Rational Fluid Resuscitation in Sepsis for the Hospitalist

Ladzinski, Adam; Thind, Guramrinder Singh; Siuba, Matthew

doi:10.1016/j.mayocp.2021.05.020

Cited by 9 publications

(10 citation statements)

References 37 publications

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“…However, it is important to recognise that patients with cirrhosis may also present in states of euvolemia or even volume overload, as they are also prone to decompensated heart failure or cirrhotic cardiomyopathy 9 . The goal of volume resuscitation is to replete intravascular volume and increase peripheral vascular tone 11 . Under‐ or over‐correction of volume status can result in hypoxic end organ injury or tissue edema with venous congestion.…”

Section: The Need For Precise Volume Assessment In Cirrhosismentioning

confidence: 99%

“…9 The goal of volume resuscitation is to replete intravascular volume and increase peripheral vascular tone. 11 Under-or over-correction of volume status can result in hypoxic end organ injury or tissue edema with venous congestion. Reflexive use of fluids for renal injury as a result of inaccurate assessment of fluid status can delay the initiation of critical therapies, such as vasopressors.…”

Section: The Need For Precis E Volume a Ss E Ss Ment In Cirrhos Ismentioning

confidence: 99%

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Review article: Practical considerations for fluid resuscitation in cirrhosis

Claudel

Jaganathan

Patel

et al. 2023

Aliment Pharmacol Ther

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Background: Standard clinical methods of assessing volume and providing resuscitation are not always applicable to patients with advanced or decompensated cirrhosis. Despite this being well known from a clinical perspective, there remains relatively little evidence to guide clinicians though fluid management in patients with cirrhosis and, often, multi-organ system dysfunction. Aims: This review summarises the current understanding of the circulatory dysfunction in cirrhosis, modalities for assessing volume status, and considerations for fluid selection. It additionally provides a practical approach to fluid resuscitation. Methods: We review current literature on cirrhosis pathophysiology in steady-state and shock, clinical implications of fluid resuscitation, and strategies to assess intravascular volume. Literature reviewed here was identified by the authors through PubMed search and review of selected papers' references. Results: Clinical management of resuscitation in advanced cirrhosis remains relatively stagnant. Although several trials have attempted to establish the superior resuscitative fluid, the lack of improvement in hard clinical outcomes leaves clinicians without clear guidance. Conclusions: The absence of consistent evidence for fluid resuscitation in patients with cirrhosis limits our ability to produce a clearly evidence-based protocol for fluid resuscitation in cirrhosis. However, we propose a preliminary practical guide to managing fluid resuscitation in patients with decompensated cirrhosis. Further studies are needed to develop and validate volume assessment tools in the specific context of cirrhosis, while randomised clinical trials of protocolized resuscitation may improve care of this patient population. 1 | INTRODUC TI ON Cirrhosis carries high morbidity and mortality in the United States (US), representing approximately 3.8 per 1000 hospitalizations in the US per year and is the fourth leading cause of death among US adults ages 45-64 years old. 1,2 Patients with cirrhosis pose unique clinical challenges secondary to their disordered circulation and the multi-system consequences of advanced cirrhosis. As patients with cirrhosis are often volume overloaded overall and simultaneously have decreased effective arterial volume, their brittle hemodynamics make them prone to bleeding, renal injury, and cardiac overload. Standard clinical methods of assessing volume and providing | 1067 CLAUDEL et al.resuscitation are therefore not always applicable. The current literature lacks a comprehensive assessment of available evidence to provide goal-directed care to the patient with decompensated cirrhosis. This review will discuss assessment of volume status and the evidence behind choice of resuscitative therapies in cirrhosis, with an emphasis on critical illness.

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Section: The Need For Precise Volume Assessment In Cirrhosismentioning

confidence: 99%

Section: The Need For Precis E Volume a Ss E Ss Ment In Cirrhos Ismentioning

confidence: 99%

Review article: Practical considerations for fluid resuscitation in cirrhosis

Claudel

Jaganathan

Patel

et al. 2023

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…A number of scholars pointed out that the severity and speed of fluid accumulation or overload are independent risk factors for adverse outcomes and are associated with the increased mortality in critically ill patients. [28][29][30][31] In clinical practice, fluid resuscitation at 30 ml/kg is not a safe threshold for all critically ill patients, especially for those patients with a poor cardiopulmonary function. In this section, we attempted to reduce the loading dose of fluid resuscitation, ie reducing to 10 or 15 ml/kg, and then, evaluated hemodynamic status to better guide fluid resuscitation, so as to avoid fluid overload.…”

Section: The Fifth Step: An Appropriate Approach To Fluid Resuscitationmentioning

confidence: 99%

A Standardized Step-by-Step Approach for the Diagnosis and Treatment of Sepsis

Gao

Wang

Zhang

et al. 2022

J Intensive Care Med

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Sepsis is the major culprit of death among critically ill patients who are hospitalized in intensive care units (ICUs). Although sepsis-related mortality is steadily declining year-by-year due to the continuous understanding of the pathophysiological mechanism on sepsis and improvement of the bundle treatment, sepsis-associated hospitalization is rising worldwide. Surviving Sepsis Campaign (SSC) guidelines are continuously updating, while their content is extremely complex and comprehensive for a precisely implementation in clinical practice. As a consequence, a standardized step-by-step approach for the diagnosis and treatment of sepsis is particularly important. In the present study, we proposed a standardized step-by-step approach for the diagnosis and treatment of sepsis using our daily clinical experience and the latest researches, which is close to clinical practice and is easy to implement. The proposed approach may assist clinicians to more effectively diagnose and treat septic patients and avoid the emergence of adverse clinical outcomes.

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“…Otro mecanismo, es la venodilatación con secuestro de sangre en el compartimiento venoso. Los pacientes con depleción de volumen intravascular verdadero se beneficiarían más con la fluidoterapia, mientras que la terapia con vasopresores puede ayudar a revertir la venodilatación (Ladzinski et al, 2021). Estos dos escenarios son muy difíciles de diagnosticar clínicamente y, a menudo, hay una superposición significativa en pacientes individuales.…”

Section: Líquidosunclassified

Sepsis y shock séptico: enfoque actual del diagnóstico y manejo terapéutico

Espinales

Milian

Anzules

2022

GICOS

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La sepsis y el shock séptico siguen siendo un problema común en pacientes críticamente enfermos, siendo responsables de una alta morbilidad, mortalidad y consumo de recursos sanitarios en todo el mundo. El objetivo de la revisión fue describir el diagnóstico y manejo terapéutico de la sepsis y shock séptico basándose en la evidencia clínica publicada hasta el momento. La búsqueda bibliográfica fue de tipo no sistemática en las bases de datos PubMed, SciELO, Science Direct, EMBASE, LILACS y Redalyc. Los criterios de inclusión fueron publicaciones en inglés, portugués y español, en las que el título, palabras clave, incluyeron información relacionada con el tema, en el periodo comprendido del 2013-2022. Los resultados obtenidos mostraron que la sepsis y el shock séptico conforman cuadros en donde la detección temprana es una acción fundamental para reducir la mortalidad y falla multiorgánica relacionada. El control adecuado de la fuente, el inicio de una terapia antimicrobiana adecuada, la restauración de la perfusión tisular a través de la reanimación con líquidos y las intervenciones avanzadas para guiar la evaluación de la reanimación y la resolución de la disfunción orgánica deben ser parte del tratamiento inicial de estas entidades. Se concluye que el diagnóstico precoz y el inicio de una estrategia terapéutica multimodal, son factores decisivos al momento de su abordaje, para mejorar el pronóstico de los pacientes.

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Rational Fluid Resuscitation in Sepsis for the Hospitalist

Cited by 9 publications

References 37 publications

Review article: Practical considerations for fluid resuscitation in cirrhosis

Review article: Practical considerations for fluid resuscitation in cirrhosis

A Standardized Step-by-Step Approach for the Diagnosis and Treatment of Sepsis

Sepsis y shock séptico: enfoque actual del diagnóstico y manejo terapéutico

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