Crystalloid infusion rate during fluid resuscitation from acute haemorrhage

Tatara, Tsuneo; Tsunetoh, Takashi; Tashiro, Chikara

doi:10.1093/bja/aem165

Cited by 24 publications

(18 citation statements)

References 8 publications

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“…In other words, crystalloid infusion can be regarded as a means of irrigating the whole body. Although a large volume of crystalloid is necessary to resuscitate patients in hemorrhagic shock, the effect is transient and is limited by the effective amount; this has been confi rmed by mathematical simulation [40,41]. The results of this mathematical model almost agree with our clinical experience, as we feel that there is a ceiling effect of crystalloid therapy for hemorrhagic hypotension (Fig.…”

Section: Crystalloid Infusion During Hemorrhagesupporting

confidence: 70%

“…This simulation employs the values of such parameters as vascular permeability and the ratio of lymph drainage from experimental data. Therefore, this simulation seemed to provide a feasible result (for details, refer to published articles [40,42]). Clinical experience in patients with sepsis with intractable hemodynamic instability has allowed us to recognize that maintaining the intravascular BV is hard to achieve, despite loading with large volumes.…”

Section: Crystalloid Infusion During Hemorrhagementioning

confidence: 99%

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Complexity of blood volume control system and its implications in perioperative fluid management

Iijima

2009

J Anesth

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The use of fluid therapy attempts to optimize blood circulation by manipulating the circulating blood volume (BV). BV may be a key intermediate parameter between fluid therapy and the blood circulation, and it has been assumed that BV can be controlled by fluid therapy. In order to construct a fluid therapy protocol, firstly, we have to confirm whether BV can actually be controlled by fluid therapy. Volume kinetics studies and dilution techniques for BV measurements have enabled the actual effects of fluid management on BV to be analyzed in the presence of various pathological conditions. Various studies have shown that the effect of fluid, especially crystalloid, on BV varies considerably among individuals, and even BV values measured at a single time point vary from 40 ml kg(-1) to 110 ml kg(-1). It has become apparent that such wide variations in interindividual BV preclude the establishment of universal optimal fluid management protocols. Thus, secondly, it should be clarified how BV is controlled, and whether or not we can control it. Perioperative BV reportedly changes in a manner that is independent of the in-out fluid balance, but is related to hormonal factors. Because inflammation and some hormones control vascular permeability and the renal adjustment of solutes and fluids, such factors may readjust the BV even after interventional fluid therapy. Perioperative BV may be predominantly controlled by an internal regulatory system, regardless of whether "restrictive" or "liberal" fluid management strategies are employed. Recognizing this physiological control of BV may help us to develop individualized fluid management strategies.

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Section: Crystalloid Infusion During Hemorrhagesupporting

confidence: 70%

Section: Crystalloid Infusion During Hemorrhagementioning

confidence: 99%

Complexity of blood volume control system and its implications in perioperative fluid management

Iijima

2009

J Anesth

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“…showed that a 75 mL/kg crystalloid infusion after hemorrhage momentarily restored BV during the infusion. When the infusion was stopped, however, BV decreased rapidly to a volume lower than it had been before the infusion [75]. This finding supports a concept developed using homeostatic blood states theory that a physiologic target BV will change according to changes in red cell volume; for example, a decrease of red cells after hemorrhage decreases the physiologic target BV by the volume of lost red cells [73].…”

Section: Reviewsupporting

confidence: 64%

The maintenance and monitoring of perioperative blood volume

et al. 2013

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The assessment and maintenance of perioperative blood volume is important because fluid therapy is a routine part of intraoperative care. In the past, patients undergoing major surgery were given large amounts of fluids because health-care providers were concerned about preoperative dehydration and intraoperative losses to a third space. In the last decade it has become clear that fluid therapy has to be more individualized. Because the exact determination of blood volume is not clinically possible at every timepoint, there have been different approaches to assess fluid requirements, such as goal-directed protocols guided by invasive and less invasive devices.This article focuses on laboratory volume determination, capillary dynamics, aspects of different fluids and how to clinically assess and monitor perioperative blood volume.

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“…In conclusion, an adaptive C‐L fluid administration system based on a compartmental model of fluid distribution computed an infusion rate to drive an endpoint of resuscitation (eg, SVV) during both absolute (controlled or uncontrolled), relative hypovolemia, or a combination of relative hypovolemia and absolute controlled hypovolemia. Fluid rates and volumes delivered approximated values recommended by studies that have modeled different fluid rates and volumes required to restore and maintain blood volume after acute hemorrhage . The proposed adaptive control framework did not require subject‐specific information (eg, age, gender, weight, diagnosis).…”

Section: Discussionmentioning

confidence: 98%

A pilot study evaluating adaptive closed‐loop fluid resuscitation during states of absolute and relative hypovolemia in dogs

Gholami

Haddad

Bailey

et al. 2018

J Vet Emergen Crit Care

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Crystalloid infusion rate during fluid resuscitation from acute haemorrhage

Abstract: Bolus crystalloid infusion exceeding 80 ml kg(-1) h(-1) may not increase effectiveness of fluid resuscitation. Crystalloid resuscitation for more than 2 h may be detrimental in view of an excessive net fluid retention.

Cited by 24 publications

References 8 publications

Complexity of blood volume control system and its implications in perioperative fluid management

Complexity of blood volume control system and its implications in perioperative fluid management

The maintenance and monitoring of perioperative blood volume

A pilot study evaluating adaptive closed‐loop fluid resuscitation during states of absolute and relative hypovolemia in dogs

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