The Renal Factor in the Post-Traumatic “Fluid Overload” Syndrome

Lucas, Charles E.; Ledgerwood, Anna M.; Shier, Michael R.; Bradley, Volker

doi:10.1097/00005373-197709000-00003

Cited by 14 publications

(3 citation statements)

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“…Although the direct mechanisms by which excess CFB might increase mortality risk are unknown, we speculate that due to increase pulmonary capillary permeability, ARDS patients are likely to be sensitive to CFB-induced changes in hydrostatic pressure, resulting in worsened pulmonary edema, escalating mechanical ventilation needs, and subsequent atelectotrauma, barotrauma, and volutrauma (23,35). Others have proposed that FO may increase atrial natriuretic peptide secretion, impair the endothelial glycocalyx, and worsen microvascular perfusion (36)(37)(38)(39)(40).…”

Section: Discussionmentioning

confidence: 94%

Positive Cumulative Fluid Balance Is Associated With Mortality in Pediatric Acute Respiratory Distress Syndrome in the Setting of Acute Kidney Injury

Zinter

Spicer

Liu

et al. 2019

Pediatric Critical Care Medicine

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Section: Discussionmentioning

confidence: 94%

Positive Cumulative Fluid Balance Is Associated With Mortality in Pediatric Acute Respiratory Distress Syndrome in the Setting of Acute Kidney Injury

Zinter

Spicer

Liu

et al. 2019

Pediatric Critical Care Medicine

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“…It has been predicted that the decrease in respiratory failure, hypertension, increased cardiac output, and renal perfusion may be due to hypervolemia. [ 37 , 38 , 39 ]…”

Section: Discussionmentioning

confidence: 99%

Hypervolemia suppresses dilutional anaemic injury in a rat model of haemodilution

Cakir

Yavuz-Aksu²,

Aksu

2022

Journal of Translational Internal Medicine

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Background and Objectives Haemodilution leads to complications in clinical practice. It is exactly unknown whether this damage is caused by the fluid or by the stretching of the vascular bed. We aimed to compare two different haemodilution techniques at the same anaemic level. Methods Normovolemic or hypervolemic haemodilution was performed on twelve adult male Wistar rats. In the normovolemic procedure, blood was withdrawn and instantaneously administered with similar amounts of 6% hydroxyethyl starch (HES 130/0.4). Fluid was administered without withdrawing blood in the hypervolemic procedure. In both models, a 25% haematocrit level was targeted and kept at this level for 90 min to deepen the anaemia effect. Besides haemodynamics measurement, renal function (creatinine, blood urea nitrogen) and injury (tissue norepinephrine, malondialdehyde) were evaluated. Also, systemic hypoxia (lactate), oxidative stress (malondialdehyde, ischaemia-modified albumin), inflammation (tumour necrosis factor-alpha [TNF-α]), osmotic stress, adrenal stress (norepinephrine, epinephrine), and vascular stretching (atrial natriuretic peptide [ANP]) were assessed. Results Arterial pressure in the normovolemic group was lower than in the hypervolemic group. Serum creatinine, blood urea nitrogen, and lactate levels were higher in the normovolemic group. Tissue norepinephrine and malondialdehyde levels were higher in the normovolemic group. Serum ANP, malondialdehyde, ischaemia-modified albumin, free haemoglobin, syndecan-1, and TNF-α were higher in both groups compared to respective baseline. Conclusions Normovolemic haemodilution may lead to hypoxic kidney injury. The hypervolemic state may be advantageous if fluid is to be administered. Thus, the effect of the fluid itself can be relatively masked.

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“…Patients with acute renal failure frequently have a decreased plasma oncotic pressure, an increased hydrostatic pressure in pulmonary capillaries because of fluid overload, and subtle capillary injury in their lungs, particularly in the perihilar region. All these factors make such patients susceptible to pulmonary edema (4,90,91). Figure 7 shows the typical perihilar x-ray localization of fluid.…”

Section: Fluid Overloadmentioning

confidence: 99%

Acute Renal Failure

Kjellstrand¹,

Teehan²

Replacement of Renal Function by Dialysis

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Incidence of acute renal failure, need for dialysis Causes of acute renal failure, general workup of patients Pathogenesis, pathophysiology, and differential diagnosis of acute renal failure Experimental studies Clinical studies Differential diagnosis Avoiding dialysis-etiologic treatment Cause of death and prognostic factors Cause of death Prognostic factors Demographic factors Co-morbid condition Basic underlying disease Type and degree of renal failure Signs of infections Complicating disorders. 'Organ system failure' Type and quantity of dialysis Multifactorial prognostic formulae Summary of prognostic factors Treatment early: resuscitation Fluid overload Hyperkalemia Treatment late: conservative Avoiding infections Re-operation and surgical complications Nutrition, hyperalimentation Bleeding Other metabolic problems Use of drugs Treatment with acute dialysis Overview of methods Comparison of dialysis methods; intermittent and continuous hemodialysis; peritoneal dialysis 821 822 822 823 823 824 824 826 828 828 828 828 828 828 828 829 829 829 829 829 829 830 830 832 834 834 834 834 835 835 835 835 Acute dialysis Start, frequency and speed of dialysis Vascular access Anticoagulation Dialyzers and dialysis machines, biocompatibility Dialysis solutions-intermittent hemodialysis Sodium Potassium Calcium Magnesium B ica rbona tel acetate Dextrose Phosphorus Chloride Dialysis solutions-continuous hemodialysis Complications of hemodialysis and their treatment Blood pressure problems Cardiac arrhythmias Electrolyte abnormalities Disequilibrium Cell destruction Hypoxemia Peritoneal dialysis Access to the peritoneum Choice of fluids and additives Complications of peritoneal dialysis Technical problems Metabolic complications Cardiovascular and pulmonary complications Infectious complications Improving survival Recovery of renal function: need for continuous dialysis

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The Renal Factor in the Post-Traumatic “Fluid Overload” Syndrome

Cited by 14 publications

References 0 publications

Positive Cumulative Fluid Balance Is Associated With Mortality in Pediatric Acute Respiratory Distress Syndrome in the Setting of Acute Kidney Injury

Positive Cumulative Fluid Balance Is Associated With Mortality in Pediatric Acute Respiratory Distress Syndrome in the Setting of Acute Kidney Injury

Hypervolemia suppresses dilutional anaemic injury in a rat model of haemodilution

Acute Renal Failure

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