Evidence-based fluid management in the ICU

Schindler, A.; Marx, Gernot

doi:10.1097/aco.0000000000000303

Cited by 19 publications

(16 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is likely that additional volume fluid loading in our mode, would have been beneficial to hemodynamic recovery. At the bedside, such a clinical pattern should be corrected by individually adapted fluid and vasopressor treatment, even though fluid management remains extremely challenging in patients with septic shock [36]. Consequently, while reduction in heart rate is counterintuitive in instances of hypovolemia, on the contrary, a lower dose of esmolol may appear more appropriate in patients with septic shock.…”

Section: Discussionmentioning

confidence: 99%

Effects of low doses of esmolol on cardiac and vascular function in experimental septic shock

et al. 2016

View full text Add to dashboard Cite

BackgroundAdministration of a selective β1-blocker, such as esmolol, in human septic shock has demonstrated cardiovascular protective effects related to heart rate reduction. Certain experimental data also indicate that esmolol exerts systemic anti-inflammatory and beneficial effects on vascular tone. Thus, the present study aimed to determine whether a non-chronotropic dose of esmolol maintains its protective cardiovascular and anti-inflammatory effects in experimental septic shock.MethodsFour hours after cecal ligation and puncture (CLP), Wistar male rats were randomly allocated to the following groups (n = 8): CLP, CLP + E-1 (esmolol: 1 mg.kg−1.h−1), CLP + E-5 (esmolol: 5 mg.kg−1.h−1), CLP + E-18 (esmolol: 18 mg.kg−1.h−1). An additional eight rats underwent sham operation. All rats received a continuous infusion of saline, analgesic and antibiotics 4 hours after the surgery. Assessment at 18 hours included in vivo cardiac function assessed by echocardiography and ex vivo vasoreactivity assessed by myography. Circulating cytokine levels (IL-6 and IL-10) were measured by ELISA. Cardiac and vascular protein expressions of p-NF-κB, IκBα, iNOS, p-AKT/AKT and p-eNOS/eNOS were assessed by western blotting.ResultsCLP induced tachycardia, hypotension, cardiac output reduction, hyperlactatemia and vascular hypo-responsiveness to vasopressors. Compared to CLP animals, heart rate was unchanged in CLP + E-1 and CLP + E-5 but was reduced in CLP + E-18. Stroke volume, cardiac output, mean arterial pressure and lactatemia were improved in CLP + E-1 and CLP + E-5, while vascular responsiveness to phenylephrine was only improved in CLP + E-5 and CLP + E-18. Plasma IL-6 levels were decreased in all esmolol groups. p-NF-κB was decreased in both cardiac and vascular tissues in CLP + E-5 and CLP + E-18.ConclusionIn experimental septic shock, low doses of esmolol still improved cardiac function and vasoreactivity. These benefits appear to be associated with a modulation of inflammatory pathways.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1580-2) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of low doses of esmolol on cardiac and vascular function in experimental septic shock

et al. 2016

View full text Add to dashboard Cite

show abstract

“…In subgroup analysis of hypovolemic patients, colloids are significantly more effective for fluid resuscitation, as they may produce a larger increase in stroke volume than crystalloids. 69 Thus, normal volume can be reached faster with colloids than with crystalloids. In subgroup analysis on elderly patients, the mortality was similar among different types of resuscitation fluids.…”

Section: Discussionmentioning

confidence: 99%

“… 77 Among critically ill patients, exposure to positive or negative fluid balance was associated with higher 1-year mortality compared with euvolemic state. 78 However, the most commonly used static parameters (such as central venous pressure [CVP] or pulmonary artery occlusion pressure [PAOP]) cannot predict volume responsiveness, 69 and echocardiography was recommended to predict and measure fluid responsiveness. 79 Among the included studies, the patients may actually have positive and negative fluid balance, and this may influence the mortality or AKI incidence, which may be more prominent in choosing fluid types on patients.…”

Section: Discussionmentioning

confidence: 99%

Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis

Liu

Mao

et al. 2018

TCRM

View full text Add to dashboard Cite

ObjectiveThe aim of this study was to compare the effectiveness of different fluids on critically ill patients who need fluid resuscitation through a systematic review and network meta-analysis (NMA).Data sourcesElectronic databases were searched up to March 2018 for randomized controlled trials comparing the effectiveness of different fluids in critically ill patients. The primary outcome was mortality, and the secondary outcomes were the incident of acute kidney injury (AKI) and risk of receiving renal replacement therapy (RRT). A Bayesian NMA was conducted, and the quality of evidence contributing to each network estimate was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria.ResultsWe deemed 49 trials eligible, including 40,910 participants. The quality of evidence was rated as moderate in most comparisons. There was no significant difference among resuscitation fluids in mortality. NMA at the 9-node level showed the most effective fluid was balanced crystalloid (BC) (80.79%, the ranking of resuscitation fluid based on cumulative probability plots and surface under the cumulative ranking curves [SUCRAs]). NMA at the 10-node level showed that the most effective fluid was Plasma-Lyte (77.52%). Results of sensitivity analyses in mortality did not reveal any significant changes in the findings for primary outcomes. High-molecular-weight hetastarch (H-HES) was associated with an increased incidence of AKI when compared with gelatin (odds ratio [OR], 0.43; 95% credibility interval [CrI], 0.19–0.94), low-molecular-weight hetastarch (L-HES; OR, 0.50; 95% CrI, 0.30–0.87), BC (OR, 0.55; 95% CrI, 0.34–0.88), and normal saline (OR, 0.56; 95% CrI, 0.34–0.93). Meanwhile, H-HES was also associated with an increased risk of receiving RRT when compared with BC (OR, 0.51; 95% CrI, 0.27–0.93) and normal saline (OR, 0.52; 95% CrI, 0.24–0.96).ConclusionBCs, especially the Plasma-Lyte, are presumably the best choice for most critically ill patients who need fluid resuscitation. Meanwhile, the use of H-HES was associated with an increased incidence of AKI and risk of receiving RRT.RegistrationPROSPERO (CRD42017072728).

show abstract

“…Previous studies on the assessment of intravascular volume and optimization of CO and renal blood flow have indicated that conventional monitoring provides insufficient data for adequate fluid management [ 13 – 16 ]. However, meta-analyses of randomized controlled trials indicate that approaches which include measurement of CO and calculate oxygen delivery to guide intravenous fluid replacement are associated with decreased mortality and postoperative complications [ 17 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Perioperative fluid management in kidney transplantation: a black box

et al. 2018

View full text Add to dashboard Cite

The incidence of delayed graft function in patients undergoing kidney transplantation remains significant. Optimal fluid therapy has been shown to decrease delayed graft function after renal transplantation. Traditionally, the perioperative volume infusion regimen in this patient population has been guided by central venous pressure as an estimation of the patient’s volume status and mean arterial pressure, but this is based on sparse evidence from mostly retrospective observational studies. Excessive volume infusion to the point of no further fluid responsiveness can damage the endothelial glycocalyx and is no longer considered to be the best approach. However, achievement of adequate flow to maintain sufficient tissue perfusion without maximization of cardiac filling remains a challenge. Novel minimally invasive technologies seem to reliably assess volume responsiveness, heart function and perfusion adequacy. Prospective comparative clinical studies are required to better understand the use of dynamic analyses of flow parameters for adequate fluid management in kidney transplant recipients. We review perioperative fluid assessment techniques and discuss conventional and novel monitoring strategies in the kidney transplant recipient.

show abstract

Evidence-based fluid management in the ICU

Abstract: Evidence-based fluid therapy includes a multifaceted diagnostic approach, the primary use of balanced crystalloids and early aggressive (septic) shock resuscitation.

Cited by 19 publications

References 58 publications

Effects of low doses of esmolol on cardiac and vascular function in experimental septic shock

Effects of low doses of esmolol on cardiac and vascular function in experimental septic shock

Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis

Perioperative fluid management in kidney transplantation: a black box

Contact Info

Product

Resources

About