Focus on fluid therapy

Perner, Anders; Hjortrup, Peter Buhl; Pettilä, Ville

doi:10.1007/s00134-017-4956-0

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…Also oliguria has been questioned as a trigger for fluid therapy because renal blood flow may be normal or even increased in patients with septic shock [23], the pathophysiology of acute kidney injury (AKI) in sepsis is complex and multifactorial [24], and systemic hemodynamic response and renal response to fluid challenge are often dissociated [25,26]. After the initial resuscitation, fluid administration may not increase urinary output and contributes to positive fluid balance and potentially worsening of AKI in patients with septic shock [17,27,28].…”

Section: Triggers and Targetsmentioning

confidence: 99%

Expert statement for the management of hypovolemia in sepsis

et al. 2018

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Hypovolemia is frequent in patients with sepsis and may contribute to worse outcome. The management of these patients is impeded by the low quality of the evidence for many of the specific components of the care. In this paper, we discuss recent advances and controversies in this field and give expert statements for the management of hypovolemia in patients with sepsis including triggers and targets for fluid therapy and volumes and types of fluid to be given. Finally, we point to unanswered questions and suggest a roadmap for future research.

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Section: Triggers and Targetsmentioning

confidence: 99%

Expert statement for the management of hypovolemia in sepsis

et al. 2018

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“…Resuscitation with intravascular fluids is one of the key interventions in septic patients and has the aim to correct symptomatic hypovolemia and restore vital organ perfusion. Although fluid resuscitation is commonly carried out, some important questions are still a matter of debate …”

Section: Introductionmentioning

confidence: 99%

Economic model of albumin infusion in septic shock: The EMAISS study

Guidet

Ghout

Ropers

et al. 2020

Acta Anaesthesiol Scand

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Background The cost‐effectiveness of albumin‐based fluid support in patients with septic shock is currently unknown. Methods In a simulation study, we compared standard medical practice and systematic 20% albumin infusion. The study population consisted of patients with septic shock admitted to one of the 28 ICUs belonging to the Cub‐Réa regional database between 1 January 2014 and 31 December 2016. Cost estimates were based on French diagnosis‐related groups and fixed daily prices. Estimation of mortality reduction relied on ALBIOS trial data documenting a Risk Ratio of 0.87 in a non‐preplanned subgroup of patients with septic shock. Life expectancy was estimated with follow up data of 184 patients with septic shock admitted in the year 2000 in the same ICUs. Several sensitivity analyses were performed including a one‐way Deterministic Sensitivity Analysis (DSA) and a Probabilistic multivariate Sensitivity Analysis (PSA). Results About 6406 patients were included. In the base‐case scenario, the mean live years gained with albumin was 0.49. The mean extra cost of using albumin was €480 per year. The cost per year gained was €974. Sensitivity analyses confirmed the robustness of the results. The probability of albumin being cost‐effective was 95% and 97% for a threshold fixed at €20 000 and €30 000 per life‐year saved, respectively. Conclusion Based on the risk reduction observed in the septic shock subgroup analysis of the ALBIOS dataset, the application of the ALBIOS trial results to Cub‐Réa data may suggest that albumin infusion is likely cost‐effective in septic shock.

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“…Other indices of RV function or for example inferior vena cava measurements may also reflect venous congestion and be associated with AKI [38]. Fluid balance may influence right ventricular function and thus interact with the association with AKI [39]. The optimal variable representing venous hemodynamic function for evaluation of association with AKI in the critically ill is to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

Associations between tricuspid annular plane systolic excursion to reflect right ventricular function and acute kidney injury in critically ill patients: a SICS-I sub-study

Wiersema

Koeze

Hiemstra

et al. 2019

Ann. Intensive Care

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BackgroundAcute kidney injury (AKI) occurs in up to 50% of all critically ill patients and hemodynamic abnormalities are assumed to contribute, but their nature and share is still unclear. We explored the associations between hemodynamic variables, including cardiac index and right ventricular function, and the occurrence of AKI in critically ill patients.MethodsIn this prospective cohort study, we included all patients acutely admitted to an intensive care unit (ICU). Within 24 h after ICU admission clinical and hemodynamic variables were registered including ultrasonographic measurements of cardiac index and right ventricular function, assessed using tricuspid annular plane systolic excursion (TAPSE) and right ventricular systolic excursion (RV S’). Maximum AKI stage was assessed according to the KDIGO criteria during the first 72 h after admission. Multivariable logistic regression modeling was used including both known predictors and univariable significant predictors of AKI. Secondary outcomes were days alive outside ICU and 90-day mortality.ResultsA total of 622 patients were included, of which 338 patients (54%) had at least AKI stage 1 within 72 h after ICU admission. In the final multivariate model higher age (OR 1.01, 95% CI 1.00–1.03, for each year), higher weight (OR 1.03 CI 1.02–1.04, for each kg), higher APACHE IV score (OR 1.02, CI 1.01–1.03, per point), lower mean arterial pressure (OR 1.02, CI 1.01–1.03, for each mmHg decrease) and lower TAPSE (OR 1.05, CI 1.02–1.09 per millimeter decrease) were all independent predictors for AKI in the final multivariate logistic regression model. Sepsis, cardiac index, RV S’ and use of vasopressors were not significantly associated with AKI in our data. AKI patients had fewer days alive outside of ICU, and their mortality rate was significantly higher than those without AKI.ConclusionsIn our cohort of acutely admitted ICU patients, the incidence of AKI was 54%. Hemodynamic variables were significantly different between patients with and without AKI. A worse right ventricle function was associated with AKI in the final model, whereas cardiac index was not.Electronic supplementary materialThe online version of this article (10.1186/s13613-019-0513-z) contains supplementary material, which is available to authorized users.

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Focus on fluid therapy

Cited by 5 publications

References 20 publications

Expert statement for the management of hypovolemia in sepsis

Expert statement for the management of hypovolemia in sepsis

Economic model of albumin infusion in septic shock: The EMAISS study

Associations between tricuspid annular plane systolic excursion to reflect right ventricular function and acute kidney injury in critically ill patients: a SICS-I sub-study

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