Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: An international cross-sectional study

Hammond, Naomi; Taylor, Colman; Finfer, Simon; Machado, Flávia Ribeiro; An, Youzhong; Billot, Laurent; Bloos, Frank; Bozza, Fernando A.; Cavalcanti, Alexandre Biasi; Correa, Maryam; Du, Bin; Hjortrup, Peter Buhl; Yang, Li; McIntryre, Lauralyn; Saxena, Manoj; Schortgen, Frédérique; Watts, Nicola; Myburgh, John; Investigators, Fluidos

doi:10.1371/journal.pone.0176292

Cited by 107 publications

(77 citation statements)

References 28 publications

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“…6,7 Crystalloid solutions with electrolyte compositions closer to that of plasma (balanced crystalloids, such as lactated Ringer’s solution or Plasma-Lyte A) represent an increasingly used alternative to saline. 8 Several observational studies 6,9,10 and a before-and-after trial 5 suggested that the use of balanced crystalloids is associated with lower rates of acute kidney injury, renal-replacement therapy, and death. However, in two pilot trials, 11,12 no significant difference in any patient outcome was reported between those who received balanced crystalloids and those who received saline.…”

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confidence: 99%

Balanced Crystalloids versus Saline in Critically Ill Adults

Self²,

et al. 2018

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BACKGROUND Both balanced crystalloids and saline are used for intravenous fluid administration in critically ill adults, but it is not known which results in better clinical outcomes. METHODS In a pragmatic, cluster-randomized, multiple-crossover trial conducted in five intensive care units at an academic center, we assigned 15,802 adults to receive saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A) according to the randomization of the unit to which they were admitted. The primary outcome was a major adverse kidney event within 30 days — a composite of death from any cause, new renal-replacement therapy, or persistent renal dysfunction (defined as an elevation of the creatinine level to ≥200% of baseline) — all censored at hospital discharge or 30 days, whichever occurred first. RESULTS Among the 7942 patients in the balanced-crystalloids group, 1139 (14.3%) had a major adverse kidney event, as compared with 1211 of 7860 patients (15.4%) in the saline group (marginal odds ratio, 0.91; 95% confidence interval [CI], 0.84 to 0.99; conditional odds ratio, 0.90; 95% CI, 0.82 to 0.99; P = 0.04). In-hospital mortality at 30 days was 10.3% in the balanced-crystalloids group and 11.1% in the saline group (P = 0.06). The incidence of new renal-replacement therapy was 2.5% and 2.9%, respectively (P = 0.08), and the incidence of persistent renal dysfunction was 6.4% and 6.6%, respectively (P = 0.60). CONCLUSIONS Among critically ill adults, the use of balanced crystalloids for intravenous fluid administration resulted in a lower rate of the composite outcome of death from any cause, new renal-replacement therapy, or persistent renal dysfunction than the use of saline. (Funded by the Vanderbilt Institute for Clinical and Translational Research and others; SMART-MED and SMART-SURG ClinicalTrials.gov numbers, NCT02444988 and NCT02547779.)

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confidence: 99%

Balanced Crystalloids versus Saline in Critically Ill Adults

Self²,

et al. 2018

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“…Several conversion formulas can be used, the most commonly known for studies of health-care-associated infections is that of Rhame and Sudderth. 3 This formula and the one used by Machado and colleagues require the assumption of the socalled steady state-ie, the number of patients entering and leaving the hospital or ward is balanced at any period. This assumption should be confirmed before reporting incidence and proportions from prevalence studies, and various graphical and formal tests are available to check this assumption.…”

Section: Use Of Prevalence Data To Study Sepsis Incidence and Mortalimentioning

confidence: 99%

Use of prevalence data to study sepsis incidence and mortality in intensive care units – Authors' reply

Cavalcanti

Azevedo

Machado

2018

The Lancet Infectious Diseases

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“…It remains difficult to find any consistencies among these published studies [6,7,8,9]. Despite of the controversies, the albumin has been widely used in intensive care unit and surgical settings as the top colloid products for critically ill patients [10].…”

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confidence: 99%

A Predicative Patient Specific Model for Human Albumin Based on Deep Neural Networks

Liu

Wang

Zhao

et al. 2020

Preprint

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Background For a critically ill patient, an accurate predictive tool for biochemical markers based on the patient prior clinical data can aide physicians to design better patient-specific treatment plans. In this study, we develop a since dynamical system model based on neural networks capable of predicting concentrations of biochemical markers, including albumin, of a critically ill patient, in real-time. Methods The metabolic process of a patient follows a patient-specific dynamical system which can be uncovered with certain accuracy from sufficient prior data taken from the patient. For a given set of patient’s biochemical markers, the dynamical system represented by deep neural networks is discovered from the prior data via deep learning methods. Results One critically ill, poly-trauma patient (injury severity score = 34 points) was enrolled in the study. Six biochemical markers (albumin (ALB), creatinine (Cr), osmotic pressure (OSM), alanine aminotransferase (ALT), total bilirubin (TB), direct bilirubin (DB)) were collected and exogenous albumin injection was administered to the patient for the total of 27 consecutive days during the study. A sliding window of data in 10 consecutive days was used as the training set and the 11th day's data as the test set to train and test the parameters in the neural network. The obtained dynamical system model is then used to forecast the chemical markers in the next 24 hours. The results are compared with the true clinical data with a relative error consistently less than 2%. Conclusions This study demonstrates that a dynamic system model can be established to monitor and predict concentrations of biochemical markers, including albumin, via neural networks and deep learning methods. This data-driven patient-specific modeling approach is applicable to any patient. Trial registration Metabolomics Dynamics Study for Severe Patient, Registered:17June,2014, https://www.clinicaltrials.gov/ct2/show/NCT02164786?term=NCT02164786&draw=2&rank=1

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Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: An international cross-sectional study

Cited by 107 publications

References 28 publications

Balanced Crystalloids versus Saline in Critically Ill Adults

Balanced Crystalloids versus Saline in Critically Ill Adults

Use of prevalence data to study sepsis incidence and mortality in intensive care units – Authors' reply

A Predicative Patient Specific Model for Human Albumin Based on Deep Neural Networks

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