Effect of goal-directed fluid therapy on renal function in critically ill patients: a systematic review and meta-analysis

Zhao, Chao; Yan, Yonghong; Li, Zhiqiang; Wu, Xinhui; Zhao, Chai; Hu, Zhenjie

doi:10.1080/0886022x.2022.2072338

Cited by 6 publications

(5 citation statements)

References 52 publications

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“…In human patients, the GDFT algorithm using advanced hemodynamic monitoring has been shown successfully to reduce the risk of perioperative complications and improve postoperative patient outcomes. [2][3][4][5] In an effort to apply these findings and improve quality of patient care in veterinary medicine, specialists are investigating the use of minimally invasive methods such as the EDM as an alternative to PATD to evaluate FR and identify the patient's position on the Frank-Starling cardiac curve. To be adopted, the minimum requirement for this technique is to demonstrate safety and provide accurate information regarding the patient's hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

Esophageal Doppler-derived indices and arterial load variables provide useful hemodynamic information during assessment of fluid responsiveness in anesthetized dogs undergoing acute changes in blood volume

Paranjape

Henao-Guerrero

Menciotti

et al. 2023

ajvr

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OBJECTIVE To investigate the relationship between invasively measured stroke volume (SV) and (1) esophageal Doppler-derived indices such as stroke distance (StrokeD), flow time corrected (FTc), stroke distance variation (SDV), and peak velocity variation (PVV); and (2) arterial load (AL) variables during evaluation of fluid responsiveness (FR) in anesthetized dogs undergoing sudden hemodynamic shifts in blood volume. ANIMALS 6 healthy male dogs. PROCEDURES Dogs were anesthetized with isoflurane, ventilated mechanically, and instrumented to undergo sequential, nonrandomized experimental stages. The dogs transitioned from normovolemia (NORMO-BL) to hypovolemia (30% blood loss; HYPO-30), followed by autologous blood transfusion, and then to hypervolemia (colloid bolus). During each stage, SV was quantified using pulmonary artery thermodilution and its relationship with StrokeD, FTc, SDV, and PVV; and AL variables such as effective arterial elastance (Ea), dynamic arterial elastance (Eadyn), and total arterial compliance (Ca) were established. RESULTS As SV decreased significantly during HYPO-30 compared to NORMO-BL, there was a significant (P < .001) decrease in StrokeD, FTc, and Ca, with simultaneous increases in SDV, PVV, Ea, and Eadyn. Upon restoration of blood volume, these values stabilized closer to NORMO-BL. A significant (P < .001) correlation was observed between SV and StrokeD, FTc, Ea, Eadyn, and Ca. CLINICAL RELEVANCE Minimally invasive StrokeD, FTc, SDV, and PVV act as SV surrogates and help assess FR during different blood volume stages in healthy dogs. During hypovolemia-induced hypotension, Ea, Eadyn, and Ca may be able to guide therapeutic decisions favoring improvement in blood pressure and SV.

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Section: Discussionmentioning

confidence: 99%

Esophageal Doppler-derived indices and arterial load variables provide useful hemodynamic information during assessment of fluid responsiveness in anesthetized dogs undergoing acute changes in blood volume

Paranjape

Henao-Guerrero

Menciotti

et al. 2023

ajvr

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“…Consistent with our observation are data from a small clinical trial (HypoResus, NCT01411852) in which the proportion of AKI was nearly twice as high in the subjects that received a conservative PHC resuscitation in comparison to the standard resuscitation group (15). There are additional data to support the notion that PHC resuscitation is associated with a lower incidence of renal injury, but its applicability to present-day resuscitation of trauma victims is uncertain (21–23). Because we only observed the association between PHC and AKI after adjustment for additional risk factors, it is possible that this finding is a statistical artifact or unique to this particular cohort.…”

Section: Discussionmentioning

confidence: 99%

Prehospital Crystalloid Resuscitation: Practice Variation and Associations With Clinical Outcomes

Weykamp

Stern

Brakenridge

et al. 2022

Shock

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Introduction: Although resuscitation guidelines for injured patients favor blood products, crystalloid resuscitation remains a mainstay in prehospital care. Our understanding of contemporary prehospital crystalloid (PHC) practices and their relationship with clinical outcomes is limited. Methods: The Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial data set was used for this investigation. We sought to identify factors associated with PHC volume variation and hypothesized that higher PHC volume is associated with worse coagulopathy and a higher risk of acute respiratory distress syndrome (ARDS) but a lower risk of acute kidney injury (AKI). Subjects were divided into groups that received <1,000 mL PHC (PHC<1,000) and ≥1,000 mL PHC (PHC≥1,000); initial laboratory values and outcomes (ARDS and AKI risk) were summarized with medians and interquartile ranges or percentages and compared using Wilcoxon rank-sum tests and chi-square tests. The primary outcome was ARDS risk. Multivariable regression was used to characterize the association of each 500 mL aliquot of PHC with initial laboratory values and clinical outcomes. Results: PHC volume among study subjects (n = 680) varied (median, 0.3 L; interquartile range, 0–0.9 L) with weak associations demonstrated among prehospital hemodynamics, intubation, Glasgow Coma Score, and Injury Severity Score (0.008 ≤ R2 ≤ 0.09); prehospital time and enrollment site explained more variation in PHC volume with R2 values of 0.2 and 0.54, respectively. Compared with PHC<1,000, PHC≥1,000 had higher INR, PT, PTT, and base deficit and lower hematocrit and platelets. The proportion of ARDS in the PHC≥1,000 group was higher than PHC<1,000 (21% vs. 12%, P < 0.01), whereas the rate of AKI was similar between groups (23% vs. 23%, P = 0.9). In regression analyses, each 500 mL of PHC was associated with increased INR and PTT, and decreased hematocrit and platelet count (P < 0.05). Each 500 mL of PHC was associated with increased ARDS risk and decreased AKI risk (P < 0.05). Conclusion: PHC administration correlates poorly with prehospital hemodynamics and injury characteristics. Increased PHC volume is associated with greater anemia, coagulopathy, and increased risk of ARDS, although it may be protective against AKI.

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“…However, Zhao et al did not find a beneficial effect of GDFT on kidney function. This could be due to differences in patients, GDFT protocol and study design in each study (Zhao et al, 2022). In current investigation, there were 4 subjects in the standard fluid therapy group who experienced AKI, in all 4 subjects a 5-10 minute period of intraoperative hypotension was found.…”

Section: Analysis Of the Incidence Of Aki In Research Subjectsmentioning

confidence: 69%

Differences in serum lactate levels, AKI incidence, and intraoperative fluid therapy based on GDFT and standards in major laparotomy surgery patients

Hidayatullah

Waloejo

Semedi

2022

ijhs

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This study aimed to analyze the differences in serum lactate levels and the incidence of Acute Kidney Injury (AKI) in GDFT-based and standard liquid therapy in major laparotomy surgery with general anesthesia at Dr Soetomo Hospital. The type of research and research design used is a randomized clinical trials. The research design is an experimental study design. The observed study variables were then followed during surgery up to 48 hours after surgery for data retrieval and measurement. Patients covered by the study were patients who underwent elective major laparotomy at GBPT of Dr Soetomo Hospital. The results revealed that the administration of crystalloid solutions in the standard group was more than that of the GDFT group, while the administration of colloidal solutions in the standard group was less than that of the GDFT group. Intraoperative fluid balance in the standard group were larger compared to the GDFT group. The standard group had higher levels of postoperative serum lactate than the GDFT group (p < 0.001). The incidence of AKI in the standard group was 4 (18.2%) and no AKI incidence was found in the GDFT group.

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Effect of goal-directed fluid therapy on renal function in critically ill patients: a systematic review and meta-analysis

Cited by 6 publications

References 52 publications

Esophageal Doppler-derived indices and arterial load variables provide useful hemodynamic information during assessment of fluid responsiveness in anesthetized dogs undergoing acute changes in blood volume

Esophageal Doppler-derived indices and arterial load variables provide useful hemodynamic information during assessment of fluid responsiveness in anesthetized dogs undergoing acute changes in blood volume

Prehospital Crystalloid Resuscitation: Practice Variation and Associations With Clinical Outcomes

Differences in serum lactate levels, AKI incidence, and intraoperative fluid therapy based on GDFT and standards in major laparotomy surgery patients

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