Positive fluid balance as a major predictor of clinical outcome of patients with sepsis/septic shock after ICU discharge

Brotfain, Evgeni; Koyfman, Leonid; Toledano, Ronen; Borer, Abraham; Fucs, Lior; Galante, Ori; Frenkel, Amit; Kutz, Ruslan; Klein, Moti

doi:10.1016/j.ajem.2016.07.058

Cited by 78 publications

(67 citation statements)

References 15 publications

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“…We believe that the extrapolation of these data to patients in better-resourced settings is not valid and thus recommend that clinicians restore euvolemia with IV fluids, more urgently initially, and then more cautiously as the patient stabilizes. There is some evidence that a sustained positive fluid balance during ICU stay is harmful [231][232][233][234][235]. We do not recommend, therefore, that fluid be given beyond initial resuscitation without some estimate of the likelihood that the patient will respond positively.…”

mentioning

confidence: 96%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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confidence: 96%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…Mean daily fluid volume was chosen in preference to the total fluid volume to avoid the potential for reverse causality where a shorter intervention period would artificially result in lower total fluid volume. c. Intraoperative fluid balance (in 100 ml increments) [24][25][26] . d. Mean daily fluid balances either until the development of AKI, or in the absence of AKI, to postoperative Day 3 24,25 .…”

Section: Fluid-specific Factorsmentioning

confidence: 99%

Associations of Fluid Amount, Type, and Balance and Acute Kidney Injury in Patients Undergoing Major Surgery

Weinberg

Чурилов

et al. 2018

Anaesth Intensive Care

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Fluid administration has been reported to be associated with an increased risk of acute kidney injury (AKI). We assessed whether, after correction for fluid balance, amount and chloride content of fluids administered have an independent association with AKI. We performed an observational study in patients after major surgery assessing the independent association of AKI with volume, chloride content and fluid balance, after adjustment for Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) score, age, elective versus emergency surgery, and duration of surgery. We studied 542 consecutive patients undergoing major surgery. Of these, 476 patients had renal function tested as part of routine clinical care and 53 patients (11.1%) developed postoperative AKI. After adjustments, a 100 ml greater mean daily fluid balance was artificially associated with a 5% decrease in the instantaneous hazard of AKI: adjusted Hazard Ratio (aHR) 0.951, 95% confidence intervals (CI) 0.935 to 0.967, P <0.001. However, after adjustment for the proportion of chloriderestrictive fluids, mean daily fluid amounts and balances, POSSUM morbidity, age, duration and emergency status of surgery, and the confounding effect of fluid balance, every 5% increase in the proportion of chloride-liberal fluid administered was associated with an 8% increase in the instantaneous hazard of AKI (aHR 1.079, 95% CI 1.032 to 1.128, P=0.001), and a 100 ml increase in mean daily fluid amount given was associated with a 6% increase in the instantaneous hazard of AKI (aHR 1.061, 95% CI 1.047 to 1.075, P <0.001). After adjusting for key risk factors and for the confounding effect of fluid balance, greater fluid administration and greater administration of chloride-rich fluid were associated with greater risk of AKI.

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“…Besides, fluid removal can be performed until the fluid responsive tests return positive results. In addition to PLR and EEOT, dynamic preload parameters, body weight quantification, bioimpedance measurements, and respiratory variations of the diameter of the inferior cava vein have been evaluated as treatment goals for deresuscitation [73,76,[79][80][81][82][83]. To reduce adverse outcomes after acute lung injury, Cordemans et al [84] used intra-abdominal pressure and the extravascular lung water index to guide the treatment protocol.…”

Section: Deresuscitation Strategies Using Monitoring Of Volume Statusmentioning

confidence: 99%

Management of perioperative volume therapy – monitoring and pitfalls

Sander

Schneck

Habicher

2020

Korean J Anesthesiol

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Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery, including the risk factors of the surgical procedure and those of the patient. There have been substantial developments over the last few decades regarding the risk of anesthesia. In the early days of anesthesia, the risk of the anesthetic procedure itself was high and led to a number of fatalities [1,2]. This has changed dramatically, and these days anesthesia-related deaths are extremely low. Such advances are likely related to drug advancements, an improved understanding of physiology, and better monitoring and management. However, death after surgery, including the whole perioperative process, has not substantially declined. The risk of death during the 30 days following surgery is 1,000 times more likely than during surgery itself [3]. According to recent data, death within 30 days of surgery is the third leading cause of death in the United States of America, behind cardiac diseases and malignancy [4]. Some recent studies have assessed this risk in detail. According to Weiser et al. [5], it is estimated that more than 310 million surgical procedures are performed worldwide. The exact complication rate and risk of death after these procedures are largely unknown. However, it is estimated that depending on the type of surgery and patient's comorbidities that about 30-40% of patients develop complications, of which up to 20% are severe and possibly life-threatening [6-8]. Besides, the mortality risk of surgery is not precisely known. It has been estimated that between 3 and 12 million patients die worldwide after surgery. The European Surgical Outcome study evaluated this in detail in a seven-day cohort study that included 46,539 patients from 498 European centers. Patients were followed for up to 60 days after their surgical procedure. Of this cohort, 1,855 patients died while in hospital, giving an in-hospital mortality rate of 4.7%. Additionally, the study Over 300 million surgical procedures are performed every year worldwide. Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery and aim to reduce the risk of complications. Perioperative hemodynamic and volume management can help to improve outcomes in perioperative patients. There has been ongoing discussion about goal-directed therapy. However, there is a consensus that fluid overload and severe fluid depletion in the perioperative period are harmful and can lead to adverse outcomes. This article provides an overview of how to evaluate the fluid responsiveness of patients, details which parameters could be used, and what limitations should be noted.

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Positive fluid balance as a major predictor of clinical outcome of patients with sepsis/septic shock after ICU discharge

Cited by 78 publications

References 15 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Associations of Fluid Amount, Type, and Balance and Acute Kidney Injury in Patients Undergoing Major Surgery

Management of perioperative volume therapy – monitoring and pitfalls

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