Response to Fluid Boluses in the Fluid and Catheter Treatment Trial

Lammi, Matthew R.; Aiello, Brianne; Burg, Gregory; Rehman, Tayyab; Douglas, Ivor S.; Wheeler, Arthur P.; deBoisblanc, Bennett P.

doi:10.1378/chest.15-0445

Cited by 45 publications

(27 citation statements)

References 22 publications

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“…5-7 59 As a result of the effects of sepsis on the venous capacitance vessels and myocardial function, it is likely that less than 40% of hypotensive patients with severe sepsis or septic shock are 'fluid responders'. [60][61][62] The goal of fluid resuscitation is to increase the stressed blood volume and MCFP more than the CVP, and thereby increase the pressure gradient for venous return. However the ability of crystalloids (the most common fluid used for the resuscitation of patients with sepsis) to expand the intravascular volume is poor.…”

Section: Fluid Responsiveness and The Haemodynamic Effects Of Fluids mentioning

confidence: 99%

A rational approach to fluid therapy in sepsis

Marik

Bellomo

2016

British Journal of Anaesthesia

238

160

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Aggressive fluid resuscitation to achieve a central venous pressure (CVP) greater than 8 mm Hg has been promoted as the standard of care, in the management of patients with severe sepsis and septic shock. However recent clinical trials have demonstrated that this approach does not improve the outcome of patients with severe sepsis and septic shock. Pathophysiologically, sepsis is characterized by vasoplegia with loss of arterial tone, venodilation with sequestration of blood in the unstressed blood compartment and changes in ventricular function with reduced compliance and reduced preload responsiveness. These data suggest that sepsis is primarily not a volume-depleted state and recent evidence demonstrates that most septic patients are poorly responsive to fluids. Furthermore, almost all of the administered fluid is sequestered in the tissues, resulting in severe oedema in vital organs and, thereby, increasing the risk of organ dysfunction. These data suggest that a physiologic, haemodynamically guided conservative approach to fluid therapy in patients with sepsis would be prudent and would likely reduce the morbidity and improve the outcome of this disease.

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Section: Fluid Responsiveness and The Haemodynamic Effects Of Fluids mentioning

confidence: 99%

A rational approach to fluid therapy in sepsis

Marik

Bellomo

2016

British Journal of Anaesthesia

238

160

View full text Add to dashboard Cite

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“…Indeed, the physiological effects of fluid boluses given in ICU appear to be small. In post hoc analyses of randomised trials in ARDS [6] and sepsis [7], the mean increase in blood pressure following a fluid bolus was in the order of 2 mmHg and decrease in heart rate 1 bpm, with no change in urine output, and even these modest benefits often dissipate after as little as 1 h [8]. These data are in stark contrast to clinician-reported perceptions of efficacy in nearly 70% of fluid boluses [2].…”

Section: Efficacy Of Intravenous Fluid Administrationmentioning

confidence: 85%

Liberal versus restrictive fluid therapy in critically ill patients

2019

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“…The increased CVP may lead to increasing venous pressure and impair organ function and microcirculatory flow, particularly for encapsulated organs such as the kidney and liver 76 . To make matters worse, the hemodynamic response to fluids in patients with circulatory shock is brief as >90% of the fluid leaks into the tissues 86 , 87 . In a systematic review of the hemodynamic response of fluid boluses in patients with sepsis, 88 the MAP increased by 7.8 ± 3.8 mm Hg immediately following the fluid bolus, but within an hour, the MAP had returned to baseline with no increase in urine output.…”

Section: Management Of Sepsismentioning

confidence: 99%

Sepsis: Current Definition, Pathophysiology, Diagnosis, and Management

2017

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Sepsis is a clinical syndrome that results from the dysregulated inflammatory response to infection that leads to organ dysfunction. The resulting losses to society in terms of financial burden, morbidity, and mortality are enormous. We provide a review of sepsis, its underlying pathophysiology, and guidance for diagnosis and management of this common disease. Current established treatments include appropriate antimicrobial agents to target the underlying infection, optimization of intravascular volume to improve stroke volume, vasopressors to counteract vasoplegic shock, and high‐quality supportive care. Appropriate implementation of established treatments combined with novel therapeutic approaches promises to continue to decrease the impact of this disease.

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Response to Fluid Boluses in the Fluid and Catheter Treatment Trial

Abstract: BACKGROUND:Recent emphasis has been placed on methods to predict fl uid responsiveness, but the usefulness of using fl uid boluses to increase cardiac index in critically ill patients with ineff ective circulation or oliguria remains unclear.

Cited by 45 publications

References 22 publications

A rational approach to fluid therapy in sepsis

A rational approach to fluid therapy in sepsis

Liberal versus restrictive fluid therapy in critically ill patients

Sepsis: Current Definition, Pathophysiology, Diagnosis, and Management

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