Abstract:Rationale: Survivors of septic shock have impaired functional status. Volume overload is associated with poor outcomes in patients with septic shock, but the impact of volume overload on functional outcome and discharge destination of survivors is unknown.Objectives: This study describes patterns of fluid management both during and after septic shock. We examined factors associated with volume overload upon intensive care unit (ICU) discharge. We then examined associations between volume overload upon ICU disc… Show more
“…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.The absence of any clear benefit following the administration of colloid compared to crystalloid solutions in the combined subgroups of sepsis, in conjunction with the expense of albumin, supports a strong recommendation for the use of crystalloid solutions in the initial resuscitation of patients with sepsis and septic shock.We were unable to recommend one crystalloid solution over another because no direct comparisons have been made between isotonic saline and balanced salt solutions in patients with sepsis.…”
Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.
“…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.The absence of any clear benefit following the administration of colloid compared to crystalloid solutions in the combined subgroups of sepsis, in conjunction with the expense of albumin, supports a strong recommendation for the use of crystalloid solutions in the initial resuscitation of patients with sepsis and septic shock.We were unable to recommend one crystalloid solution over another because no direct comparisons have been made between isotonic saline and balanced salt solutions in patients with sepsis.…”
Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.
“…6,34,36,39,40 There are single studies suggesting that other potentially modifiable ICU interventions, including liberal fluid administration and transfusion, journal.publications.chestnet.org may contribute to ICUAW, although these associations need verification in larger patient cohorts. 45,46 Prolonged immobilization is associated with atrophy in patients who are critically ill. Muscle disuse is associated with changes in muscle diameter, length, and contractile strength.…”
Section: In-hospital Risk Factors For Icuawmentioning
Survivorship after critical illness is an increasingly important health-care concern as ICU use continues to increase while ICU mortality is decreasing. Survivors of critical illness experience marked disability and impairments in physical and cognitive function that persist for years after their initial ICU stay. Newfound impairment is associated with increased health-care costs and use, reductions in health-related quality of life, and prolonged unemployment. Weakness, critical illness neuropathy and/or myopathy, and muscle atrophy are common in patients who are critically ill, with up to 80% of patients admitted to the ICU developing some form of neuromuscular dysfunction. ICU-acquired weakness (ICUAW) is associated with longer durations of mechanical ventilation and hospitalization, along with greater functional impairment for survivors. Although there is increasing recognition of ICUAW as a clinical entity, significant knowledge gaps exist concerning identifying patients at high risk for its development and understanding its role in long-term outcomes after critical illness. This review addresses the epidemiologic and pathophysiologic aspects of ICUAW; highlights the diagnostic challenges associated with its diagnosis in patients who are critically ill; and proposes, to our knowledge, a novel strategy for identifying ICUAW.
“…Over two-thirds of critically ill patients qualify the definition of volume overload (i.e., increase the weight more than 10% of admission body weight) in their first day of intensive care unit (ICU) stay [6], and most patients will be discharged from ICU while volume overloaded [7]. Fluid overload is associated with increased mortality in different patient populations, such as patients with sepsis, acute lung injury (ALI), and acute kidney injury (AKI) [8][9][10][11][12][13][14].…”
Objective Fluid overload is common among critically ill patients and is associated with worse outcomes. We aimed to assess the effect of diuretics on urine output, vasopressor dose, acute kidney injury (AKI) incidence, and need for renal replacement therapies (RRT) among patients who receive vasopressors. Patients and methods This is a single-center retrospective study of all adult patients admitted to the intensive care unit between January 2006 and December 2016 and received >6 hours of vasopressor therapy and at least one concomitant dose of diuretic. We excluded patients from cardiac care units. Hourly urine output and vasopressor dose for 6 hours before and after the first dose of diuretic therapy was compared. Rates of AKI development and RRT initiation were assessed with a propensity-matched cohort of patients who received vasopressors but did not receive diuretics. Results There was an increasing trend of prescribing diuretics in patients receiving vasopressors over the course of the study. We included 939 patients with median (IQR) age of 68(57, 78) years old and 400 (43%) female. The average hourly urine output during the first six hours following time zero in comparison with average hourly urine output during the six hours prior to time zero was significantly higher in diuretic group in comparison with patients who did not receive diuretics [81 (95% CI 73-89) ml/h vs. 42 (95% CI 39-45) ml/h, respectively; p<0.001]. After propensity matching, the rate of AKI within 7 days of exposure and the need for RRT were similar between the study and matched control patients (66 (15.6%) vs. 83 (19.6%), p = 0.11, and 34 (8.0%) vs. 37 (8.7%), p = 0.69, respectively). Mortality, however,
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