The great fluid debate: methodology, physiology and appendicitis

Priebe, Hans‐Joachim; Malbrain, Manu L N G; Elbers, Paul

doi:10.5603/ait.a2015.0067

Cited by 4 publications

(1 citation statement)

References 12 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It should also be stated that there are opposing views regarding the use of starches [79]. For example, several criticisms regarding the CHEST trial have been put forward which still require to be addressed [80,81]. Furthermore, it can be stated that in the CHEST trial starches were administered to patients that were not hypovolemic.…”

Section: Fluid Management After Surgerymentioning

confidence: 99%

Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA)

Malbrain

Länger

Annane

et al. 2020

Ann. Intensive Care

Self Cite

191

130

View full text Add to dashboard Cite

Intravenous fluid administration should be considered as any other pharmacological prescription. There are three main indications: resuscitation, replacement, and maintenance. Moreover, the impact of fluid administration as drug diluent or to preserve catheter patency, i.e., fluid creep, should also be considered. As for antibiotics, intravenous fluid administration should follow the four Ds: drug, dosing, duration, de-escalation. Among crystalloids, balanced solutions limit acid-base alterations and chloride load and should be preferred, as this likely prevents renal dysfunction. Among colloids, albumin, the only available natural colloid, may have beneficial effects. The last decade has seen growing interest in the potential harms related to fluid overloading. In the perioperative setting, appropriate fluid management that maintains adequate organ perfusion while limiting fluid administration should represent the standard of care. Protocols including a restrictive continuous fluid administration alongside bolus administration to achieve hemodynamic targets have been proposed. A similar approach should be considered also for critically ill patients, in whom increased endothelial permeability makes this strategy more relevant. Active de-escalation protocols may be necessary in a later phase. The R.O.S.E. conceptual model (Resuscitation, Optimization, Stabilization, Evacuation) summarizes accurately a dynamic approach to fluid therapy, maximizing benefits and minimizing harms. Even in specific categories of critically ill patients, i.e., with trauma or burns, fluid therapy should be carefully applied, considering the importance of their specific aims; maintaining peripheral oxygen delivery, while avoiding the consequences of fluid overload.

show abstract

Section: Fluid Management After Surgerymentioning

confidence: 99%

Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA)

Malbrain

Länger

Annane

et al. 2020

Ann. Intensive Care

Self Cite

191

130

View full text Add to dashboard Cite

show abstract

The Place for Starches and Other Colloids

Salhotra,

Wong,

Malbrain

2023

Rational Use of Intravenous Fluids in Critically Ill Patients

View full text Add to dashboard Cite

This chapter provides a comprehensive review of synthetic colloids, specifically hydroxyethyl starch (HES) solutions, and their role in resuscitation of critically ill, perioperative, and trauma patients. This chapter addresses various questions, including the crystalloid versus colloid debate, the strengths and weaknesses of different fluid trials and meta-analyses, and the specific situations or patient groups where colloids may have an advantage. This chapter focuses on the results of five major trials that compare the use of crystalloids versus colloids in critically ill patients. The 6S study and the CHEST trial confirmed the suspicion of renal damage associated with HES solutions, and the European Medicines Agency’s (EMA) safety committee prohibited the use of HES solutions in critically ill, septic, and burn patients, or those with kidney injury in 2013. However, many questions and controversies remained thereafter and more recently the European Commission has suspended the marketing authorizations of HES solutions for infusion. The use of HES and other synthetic colloids should be restricted to resuscitation in the perioperative setting or in limited volumes with extreme caution in trauma settings outside of the EU. The take-home messages include the availability of natural and synthetic colloids, the lack of outcome benefit in clinical trials, the association of HES with renal failure and increased use of renal replacement therapy, and the unsafe use of synthetic colloids in perioperative patients. This chapter recommends limiting the dose of synthetic colloids to 30ml/kg when given in the peri- and postoperative phase.

show abstract