrin C White, Bryan A Dickson
OBJECTIVE: To assess current rates of complications of diabetic ketoacidosis (DKA), particularly cerebral edema, in a large tertiary-care pediatric hospital with a consistent management protocol. STUDY DESIGN: We report our single-center retrospective experience with 3712 admissions with DKA in 1999-2011. Our DKA protocol features a "3-bag" system using 2 bags of rehydration fluids, identical except for the presence in 1 bag of 10% dextrose, to allow rapid adjustment of glucose infusion rate...
September 2013: Journal of Pediatrics
Kambiz Kalantari, Jamison N Chang, Claudio Ronco, Mitchell H Rosner
Accurate assessment of a patient's volume status, as well as whether they will respond to a fluid challenge with an increase in cardiac output, is a critical task in the care of critically ill patients. Despite this, most decisions regarding fluid therapy are made either empirically or with limited and poor data. Given recent data highlighting the negative impact of either inadequate or overaggressive fluid therapy, understanding the tools and techniques available for accurate volume assessment is critical...
June 2013: Kidney International
2014-08-04 03:42:05
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