Fluid Balance and the Adult Respiratory Distress Syndrome<sup>1–</sup><sup>3</sup>

Simmons, R. S.; Berdine, Gilbert; Seidenfeld, John J.; Prihoda, T. J.; Harris, Glenn D.; Smith, Jan D.; Gilbert, Thomas; Mota, Écila Campos; Johanson, W. G.

doi:10.1164/arrd.1987.135.4.924

Cited by 254 publications

(92 citation statements)

References 15 publications

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“…Of interest, the positive fluid balance of the liberal group was comparable to other ARDS network studies ( Figure 7) (16,24). Moreover, these findings are comparable to other previous studies (25), thus suggesting that the liberal, not the conservative, fluid approach reflected long-standing clinical practice.…”

Section: Fluid Overload In Akisupporting

confidence: 88%

Fluid Administration in Critically Ill Patients with Acute Kidney Injury

Schrier

2010

Clinical Journal of the American Society of Nephrology

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Physiologic end points for fluid resuscitation in septic shock patients with acute kidney injury (AKI) have been undertaken in randomized studies using the Early Goal-Directed Therapy (EGDT) approach. These studies have demonstrated a beneficial effect on in-hospital mortality with EGDT. The Saline versus Albumin Fluid Evaluation (SAFE) randomized study in critically ill patients demonstrated no difference in survival when saline versus albumin solutions were used for resuscitation. However, a benefit of albumin has been demonstrated in a randomized study on renal function and survival in cirrhotic patients with spontaneous bacterial periotonitis. On the other hand, recent observational studies have shown a correlation between fluid overload and mortality in AKI patients whether or not they necessitated dialysis. Moreover, the Adult Respiratory Distress Syndrome ( F luid administration is frequently necessary to stabilize the patient with severe sepsis or septic shock. Moreover, sepsis has been reported to account for approximately 50% of patients with acute kidney injury (AKI) in intensive care units (ICUs) (1). Thus the timing and type of fluid administered as well as renal outcomes are very important. Recently, the timing of the fluid administration and the physiologic end points to be monitored have emerged as Early Goal-Directed Therapy (EGDT) (2). In the patient with septic shock, early intervention with fluid resuscitation within the first 6 hours in the emergency department (ED) has been described as EGDT. Previous studies had generally reported results relating to later interventions in ICUs after admission from the ED.The predefined physiologic goals of EGDT within 6 hours of diagnosis are mean arterial pressure Ն 65 mmHg, central venous pressure (CVP) between 8 and 12 mmHg, improvement of blood lactate levels, central venous oxygen saturation Ͼ 70%, and urine output Ն 0.5 ml/kg/h. The first randomized study to test this protocol-driven approach was undertaken in patients with systemic inflammatory response syndrome criteria: systolic blood pressure Յ 90 mmHg or lactate Ն 4 mmol/L, central venous oxygen saturation Ͻ 50%, and mean serum creatinine 2.6 mg/dl.Compared with the control group receiving standard emergency care, the EGDT group received more fluid, blood transfusions, and inotropic use with dobutamine. The physiologic parameters were improved in the EGDT group during the first 6 hours (Table 1). Moreover, the primary end point of inhospital mortality was less in the EGDT group (30.5 versus 46.5%, P Ͻ 0.009). Other physiologic parameters were also improved during hours 7 to 72 (Table 2). Of note, although more fluid was administered from 0 to 6 hours in the ED, the EGDT group received less fluid during hours 7 to 72 and fewer of these patients were on mechanical ventilation (2.6% versus 16.8%, P Ͻ 0.001). This initial study did not specifically examine AKI but examined multiple organ functioning scores (Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score), wh...

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Section: Fluid Overload In Akisupporting

confidence: 88%

Fluid Administration in Critically Ill Patients with Acute Kidney Injury

Schrier

2010

Clinical Journal of the American Society of Nephrology

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“…However, it could also be related to volume overload and its diluting effect on the serum creatinine. Previous studies have reported the association between volume overload and mortality, in both adults and children (22,23). We also noted that a previous exposure to nephrotoxic agents was associated with a lower risk for death.…”

Section: Discussionsupporting

confidence: 68%

North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI)

Cruz

Bolgan

Perazella

et al. 2007

Clinical Journal of the American Society of Nephrology

235

164

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Acute kidney injury (AKI) in the intensive care unit (ICU) is associated with an enhanced mortality. The Acute Dialysis Quality Initiative group has proposed the RIFLE (Risk-Injury-Failure-Loss-ESRD) classification to standardize the approach to AKI. This study was performed to estimate the AKI incidence in ICU patients in northeastern Italy and describe clinical characteristics and outcomes of patients with AKI on the basis of their RIFLE class. A prospective multicenter observational study was performed of patients who fulfilled AKI criteria in 19 ICU in northeastern Italy. Data were analyzed using multivariate logistic regression and survival curve analysis. Of 2164 ICU patients who were admitted during the study period, 234 (10.8%; 95% confidence interval 9.5 to 12.1%) developed AKI; 19% were classified as risk (R), 35% as injury (I), and 46% as failure (F). Preexisting kidney disease was present in 36.8%. The most common causes of AKI were prerenal causes (38.9%) and sepsis (25.6%). At diagnosis of AKI, median serum creatinine and urine output were 2.0 mg/dl and 1100 ml/d, respectively. ICU mortality was 49.5% in class F, 29.3% in I, and 20% in R. Independent risk factors for mortality included RIFLE class, sepsis, and need for renal replacement therapy, whereas a postsurgical cause of AKI, exposure to nephrotoxins, higher serum creatinine, and urine output were associated with lower mortality risk. In this study, AKI incidence in the ICU was between 9 and 12%, with 3.3% of ICU patients requiring renal replacement therapy. Sepsis was a significant contributing factor. Overall mortality was between 30 and 42%, and was highest among those in RIFLE class F.

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“…HOST DEFENCE RESPONSE AND OUTCOME IN ARDS ARDS, by day 3-7 clearly separated survivors (increased) from nonsurvivors (decreased or no change) [50,108,[138][139][140][141][142][143][144][145]. In one report, mortality rate in patients with and without improvement in lung function by day 7 of ARDS was 43 and 97%, respectively [141].…”

Section: Gas Exchange and Lung Mechanicsmentioning

confidence: 99%

The role of the host defence response in the progression and outcome of ARDS: pathophysiological correlations and response to glucocorticoid treatment

Gu¹

1996

Eur Respir J

114

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T Th he e r ro ol le e o of f t th he e h ho os st t d de ef fe en nc ce e r re es sp po on ns se e i in n t th he e p pr ro og gr re es ss si io on n a an nd d o ou ut tc co om me e o of f A AR RD DS S: : p pa at th ho op ph hy ys si io ol lo og gi ic ca al l c co or rr re el la at ti io on ns s a an nd d r re es sp po on ns se e t to o g gl lu uc co oc co or rt ti ic co oi id d t tr re ea at tm me en nt t

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Fluid Balance and the Adult Respiratory Distress Syndrome^1–³

Cited by 254 publications

References 15 publications

Fluid Administration in Critically Ill Patients with Acute Kidney Injury

Fluid Administration in Critically Ill Patients with Acute Kidney Injury

North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI)

The role of the host defence response in the progression and outcome of ARDS: pathophysiological correlations and response to glucocorticoid treatment

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Fluid Balance and the Adult Respiratory Distress Syndrome1–3

Cited by 254 publications

References 15 publications

Fluid Administration in Critically Ill Patients with Acute Kidney Injury

Fluid Administration in Critically Ill Patients with Acute Kidney Injury

North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI)

The role of the host defence response in the progression and outcome of ARDS: pathophysiological correlations and response to glucocorticoid treatment

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Fluid Balance and the Adult Respiratory Distress Syndrome^1–³