Importance of the Infusion Rate for the Plasma Expanding Effect of 5% Albumin, 6% HES 130/0.4, 4% Gelatin, and 0.9% NaCl in the Septic Rat*

Bark, Björn P.; Persson, Johan; Grände, Per‐Olof

doi:10.1097/ccm.0b013e318274157e

Cited by 41 publications

(43 citation statements)

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“…These hypotheses have been confirmed in experimental studies on the septic rat and guinea pig, which showed greater loss of plasma volume when the infusion of albumin was given at a fast rate than when given at a slow rate (Bark et al, 2013;Bark and Grände 2014).…”

Section: Principles Of Transcapillary Exchange In Tissues Outside Thesupporting

confidence: 64%

Severe traumatic brain injury management and clinical outcome using the Lund concept

2014

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Section: Principles Of Transcapillary Exchange In Tissues Outside Thesupporting

confidence: 64%

Severe traumatic brain injury management and clinical outcome using the Lund concept

2014

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“…51 Because of the endothelial injury, capillary leak, and increased hydrostatic pressures, , 5% of infused crystalloid remains intravascular within 3 h after infusion, resulting in an increase in EVLW and further tissue edema. 52 Increased EVLW has been demonstrated to be a strong independent predictor of death. 53 -55 In patients with pneumonia, large-volume fl uid resuscitation may result in severe pulmonary edema.…”

Section: Fluid Therapymentioning

confidence: 99%

Early Management of Severe Sepsis

Marik

2014

Chest

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“…However, further clinical studies are required to determine whether such hemodynamic benefits are sustainable and sufficient for improving survival, even though Bark et al (2) speculated that the hemodynamic benefit after starting infusion of colloids can be maintained for 5-6 hrs with slow infusion, compared only 1-1.5 hrs with fast infusion. Furthermore, it remains unclear whether currently available clinical markers or other variables can be used to monitor the adequacy of a slow-infusion rate of fluids during fluid volume resuscitation, since the magnitude of sepsis-induced hypovolemia and hemodynamic states varies considerably.…”

mentioning

confidence: 94%

“…It is time to take into account not only fluid type, but also the infusion rate for fluid resuscitation in patients with sepsis. T racheal intubation in the operating room, emergency department, or the ICU in the best of circumstances may lead to morbidity and mortality (1,2,3). It is often stated "kids are not small adults."…”

mentioning

confidence: 97%

“…Similar to the adult population, it is recognized that critically ill pediatric patients are at increased risk of morbidity during tracheal intubation as compared with the healthy child undergoing elective tracheal intubation. Data exist regarding tracheal intubation in primarily the adult population (1,2,3). These studies show adult ICU patients undergoing tracheal intubation have increased morbidity and mortality related to intubation (2).…”

mentioning

confidence: 98%

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Impact of Fluid Infusion Rate on Restoring Plasma Volume in Sepsis*

Ishihara¹

2013

Critical Care Medicine

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931C orrection of hypovolemia is fundamental, but it is one of the most important factors in managing critically ill patients. In patients with sepsis, intensivists and investigators are generally interested in the type of colloids and crystalloids, as well as the total volume of fluids required to overcome hypovolemia. However, they may have been overlooking the infusion rate of administered fluids, since it is believed that hypovolemia should be treated as early as possible to improve survival (1). In this issue of Critical Care Medicine, Bark et al (2) from Lund University Hospital in Sweden report their experiment highlighting the importance of the infusion rate of different types of fluids for maintaining normal plasma volume in septic rats. A fixed volume of different types of colloids and a crystalloid including 5% albumin, 6% hydroxyethyl starch 130/0.4, 4% gelatin, and 0.9% NaCl was administered via fast or slow infusion. In the fast-infusion group, fluids were administered over 15 mins, while in the slow-infusion group, fluids were administered over 3 hrs. Measurement of plasma volume was carefully performed at 3 hrs after the start of volume resuscitation using human iodine-125 ( 125 I) albumin, even though this volume marker is known to overestimate plasma volume in critical illness associated with increased capillary protein leakage (3). Although the interval between the end of fluid administration and measurement was apparently different between the two infusion groups, the authors demonstrate the negligible effect of the interval by additional experiments (Fig. 4C). The results show that plasma volume expansion by a colloid is greater when infused slowly, an effect more pronounced with albumin. The authors also speculate the mechanism mediating the increased transcapillary fluid loss due to the fast infusion of colloids in the presence of increased permeability. A transient increase in arterial pressure and hemo dilution would have a significant impact on transcapillary fluid loss, but this mechanism was not observed in the absence of increased permeability (4). In a clinical setting, Wills et al (5) showed that the effect of fast infusion of hydroxyethyl starch or dextran is obvious only during the first 2 hrs in children with dengue shock syndrome characterized by severe vascular leakage as judged by changes in hematocrit. Considering the results of the experimental study by Bark et al (2) as well as human studies indicating that a lower net fluid balance is associated with fewer days of ventilator use and fewer days in the ICU (6, 7), a slow rather than a fast infusion of colloids, particularly albumin, would have the potential to improve survival, even though evidence that colloids provide better survival is lacking (8).Bark et al (2) gave three-fold more 0.9% NaCl than colloids to achieve a similar effect on plasma volume expansion but resultant expansion was poor regardless of the infusion rate because crystalloids were rapidly distributed from the intravascular to the interstitial fluid comp...

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Importance of the Infusion Rate for the Plasma Expanding Effect of 5% Albumin, 6% HES 130/0.4, 4% Gelatin, and 0.9% NaCl in the Septic Rat*

Abstract: The study showed that the PV expansion by a colloid was greater when given at a slow than at a fast infusion rate, an effect more pronounced for albumin. This difference was not seen for NaCl. The PV-expanding effect was poor for NaCl and better for albumin than for the other colloids.

Cited by 41 publications

References 20 publications

Severe traumatic brain injury management and clinical outcome using the Lund concept

Severe traumatic brain injury management and clinical outcome using the Lund concept

Early Management of Severe Sepsis

Impact of Fluid Infusion Rate on Restoring Plasma Volume in Sepsis*

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