Understanding volume kinetics

Hahn, Robert G.

doi:10.1111/aas.13533

Cited by 61 publications

(119 citation statements)

References 52 publications

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“…The fluid that was eliminated from the kinetic system by this mechanism remained in the body but did not equilibrate with the plasma during the period of the study. A higher k b than k 10 has previously been reported only during general anesthesia [2,23,24].…”

Section: Discussionmentioning

confidence: 58%

“…The pharmacokinetic approach used here, volume kinetics, uses the inverse of the hemodilution and the urinary excretion as input in pharmacokinetic calculations [1,2]. The calculations distinguish a "wall" between a central (V c ) and an extravascular compartment (V t ), which probably represents the difficulty for fluid to expand the interstitial fluid space.…”

Section: Discussionmentioning

confidence: 99%

“…Volume kinetics is a method for analyzing the distribution and elimination of infusion fluids [1,2]. The approach has similarities to drug pharmacokinetics but uses the excreted urine volume and the plasma dilution derived from serial analyses of the blood Hb concentration as inputs in the calculations.…”

Section: Population Volume Kineticsmentioning

confidence: 99%

“…Pharmacokinetic methods can be applied to fluid volumes, which is of interest in anesthesia and surgery where large amounts are given by intravenous infusion. The most commonly used approach is volume kinetics, which uses the hemodilution and the urinary excretion as input in the calculations [1,2]. The hemodilution is the inverse of the blood water concentration and, therefore, shows how the infused volume is distributed; as per volume, the blood contains little more than hemoglobin and water [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…The most commonly used approach is volume kinetics, which uses the hemodilution and the urinary excretion as input in the calculations [1,2]. The hemodilution is the inverse of the blood water concentration and, therefore, shows how the infused volume is distributed; as per volume, the blood contains little more than hemoglobin and water [2,3]. So far, volume kinetics has dealt with anesthesia and surgery where fluid is given to ensure adequate organ perfusion.…”

Section: Introductionmentioning

confidence: 99%

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Volume kinetic analysis of fluid retention after induction of general anesthesia

Hahn

Nemme

2020

BMC Anesthesiol

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Background: Induction of general anesthesia increases the hemodilution resulting from infusion of crystalloid fluid, which is believed to be due to slower distribution caused by arterial hypotension. When normal distribution returns is not known. Methods: An intravenous infusion of 25 mL kg − 1 of Ringer's lactate was infused over 30 min to 25 volunteers just after induction of general anesthesia for open abdominal hysterectomy. A two-volume model was fitted to the repeated measurements of the blood hemoglobin concentration and the urinary excretion using mixed-effects modelling software. Individual-specific covariates were added in sequence. Results: Distribution of infused fluid was interrupted during the first 20 min of the infusions. During this time 16.6 mL kg − 1 of lactated Ringer's had been infused, of which virtually all remained in the circulating blood. Thereafter, the fluid kinetics was similar to that previously been found in awake volunteers except for the elimination rate constant (k 10), which remained to be very low (0.86 × 10 − 3 min − 1). Redistribution of infused fluid from the interstitium to the plasma occurred faster (higher k 21) when the arterial pressure was low. No covariance was found between the fixed parameters and preoperatively concentrated urine, the use of sevoflurane or propofol to maintain the anesthesia, or the plasma concentrations of two degradation products of the endothelial glycocalyx, syndecan-1 and heparan sulfate. Conclusions: Induction of general anesthesia interrupted the distribution of lactated Ringer's solution up to when 16.6 mL kg − 1 of crystalloid fluid had been infused. Plasma volume expansion during this period of time was pronounced. Trial registration: Controlled-trials.com (ISRCTN81005631) on May 17, 2016 (retrospectively registered).

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Population Volume Kineticsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Volume kinetic analysis of fluid retention after induction of general anesthesia

Hahn

Nemme

2020

BMC Anesthesiol

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Fluid Therapy for Critically Ill Adults With Sepsis

Zampieri

Bagshaw

Semler

2023

JAMA

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ImportanceApproximately 20% to 30% of patients admitted to an intensive care unit have sepsis. While fluid therapy typically begins in the emergency department, intravenous fluids in the intensive care unit are an essential component of therapy for sepsis.ObservationsFor patients with sepsis, intravenous fluid can increase cardiac output and blood pressure, maintain or increase intravascular fluid volume, and deliver medications. Fluid therapy can be conceptualized as 4 overlapping phases from early illness through resolution of sepsis: resuscitation (rapid fluid administered to restore perfusion); optimization (the risks and benefits of additional fluids to treat shock and ensure organ perfusion are evaluated); stabilization (fluid therapy is used only when there is a signal of fluid responsiveness); and evacuation (excess fluid accumulated during treatment of critical illness is eliminated). Among 3723 patients with sepsis who received 1 to 2 L of fluid, 3 randomized clinical trials (RCTs) reported that goal-directed therapy administering fluid boluses to attain a central venous pressure of 8 to 12 mm Hg, vasopressors to attain a mean arterial blood pressure of 65 to 90 mm Hg, and red blood cell transfusions or inotropes to attain a central venous oxygen saturation of at least 70% did not decrease mortality compared with unstructured clinical care (24.9% vs 25.4%; P = .68). Among 1563 patients with sepsis and hypotension who received 1 L of fluid, an RCT reported that favoring vasopressor treatment did not improve mortality compared with further fluid administration (14.0% vs 14.9%; P = .61). Another RCT reported that among 1554 patients in the intensive care unit with septic shock treated with at least 1 L of fluid compared with more liberal fluid administration, restricting fluid administration in the absence of severe hypoperfusion did not reduce mortality (42.3% vs 42.1%; P = .96). An RCT of 1000 patients with acute respiratory distress during the evacuation phase reported that limiting fluid administration and administering diuretics improved the number of days alive without mechanical ventilation compared with fluid treatment to attain higher intracardiac pressure (14.6 vs 12.1 days; P &lt; .001), and it reported that hydroxyethyl starch significantly increased the incidence of kidney replacement therapy compared with saline (7.0% vs 5.8%; P = .04), Ringer lactate, or Ringer acetate.Conclusions and RelevanceFluids are an important component of treating patients who are critically ill with sepsis. Although optimal fluid management in patients with sepsis remains uncertain, clinicians should consider the risks and benefits of fluid administration in each phase of critical illness, avoid use of hydroxyethyl starch, and facilitate fluid removal for patients recovering from acute respiratory distress syndrome.

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Low‐Fouling Zwitterionic Polymeric Colloids as Resuscitation Fluids for Hemorrhagic Shock

et al. 2022

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Colloids, known as volume expanders, have been used as resuscitation fluids for hypovolemic shock for decades, as they increase plasma oncotic pressure and expand intravascular volume. However, recent studies show that commonly used synthetic colloids have adverse interactions with human biological systems. In this work, a low‐fouling amine(N)‐oxide‐based zwitterionic polymer as an alternative volume expander with improved biocompatibility and efficacy is designed. It is demonstrated that the polymer possesses antifouling ability, resisting cell interaction and deposition in major organs, and is rapidly cleared via renal filtration and hepatic circulation, reducing the risk of long‐term side effects. Furthermore, in vitro and in vivo studies show an absence of adverse effects on hemostasis or any acute safety risks. Finally, it is shown that, in a head‐to‐head comparison with existing colloids and plasma, the zwitterionic polymer serves as a more potent oncotic agent for restoring intravascular volume in a hemorrhagic shock model. The design of N‐oxide‐based zwitterionic polymers may lead to the development of alternative fluid therapies to treat hypovolemic shock and to improve fluid management in general.

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Understanding volume kinetics

Cited by 61 publications

References 52 publications

Volume kinetic analysis of fluid retention after induction of general anesthesia

Volume kinetic analysis of fluid retention after induction of general anesthesia

Fluid Therapy for Critically Ill Adults With Sepsis

Low‐Fouling Zwitterionic Polymeric Colloids as Resuscitation Fluids for Hemorrhagic Shock

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