Intravenous fluid therapy in critically ill adults

Finfer, Simon; Myburgh, John; Bellomo, Rinaldo

doi:10.1038/s41581-018-0044-0

Cited by 177 publications

(184 citation statements)

References 103 publications

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“…Hydroxyethyl starch, one of the frequently administered colloid solutions, may have an unacceptable safety profile, notably by inducing potential nephrotoxicity, while offering no benefits other than a clinically unimportant volume-sparing effect. 22 Some evidence supports the specific use of albumin for volume loading in ACLF patients. Indeed, albumin offers numerous advantages over crystalloids beyond the simple volume expansion in patients with cirrhosis.…”

Section: Choice Of Fluid Therapymentioning

confidence: 97%

Shock Etiologies and Fluid Management in Liver Failure

Weiss

Paugam–Burtz

Jaber

2018

Semin Respir Crit Care Med

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Liver failure can occur in patients with or without underlying chronic liver disease (mainly cirrhosis) and is, respectively, termed acute on chronic liver failure or acute liver failure (ALF). In both cases, it is associated with marked systemic inflammation and profound hemodynamic disturbances, that is, increased cardiac output, peripheral vasodilation, and decreased systemic vascular resistance, on top of several superimposed etiologies of shock. In patients with cirrhosis, sepsis is the main cause of intensive care unit admission but portal hypertension-related gastrointestinal hemorrhage is also common. Septic shock is also particularly frequent in patients with ALF and can complicate the initial hypovolemic shock related to poor oral intake, vomiting, and encephalopathy prior to admission. Given the susceptibility of the liver to hypoxia and also the potential deleterious effects of fluid on liver function, the assessment of hemodynamic status and volume responsiveness is especially important in these patients. However, one should keep in mind that the hyperdynamic state and low systemic vascular resistance in liver failure may bias the accuracy of some hemodynamic monitoring devices. Fluid therapy should use crystalloids, and balanced salt solutions may limit the risk of hyperchloremic acidosis and subsequent adverse kidney events. Nevertheless, the beneficial effects of albumin resuscitation have been demonstrated in patients with cirrhosis and may reflect more than mere volume expansion.

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Section: Choice Of Fluid Therapymentioning

confidence: 97%

Shock Etiologies and Fluid Management in Liver Failure

Weiss

Paugam–Burtz

Jaber

2018

Semin Respir Crit Care Med

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“…In 2013, another meta-analysis on HES (25), including patients with different causes were grouped as one. Our analyses used a more comprehensive classi cation of those resuscitation uids according to the current knowledge (11) and separated patients' conditions, which yielded more clinically meaningful information.…”

Section: Previous Studies and Important Differences From This Studymentioning

confidence: 99%

“…Many review articles are opposed to gelatin use for uid resuscitation due to the risk of anaphylaxis and renal injury, but those opinions were based on animal studies, case series, or RCTs designed for other purposes (11,29,30). Recent large RCTs reveal opposing results, in that gelatin is associated with a non-signi cant, lower mortality than balanced crystalloids and saline 3 .…”

Section: Gelatinmentioning

confidence: 99%

“…Compared to isooncotic albumin, hyperoncotic albumin leads to a higher osmotic pressure, which may alter intra-glomerular oncotic force and osmotic nephrosis, and is associated with worse kidney damage (10). Chemical components, molecular weights, and colloid concentration might expose the human body to different levels of hazards (11). Among crystalloids, saline worsens acidosis and bleeding tendency compared to balanced crystalloids (12).…”

Section: Introductionmentioning

confidence: 99%

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Resuscitation Fluid Types in Sepsis, Surgical, and Trauma Patients: A Systematic Review and Sequential Network Meta-analyses

Tseng

Chen

et al. 2020

Preprint

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Background: Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with serious adverse events (AEs). Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be infer from sepsis to other patient group is uncertain, and other AEs is not comprehensive. This study aims to compare the survival benefits and AEs of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods: Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. CINeMA (Confidence in Network Meta-Analysis) web application was used to rate confidence in synthetic evidence. Results: Fifty-eight trials (n=26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer renal AEs, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids reduced mortality more than saline (OR, 0.84; 95% CI 0.74 to 0.95) and L-HES (OR, 0.81; 95% CI 0.69 to 0.95) and reduced renal AEs more than L-HES (OR, 0.80; 95% CI 0.65 to 0.99). However, they required the largest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was superior to iso-oncotic albumin (OR, 0.55; 95% CI 0.35 to 0.87).Conclusions: For sepsis and surgical patients, we recommend balanced crystalloids and albumin, rather than L-HES and saline. For traumatic brain injury patients, we recommend saline or L-HES, rather than iso-oncotic albumin or balanced crystalloids. These findings could guide physicians’ fluid selection.Trial registry: PROSPERO website, registration number: CRD42018115641).

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“…Echocardiography is increasingly advocated and clinically used in anaesthesia and intensive care for the assessment of haemodynamically unstable patients, including those with significantly changed volume status . A number of protocols suggest echocardiographic parameters such as left ventricular end diastolic volume, inferior/superior vena cava diameter, E / e ′ as surrogates for intravascular volume and filling pressures .…”

Section: Introductionmentioning

confidence: 99%

The stop‐flow arm equilibrium pressure in preoperative patients: Stressed volume and correlations with echocardiography

Yastrebov

Åneman

Slama

et al. 2019

Acta Anaesthesiol Scand

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Background:The distending intravascular pressure at no flow conditions reflects the stressed volume. While this haemodynamic variable is recognised as clinically important, there is a paucity of reports of its range and responsiveness to volume expansion in patients without cardiovascular disease and no reports of correlations to echocardiographic assessments of left ventricular filling.Methods: Twenty-seven awake (13 male), spontaneously breathing patients without any history of cardiopulmonary, vascular or renal disease were studied prior to induction of anaesthesia. The no-flow equilibrium pressure in the arm following rapid circulatory occlusion (P arm ) was measured via a radial arterial catheter. Transthoracic echocardiography was used to measure left ventricular end diastolic area and volume as well as the diameter of the inferior vena cava. The P arm and echocardiographic variables were measured before and after administration of 500 mL 0.9% NaCl over 10 minutes. Changes were analysed by paired t test, Pearson's correlation and multiple linear regression. Results: P arm increased overall from 22 ± 5 mm Hg to 25 ± 6 mm Hg (mean difference 3.0 ± 4.5 mm Hg, P = 0.002) following the fluid bolus with corresponding increases in arterial pressure and echocardiographic variables. Variability in the direction of the P arm response reflected concomitant changes in vascular compliance. Only weak correlations were observed between changes in P arm and inferior vena cava diameter indexed to body surface area (R 2 = 0.29, P = 0.01). Conclusion: Preoperative measurements of P arm increased following acute expansion of the intravascular volume. Echocardiography demonstrated poor correlation with P arm .

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Intravenous fluid therapy in critically ill adults

Cited by 177 publications

References 103 publications

Shock Etiologies and Fluid Management in Liver Failure

Shock Etiologies and Fluid Management in Liver Failure

Resuscitation Fluid Types in Sepsis, Surgical, and Trauma Patients: A Systematic Review and Sequential Network Meta-analyses

The stop‐flow arm equilibrium pressure in preoperative patients: Stressed volume and correlations with echocardiography

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