The Use of Fluids in Sepsis

Avila, Audrey A; Kinberg, Eliezer; Sherwin, Nomi K.; Taylor, Robinson D

doi:10.7759/cureus.528

Cited by 13 publications

(13 citation statements)

References 22 publications

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“…62 We refer the reader to excellent reviews regarding optimal fluid therapeutic strategies in sepsis. 62–64…”

Section: Sepsis Pathophysiologymentioning

confidence: 99%

“…[59][60][61] In addition to the findings from this study, the restricted accessibility, safety issues, and the expensive value of colloids shifted the debate toward identifying the ideal crystalloid composition (eg, Ringer lactate, Ringer acetate, etc). 62 We refer the reader to excellent reviews regarding optimal fluid therapeutic strategies in sepsis. [62][63][64] The utilization of magnetic resonance imaging (MRI) in the diagnosis of SAE offers a unique opportunity in capturing some of the morphologic, ischemic, and metabolic alterations associated with sepsis.…”

Section: The Cns In Sepsis: Sickness Behavior and Saementioning

confidence: 99%

“…62 We refer the reader to excellent reviews regarding optimal fluid therapeutic strategies in sepsis. [62][63][64] The utilization of magnetic resonance imaging (MRI) in the diagnosis of SAE offers a unique opportunity in capturing some of the morphologic, ischemic, and metabolic alterations associated with sepsis. A summary of MRI findings in acute sepsis is shown in Table 1.…”

Section: The Cns In Sepsis: Sickness Behavior and Saementioning

confidence: 99%

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Targeting the Blood-Brain Barrier to Prevent Sepsis-Associated Cognitive Impairment

Nwafor

Brichacek

Mohammad

et al. 2019

J Cent Nerv Syst Dis

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Sepsis is a systemic inflammatory disease resulting from an infection. This disorder affects 750 000 people annually in the United States and has a 62% rehospitalization rate. Septic symptoms range from typical flu-like symptoms (eg, headache, fever) to a multifactorial syndrome known as sepsis-associated encephalopathy (SAE). Patients with SAE exhibit an acute altered mental status and often have higher mortality and morbidity. In addition, many sepsis survivors are also burdened with long-term cognitive impairment. The mechanisms through which sepsis initiates SAE and promotes long-term cognitive impairment in septic survivors are poorly understood. Due to its unique role as an interface between the brain and the periphery, numerous studies support a regulatory role for the blood-brain barrier (BBB) in the progression of acute and chronic brain dysfunction. In this review, we discuss the current body of literature which supports the BBB as a nexus which integrates signals from the brain and the periphery in sepsis. We highlight key insights on the mechanisms that contribute to the BBB’s role in sepsis which include neuroinflammation, increased barrier permeability, immune cell infiltration, mitochondrial dysfunction, and a potential barrier role for tissue non-specific alkaline phosphatase (TNAP). Finally, we address current drug treatments (eg, antimicrobials and intravenous immunoglobulins) for sepsis and their potential outcomes on brain function. A comprehensive understanding of these mechanisms may enable clinicians to target specific aspects of BBB function as a therapeutic tool to limit long-term cognitive impairment in sepsis survivors.

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“…62 We refer the reader to excellent reviews regarding optimal fluid therapeutic strategies in sepsis. 62–64…”

Section: Sepsis Pathophysiologymentioning

confidence: 99%

Section: The Cns In Sepsis: Sickness Behavior and Saementioning

confidence: 99%

Section: The Cns In Sepsis: Sickness Behavior and Saementioning

confidence: 99%

See 1 more Smart Citation

Targeting the Blood-Brain Barrier to Prevent Sepsis-Associated Cognitive Impairment

Nwafor

Brichacek

Mohammad

et al. 2019

J Cent Nerv Syst Dis

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“…Sepsis is one of the main reasons for ICU admissions, and 6%-30% of all ICU patients are assumed to suffer from sepsis [ 44 ]. The disease is associated with a high mortality and a considerable cost burden [ 45 - 47 ]. The adequate initial volume application is essential in the initial resuscitation of sepsis [ 8 - 11 ], and it affects patients’ outcome and mortality risk [ 4 - 6 ].…”

Section: Discussionmentioning

confidence: 99%

Fluid Administration in Emergency Room Limited by Lung Ultrasound in Patients with Sepsis: Protocol for a Prospective Phase II Multicenter Randomized Controlled Trial

Mohamed¹,

Malewicz²,

Zehry³

et al. 2020

JMIR Res Protoc

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Background Sepsis remains a major health challenge with high mortality. Adequate volume administration is fundamental for a successful outcome. However, individual fluid needs differ between patients due to varying degrees of systemic vasodilation, circulatory flow maldistribution, and increased vascular permeability. The current fluid resuscitation practice has been questioned. Fluid overload is associated with higher mortality in sepsis. A sign of fluid overload is extravascular lung water, seen as B lines in lung ultrasound. B lines correlate inversely with oxygenation (measured by a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen ie, PaO2/FiO2). Thus, B lines seen by bedside ultrasound may have a role in guiding fluid therapy. Objective We aim to evaluate if fluid administration guided by lung ultrasound in patients with sepsis in emergency departments will lead to better oxygenation and patient outcomes than those in the standard therapy. Methods A phase II, multicenter, randomized, open-label, parallel-group, superiority trial will be performed. Patients will be recruited at emergency departments of the participating centers. A total of 340 patients will be randomly allocated to the intervention or standard-of-care group (30mL/kg). The intervention group will receive ultrasound-guided intravenous fluid until 3 B lines appear. The primary outcome will be oxygenation (measured as PaO2/FiO2 ratio) at 48 hours after starting intravenous fluid administration. Secondary outcomes will be patients’ outcome parameters, including oxygenation after 15 mL/kg fluid at 6, 12, 24, and 48 hours; sepsis progress through Sequential Organ Failure Assessment (SOFA) scores; pulmonary edema evaluation; and 30-day mortality. Results The trial will be conducted in accordance with the Declaration of Helsinki. Institutional review board approval will be sought after the participating sites are selected. The protocol will be registered once the institutional review board approval is granted. The trial duration is expected to be 1.5-2.5 years. The study is planned to be performed from 2021 to 2022, with enrollment starting in 2021. First results are expected in 2022. Informed written consent will be obtained before the patient’s enrollment in the study. An interim analysis and data monitoring will ensure the patient safety. The results will be published in a peer-reviewed journal and discussed at international conferences. Conclusions This is a protocol for a randomized control trial that aims to evaluate the role of bedside ultrasound in guiding fluid therapy in patients with sepsis via B lines evaluation. International Registered Report Identifier (IRRID) PRR1-10.2196/15997

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“…Initial fluid resuscitation with crystalloids should be started to achieve minimum of 30 mL kg −1 of fluids in the first 3 h in patients with sepsis-induced tissue hypoperfusion. 35 , 47 , 48 Despite lack of controlled data to support this volume and rate of fluid delivery, some interventional studies have described this as usual practice during initial resuscitation, and observed evidence supports this practice. 46 , 49 …”

Section: Care Bundlesmentioning

confidence: 99%

Sepsis: The evolution in definition, pathophysiology, and management

2019

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There has been a significant evolution in the definition and management of sepsis over the last three decades. This is driven in part due to the advances made in our understanding of its pathophysiology. There is evidence to show that the manifestations of sepsis can no longer be attributed only to the infectious agent and the immune response it engenders, but also to significant alterations in coagulation, immunosuppression, and organ dysfunction. A revolutionary change in the way we manage sepsis has been the adoption of early goal-directed therapy. This involves the early identification of at-risk patients and prompt treatment with antibiotics, hemodynamic optimization, and appropriate supportive care. This has contributed significantly to the overall improved outcomes with sepsis. Investigation into clinically relevant biomarkers of sepsis are ongoing and have yet to yield effective results. Scoring systems such as the sequential organ failure assessment and Acute Physiology and Chronic Health Evaluation help risk-stratify patients with sepsis. Advances in precision medicine techniques and the development of targeted therapy directed at limiting the excesses of the inflammatory and coagulatory cascades offer potentially viable avenues for future research. This review summarizes the progress made in the diagnosis and management of sepsis over the past two decades and examines promising avenues for future research.

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The Use of Fluids in Sepsis

Cited by 13 publications

References 22 publications

Targeting the Blood-Brain Barrier to Prevent Sepsis-Associated Cognitive Impairment

Targeting the Blood-Brain Barrier to Prevent Sepsis-Associated Cognitive Impairment

Fluid Administration in Emergency Room Limited by Lung Ultrasound in Patients with Sepsis: Protocol for a Prospective Phase II Multicenter Randomized Controlled Trial

Sepsis: The evolution in definition, pathophysiology, and management

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