Association Between Initial Fluid Choice and Subsequent In-Hospital Mortality During the Resuscitation of Adults With Septic Shock

Raghunathan, Karthik; Bonavia, Anthony; Nathanson, Brian H.; Beadles, Christopher; Shaw, Andrew; Brookhart, M. Alan; Miller, Timothy E.; Lindenauer, Peter K.

doi:10.1097/01.sa.0000490908.07423.52

Cited by 5 publications

(7 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the first one, the authors showed a decrease in in-hospital mortality for any increase in the fraction of balanced solutions over the total amount of fluids intravenously received for the initial resuscitation (2 days), irrespective of the total amount of fluids received [58]. In the second study, the administration of intravenous balanced solutions in association with 0.9% NaCl appeared to be associated with a lower in-hospital mortality and a similar length of stay and costs per day as compared to the exclusive administration of 0.9% NaCl [59].…”

Section: Balanced Intravenous Solutions In Relation To Safety and Surmentioning

confidence: 84%

“…This issue has been addressed by the same group of investigators in two large retrospective studies performed on the same large clinical database in two different cohorts of patients with sepsis [58,59]. In the first one, the authors showed a decrease in in-hospital mortality for any increase in the fraction of balanced solutions over the total amount of fluids intravenously received for the initial resuscitation (2 days), irrespective of the total amount of fluids received [58].…”

Section: Balanced Intravenous Solutions In Relation To Safety and Surmentioning

confidence: 94%

See 1 more Smart Citation

Intravenous balanced solutions: from physiology to clinical evidence

Länger

Santini

Scotti

et al. 2015

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

Abstract"Balanced" solutions are commonly defined as intravenous fluids having an electrolyte composition close to that of plasma. As such, they should minimally affect acid-base equilibrium, as compared to the commonly reported 0.9% NaCl-related hyperchloremic metabolic acidosis. Recently, the term "balanced" solution has been also employed to indicate intravenous fluids with low chloride content, being the concentration of this electrolyte the most altered in 0.9% NaCl as compared to plasma, and based upon a suggested detrimental alteration of renal function associated with hyperchloremia. Despite efforts made towards its identification, the ideal balanced solution, with minimal effects on acid-base status, low chloride content, and adequate tonicity, is not yet available. After the accumulation of pre-clinical and clinical physiologic data, in the last three years, several clinical trials, mostly observational and retrospective, have addressed the question of whether the use of balanced solutions has beneficial effects as compared to the standard of care, sometimes even suggesting an improvement in survival. Nonetheless, the first large randomized controlled trial comparing the effects of a balanced vs. unbalanced solutions on renal function in critically-ill patients (SPLIT trial, the 0.9% saline vs. Plasma-Lyte 148 for Intensive Care Unit Fluid Therapy), just recently published, showed identical equipoise between the two treatments. In the present review, we offer a comprehensive and updated summary on this issue, firstly, by providing a full physiological background of balanced solutions; secondly, by summarizing their potential pathophysiologic effects; and lastly, by presenting the clinical evidence available to support their use at the present time.

show abstract

Section: Balanced Intravenous Solutions In Relation To Safety and Surmentioning

confidence: 84%

Section: Balanced Intravenous Solutions In Relation To Safety and Surmentioning

confidence: 94%

Intravenous balanced solutions: from physiology to clinical evidence

Länger

Santini

Scotti

et al. 2015

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

show abstract

“…10,24 PLG was used to acutely expand intravascular volume by 25%. Large volumes of PLG are commonly used in shock treatment 25 and display a neutral effect on the coagulation system. 26 ACZ was used to promote carbon dioxide-mediated cerebral arteriolar vasodilation.…”

Section: Discussionmentioning

confidence: 99%

Cerebral collateral therapeutics in acute ischemic stroke: A randomized preclinical trial of four modulation strategies

Beretta

Versace

Carone

et al. 2017

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

Cerebral collaterals are dynamically recruited after arterial occlusion and highly affect tissue outcome in acute ischemic stroke. We investigated the efficacy and safety of four pathophysiologically distinct strategies for acute modulation of collateral flow (collateral therapeutics) in the rat stroke model of transient middle cerebral artery (MCA) occlusion. A composed randomization design was used to assign rats (n = 118) to receive phenylephrine (induced hypertension), polygeline (intravascular volume load), acetazolamide (cerebral arteriolar vasodilation), head down tilt (HDT) 15° (cerebral blood flow diversion), or no treatment, starting 30 min after MCA occlusion. Compared to untreated animals, treatment with collateral therapeutics was associated with lower infarct volumes (62% relative mean difference; 51.57 mm3 absolute mean difference; p < 0.001) and higher chance of good functional outcome (OR 4.58, p < 0.001). Collateral therapeutics acutely increased cerebral perfusion in the medial (+40.8%; p < 0.001) and lateral (+19.2%; p = 0.016) MCA territory compared to pretreatment during MCA occlusion. Safety indicators were treatment-related mortality and cardiorespiratory effects. The highest efficacy and safety profile was observed for HDT. Our findings suggest that acute modulation of cerebral collaterals is feasible and provides a tissue-saving effect in the hyperacute phase of ischemic stroke prior to recanalization therapy.

show abstract

“…Observational studies among critically ill adults suggested that use of balanced crystalloids might reduce the risk of death. 46 –48…”

Section: Crystalloidsmentioning

confidence: 99%

Fluid Management in Sepsis

Brown

Semler

2018

J Intensive Care Med

View full text Add to dashboard Cite

Among critically ill adults, sepsis remains both common and lethal. In addition to antibiotics and source control, fluid resuscitation is a fundamental sepsis therapy. The physiology of fluid resuscitation for sepsis, however, is complex. A landmark trial found early goal-directed sepsis resuscitation reduced mortality, but 3 recent multicenter trials did not confirm this benefit. Multiple trials in resource-limited settings have found increased mortality with early fluid bolus administration in sepsis, and the optimal approach to early sepsis resuscitation across settings remains unknown. After initial resuscitation, excessive fluid administration may contribute to edema and organ dysfunction. Using dynamic variables such as passive leg raise testing can predict a patient's hemodynamic response to fluid administration better than static variables such as central venous pressure. Whether using measures of "fluid responsiveness" to guide fluid administration improves patient outcomes, however, remains unknown. New evidence suggests improved patient outcomes with the use of balanced crystalloids compared to saline in sepsis. Albumin may be beneficial in septic shock, but other colloids such as starches, dextrans, and gelatins appear to increase the risk of death and acute kidney injury. For the clinician caring for patients with sepsis today, the initial administration of 20 mL/kg of intravenous balanced crystalloid, followed by consideration of the risks and benefits of subsequent fluid administration represents a reasonable approach. Additional research is urgently needed to define the optimal dose, rate, and composition of intravenous fluid during the management of patients with sepsis and septic shock.

show abstract

Association Between Initial Fluid Choice and Subsequent In-Hospital Mortality During the Resuscitation of Adults With Septic Shock

Cited by 5 publications

References 18 publications

Intravenous balanced solutions: from physiology to clinical evidence

Intravenous balanced solutions: from physiology to clinical evidence

Cerebral collateral therapeutics in acute ischemic stroke: A randomized preclinical trial of four modulation strategies

Fluid Management in Sepsis

Contact Info

Product

Resources

About