Aiming for zero fluid accumulation: First, do no harm

Nieto, Orlando Rubén Pérez; Wong, Adrian; Fermin, Jorge Lopez; López, Éder Iván Zamarrón; Aguilar, Jose A Meade; Deloya-Tomás, Ernesto; Moya, Jorge D Carrion; Gutierrez, Gabriela Castillo; Ramos, Maria G Olvera; Montes, Xiomara García; Gutiérrez, Manuel; Aguilar, Fernando George; Díaz, Jesús Salvador Sánchez; Orozco, Raúl Soriano; Argaiz, Eduardo R.; Hernández‐Gilsoul, Thierry; Rio, Roberto Secchi Del; Ñamendys‐Silva, Silvio A.; Malbrain, Manu

doi:10.5114/ait.2021.105252

Cited by 18 publications

(10 citation statements)

References 119 publications

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“…Only half of patients with septic shock are volume-responsive during initial resuscitation, around 30% after two hours, and less than 20% after four hours[ 96 ]. The hemodynamic response to fluid administration can be assessed by dynamic tests that evaluate whether an increase in preload increases cardiac output[ 97 , 98 ].…”

Section: Hemodynamic Monitoringmentioning

confidence: 99%

Emerging concepts in the care of patients with cirrhosis and septic shock

Jiménez¹,

Garcia‐Tsao²,

Saffo³

2023

World J Hepatol

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Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review, we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly.

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Section: Hemodynamic Monitoringmentioning

confidence: 99%

Emerging concepts in the care of patients with cirrhosis and septic shock

Jiménez¹,

Garcia‐Tsao²,

Saffo³

2023

World J Hepatol

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“…We also identified the association between low FB and increased odds of mortality or HRQL deterioration, which may be due to inadequate fluid resuscitation, potentially contributing to clinical and/or subclinical ischemia to numerous organs and ultimately HRQL deterioration. The results of this study suggest that fluid can be harmful when administered in quantities either too high or too low relative to a patient’s requirements and objective assessments are needed to aid clinicians in fluid titration (38–40).…”

Section: Discussionmentioning

confidence: 99%

Fluid Balance and Its Association With Mortality and Health-Related Quality of Life: A Nonprespecified Secondary Analysis of the Life After Pediatric Sepsis Evaluation

Stenson

Banks

Reeder

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES: To evaluate the association between fluid balance (FB) and health-related quality of life (HRQL) among children at 1 month following community-acquired septic shock. DESIGN: Nonprespecified secondary analysis of the Life After Pediatric Sepsis Evaluation. FB was defined as 100 × [(cumulative PICU fluid input – cumulative PICU fluid output)/PICU admission weight]. Three subgroups were identified: low FB (< 5%), medium FB (5%–15%), and high FB (> 15%) based on cumulative FB on days 0–3 of ICU stay. HRQL was measured at ICU admission and 1 month after using Pediatric Quality of Life Inventory 4.0 Generic Core or Infant Scales or the Stein-Jessop Functional Status Scale. The primary outcome was a composite of mortality or greater than 25% decline in HRQL 1 month after admission compared with baseline. SETTING: Twelve academic PICUs in the United States. PATIENTS: Critically ill children between 1 month and 18 years, with community-acquired septic shock who survived to at least day 4. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred ninety-three patients were included of whom 66 (23%) had low FB, 127 (43%) had medium FB, and 100 (34%) had high FB. There was no difference in Pediatric Risk of Mortality Score 3 (median 11 [6, 17]), age (median 5 [1, 12]), or gender (47% female) between FB groups. After adjusting for potential confounders and comparing with medium FB, higher odds of mortality or greater than 25% HRQL decline were seen in both the low FB (odds ratio [OR] 2.79 [1.20, 6.57]) and the high FB (OR 2.16 [1.06, 4.47]), p = 0.027. Compared with medium FB, low FB (OR 4.3 [1.62, 11.84]) and high FB (OR 3.29 [1.42, 8.00]) had higher odds of greater than 25% HRQL decline. CONCLUSIONS: Over half of the children who survived septic shock had low or high FB, which was associated with a significant decline in HRQL scores. Prospective studies are needed to determine if optimization of FB can improve HRQL outcomes.

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“…The majority of patients with septic shock are fluid non-responders, and many of them experience fluid overload [ 13 , 100 ]. In this context, international recommendations regarding fluid management in the early phase of septic shock are currently debated [ 101 ], and those regarding the later phase of septic shock are not clearly defined [ 102 ].…”

Section: Discussionmentioning

confidence: 99%

Methods of assessing fluid responsiveness in septic shock patients: a narrative review

Weigl¹,

Adamski²,

Onichimowski³

et al. 2022

ait

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Septic shock, similar to other types of circulatory shock, is characterised by peripheral hypoperfusion and, consequently, inadequate tissue oxygen deli very. It is commonly believed that intravenous fluid infusion improves organ perfusion and reverses cel lular dysoxia. This belief might be valid in the early phase of septic shock, and some earlier studies [1] and international recommendations (Surviving Sepsis Campaign) [2] support this view. The physio logical rationale behind fluid bolus administration is that it causes intravascular volume expansion. According to the FrankStarling principle, increased left ventricular enddiastolic volume (i.e., preload) increases stroke volume (SV), resulting in improved organ perfusion. This mechanism works until the optimal preload is achieved. However, the patho physiology of septic shock is complex and compris es both distributive and cardiogenic components. At the peripheral level, the inflammatory process in sepsis damages the endothelial glycocalyx [3] and

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Aiming for zero fluid accumulation: First, do no harm

Cited by 18 publications

References 119 publications

Emerging concepts in the care of patients with cirrhosis and septic shock

Emerging concepts in the care of patients with cirrhosis and septic shock

Fluid Balance and Its Association With Mortality and Health-Related Quality of Life: A Nonprespecified Secondary Analysis of the Life After Pediatric Sepsis Evaluation

Methods of assessing fluid responsiveness in septic shock patients: a narrative review

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