Everything you need to know about deresuscitation

Malbrain, Manu L N G; Martin, Greg S.; Ostermann, Marlies

doi:10.1007/s00134-022-06761-7

Cited by 50 publications

(49 citation statements)

References 29 publications

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“…When treating the critically ill, we can recognize the typical timing and aggressivity of the therapy, but not the source of the disease. For the time evolution of fluid treatment and accumulation, the R-O-S-E acronym ( Figure 1 ) has been proposed [ 5 ]. Instead of Resuscitation, Optimization, Stabilization, and Evacuation, we can sometimes see other acronyms replacing the “R” with “S” as Salvage or “E” with “D” as De-escalation.…”

Section: Rose Concept and Individual Fluid Managementmentioning

confidence: 99%

“…However, the evacuation process should not be deliberate, and we must monitor the patient’s hemodynamic status and laboratory values (sodium, osmolality, and blood urea nitrogen) very carefully. Sometimes we speak about a late goal-directed fluid removal strategy [ 5 ]. Our aim should be on the physiologic level of fluid responsiveness without signs of low cardiac output and standard laboratory.…”

Section: Active Evacuationmentioning

confidence: 99%

“…Moreover, Lowell described the concept of fluid overload in 1990 [ 4 ], which evolved into fluid accumulation (any increase in weight induced by fluids) and fluid accumulation syndrome (FAS). The FAS has recently been defined as any amount of fluid accumulation that leads to organ dysfunction [ 5 ]. Based on clinical practice, the lungs are an organ extremely vulnerable to fluid accumulation, and multiple studies demonstrate the benefit of “dry” or “restrictive” regimes [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Individualizing Fluid Management in Patients with Acute Respiratory Distress Syndrome and with Reduced Lung Tissue Due to Surgery—A Narrative Review

Beneš

Kasperek

Smékalová

et al. 2023

JPM

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Fluids are the cornerstone of therapy in all critically ill patients. During the last decades, we have made many steps to get fluid therapy personalized and based on individual needs. In patients with lung involvement—acute respiratory distress syndrome—finding the right amount of fluids after lung surgery may be extremely important because lung tissue is one of the most vulnerable to fluid accumulation. In the current narrative review, we focus on the actual perspectives of fluid therapy with the aim of showing the possibilities to tailor the treatment to a patient’s individual needs using fluid responsiveness parameters and other therapeutic modalities.

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Section: Rose Concept and Individual Fluid Managementmentioning

confidence: 99%

Section: Active Evacuationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Individualizing Fluid Management in Patients with Acute Respiratory Distress Syndrome and with Reduced Lung Tissue Due to Surgery—A Narrative Review

Beneš

Kasperek

Smékalová

et al. 2023

JPM

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“…Concomitant vasopressor therapy should be considered in case of vasodilation and hypotension and inotropic support in the setting of heart failure. Diuretics only have a role in oliguria if fluid accumulation has occurred and should only be administered following an assessment of the intravascular fluid status [8].…”

Section: Managementmentioning

confidence: 99%

Management of oliguria

2022

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“…Objective assessment of hemodynamic conditions is fundamental to guide the clinical management of the cardiac surgery patient during the postoperative period [ 1 , 2 , 3 ]. Meticulous fluid management is crucial in patients undergoing cardiac surgery, particularly in those with heart failure; prolonged operative and aortic cross-clamp time; or preexisting kidney, lung, or liver dysfunction [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Association between Hepatic Venous Congestion and Adverse Outcomes after Cardiac Surgery

et al. 2022

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Introduction: Hepatic venous flow patterns reflect pressure changes in the right ventricle and are also markers of systemic venous congestion. Fluid management is crucial in patients undergoing cardiac surgery. Methods: Our goal was to determine which factors are associated with the increased congestion of the liver as measured by Doppler ultrasound in patients undergoing cardiac surgery. This prospective, observational study included 41 patients without preexisting liver disease who underwent cardiac surgery between 1 January 2021 and 30 September 2021 at a tertiary heart center. In addition to routine echocardiographic examination, we recorded the maximal velocity and velocity time integral (VTI) of the standard four waves seen in the common hepatic vein (flow profile) using Doppler ultrasound preoperatively and at the 20–24th hour of the postoperative period. The ratios of the retrograde and anterograde hepatic venous waves were calculated, and the waveforms were compared to the baseline value and expressed as a delta ratio. Demographic data, pre- and postoperative echocardiographic parameters, intraoperative variables (procedure, cardiopulmonary bypass time), postoperative factors (fluid balance, vasoactive medication requirement, ventilation time and parameters) and perioperative laboratory parameters (liver and kidney function tests, albumin) were used in the analysis. Results: Of the 41 patients, 20 (48.7%) were males, and the median age of the patients was 65.9 years (IQR: 59.8–69.9 years). Retrograde VTI growth showed a correlation with positive fluid balance (0.89 (95% CI 0.785–0.995) c-index. After comparing the postoperative echocardiographic parameters of the two subgroups, right ventricular and atrial diameters were significantly greater in the “retrograde VTI growth” group. The ejection fraction and decrement in ejection fraction to preoperative parameters were significantly different between the two groups. (p = 0.001 and 0.003). Ventilation times were longer in the retrograde VTI group. The postoperative vs. baseline delta VTI ratio of the hepatic vein correlated with positive fluid balance, maximum central venous pressure, and ejection fraction. (B = −0.099, 95% CI = −0.022–0.002, p = 0.022, B = 0.011, 95% CI = 0.001–0.021, p = 0.022, B = 0.091, 95% CI = 0.052–0.213, p = 0.002, respectively.) Conclusion: The increase of the retrograde hepatic flow during the first 24 h following cardiac surgery was associated with positive fluid balance and the decrease of the right ventricular function. Measurement of venous congestion or venous abdominal insufficiency seems to be a useful tool in guiding fluid therapy and hemodynamic management.

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Everything you need to know about deresuscitation

Cited by 50 publications

References 29 publications

Individualizing Fluid Management in Patients with Acute Respiratory Distress Syndrome and with Reduced Lung Tissue Due to Surgery—A Narrative Review

Individualizing Fluid Management in Patients with Acute Respiratory Distress Syndrome and with Reduced Lung Tissue Due to Surgery—A Narrative Review

Management of oliguria

Association between Hepatic Venous Congestion and Adverse Outcomes after Cardiac Surgery

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