Effects of fluid administration on arterial load in septic shock patients

García, Manuel Ignacio Monge; González, Pedro Guijo; Romero, Manuel Gracia; Cano, Anselmo Gil; Oscier, Chris; Rhodes, Andrew; Grounds, Robert Michael; Cecconi, Maurizio

doi:10.1007/s00134-015-3898-7

Cited by 105 publications

(63 citation statements)

References 36 publications

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“…Conversely, the pH‐lowering effects of saline may lead to higher doses of vasopressors for longer durations compared with balanced fluid resuscitation . Over‐resuscitation with fluids was also found to decrease the systemic vascular resistance, negating the intended therapeutic effect of the fluid or vasopressor used . Hydrocortisone may also interact with the fluid compartments; pretreatment with this agent was shown to preserve glycocalyx integrity in both septic animal models and pilot surgical studies .…”

Section: Fluid Pharmacokinetics and Pharmacodynamics In The Septic Pamentioning

confidence: 99%

Establishing the Therapeutic Index of Fluid Resuscitation in the Septic Patient: A Narrative Review and Meta‐Analysis

2020

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This comprehensive review comparatively evaluates the safety and benefits of parenteral fluids used in resuscitation with a focus on sepsis. It also provides a random‐effects meta‐analysis of studies comparing restrictive resuscitation and usual care in sepsis with the primary outcome of mortality. In the septic patient, fluid therapy remains a complex interplay between fluid compartments in the body, the integrity of the endothelial barrier, and the inflammatory tone of the patient. Recent data have emerged describing the pharmacokinetics of fluid resuscitation that can be affected by the factors just listed, as well as mean arterial pressure, rate of infusion, volume of fluid infusate, nature of the fluid, and drug interactions. Fluid overload in sepsis has been associated with vasodilation, kidney injury, and increased mortality. Restrictive resuscitation after the initial septic insult is an emerging practice. Our search strategy of Medline databases revealed six randomized studies with 706 patients that examined restrictive resuscitation in sepsis. Results of this meta‐analysis demonstrated no differences in mortality with restrictive resuscitation compared with usual care (30.6% vs 37.8%; risk ratio 0.83, 95% confidence interval 0.66–1.05, respectively) but was limited by the small number of studies and larger quantities of pre‐randomization fluids. Another approach to address fluid overload is active (diuresis) de‐resuscitation strategies that may shorten the need for mechanical ventilation and intensive care unit length of stay. Data suggest that colloids may confer mortality benefit over saline in the most severely ill septic patients. Compared with isotonic saline, balanced resuscitation fluids are associated with a lower incidence of acute kidney injury and mortality. The benefits of balanced resuscitation fluids are most evident when higher volumes of fluids are used for sepsis. Clinicians should consider these pharmacotherapeutic factors when selecting a fluid, its quantity, and rate of infusion.

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Section: Fluid Pharmacokinetics and Pharmacodynamics In The Septic Pamentioning

confidence: 99%

Establishing the Therapeutic Index of Fluid Resuscitation in the Septic Patient: A Narrative Review and Meta‐Analysis

2020

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“…Monge-Garcia et al administered 500 mL of either crystalloid or colloid for 30 min and evaluated the SV/CO using Doppler transesophageal echocardiography and reported a 10% decrease in the SVR by infusion in fluid responders (67%) [10]. This result suggests that not only increased preload but also decreased afterload is involved in the increase of SV/CO with small amounts of fluid challenge.…”

Section: Reviewmentioning

confidence: 99%

“…Conditions are consistent with blood pressure control for critically ill patients, who have sepsis or ARDS. SVR is also known to decrease by infusion in septic patients [10]. Furthermore, in septic patients, although the MAP is transiently increased by the fluid bolus administration, it returns to base line within 1 h [8, 9].…”

Section: Reviewmentioning

confidence: 99%

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Predicting the Need for Fluid Therapy—Does Fluid Responsiveness Work?

Ueyama

Kiyonaka

2017

j intensive care

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Fluid overdose can be harmful in critically ill patients. Since central venous pressure (CVP) is currently considered to be an inappropriate indicator of preload, much attention is being given to predicting fluid responsiveness, i.e., the response of stroke volume (SV) or cardiac output (CO) to fluid challenge. However, when fluid responsiveness was evaluated in critically ill patients, including sepsis, only 40–50% of the patients responded. Moreover, most fluid responders do not show significant hemodynamic improvement after fluid administration. In this review, we discuss why fluid responsiveness based on the Starling mechanism did not work well in the clinical setting.According to the Starling mechanism, a patient whose SV/CO significantly increases after a fluid challenge is considered to be a fluid responder and judged to need fluid therapy. However, the currently recommended fluid challenge dose of crystalloid 250–500 mL has little effect on increasing blood volume and is not sufficient to increase the preload of the Starling curve. Especially in septic patients, due to their vascular hyperpermeability, increase in blood volume is even smaller. Furthermore, Infusion induced hemodilution is known to reduce blood viscosity and hematocrit, as a result, decreasing afterload. This indicates that the increased SV/CO after fluid challenge is caused not only by increased preload but also by decreased afterload. For these reasons, fluid responsiveness with small crystalloid challenge is questionable as a clinical indicator of fluid therapy.

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“…Moreover, studies have shown that only approximately 50% of critically ill patients in whom the fluid is administered do exhibit an increase in blood flow and that half of the patients will receive unnecessary fluid loading. [4567891011]…”

Section: Introductionmentioning

confidence: 99%

Passive leg raising: Simple and reliable technique to prevent fluid overload in critically ill patients

Assadi

2017

Int J Prev Med

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Background:Dynamic measures, the response to stroke volume (SV) to fluid loading, have been used successfully to guide fluid management decisions in critically ill patients. However, application of dynamic measures is often inaccurate to predict fluid responsiveness in patients with arrhythmias, ventricular dysfunction or spontaneously breathing critically ill patients. Passive leg raising (PLR) is a simple bedside maneuver that may provide an accurate alternative to guide fluid resuscitation in hypovolemic critically ill patients.Methods:Pertinent medical literature for fluid responsiveness in the critically ill patient published in English was searched over the past three decades, and then the search was extended as linked citations indicated.Results:Thirty-three studies including observational studies, randomized control trials, systemic review, and meta-analysis studies evaluating fluid responsiveness in the critically ill patient met selection criteria.Conclusions:PLR coupled with real-time SV monitors is considered a simple, noninvasive, and accurate method to determine fluid responsiveness in critically ill patients with high sensitivity and specificity for a 10% increase in SV. The adverse effect of albumin on the mortality of head trauma patients and chloride-rich crystalloids on mortality and kidney function needs to be considered when choosing the type of fluid for resuscitation.

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Effects of fluid administration on arterial load in septic shock patients

Cited by 105 publications

References 36 publications

Establishing the Therapeutic Index of Fluid Resuscitation in the Septic Patient: A Narrative Review and Meta‐Analysis

Establishing the Therapeutic Index of Fluid Resuscitation in the Septic Patient: A Narrative Review and Meta‐Analysis

Predicting the Need for Fluid Therapy—Does Fluid Responsiveness Work?

Passive leg raising: Simple and reliable technique to prevent fluid overload in critically ill patients

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