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Mayerhöfer T, Lehner GF, Joannidis M. [Volume therapy: which preparation for which situation?]. Med Klin Intensivmed Notfmed 2024; 119:640-649. [PMID: 39382683 PMCID: PMC11538216 DOI: 10.1007/s00063-024-01194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 09/09/2024] [Indexed: 10/10/2024]
Abstract
The most commonly used fluids for volume therapy are crystalloids and colloids. Crystalloids comprise 0.9% sodium chloride and balanced crystalloids (BC). Colloids can be divided into artificial colloids and human albumin (a natural colloid). Large studies show advantages for BC over 0.9% NaCl with respect to renal endpoints, probably due to the unphysiologically high chloride content of 0.9% NaCl. However, other studies, such as the BaSICS and PLUS trials, showed no significant differences in mortality in a heterogeneous population. Despite this, meta-analyses suggest advantages for BC. Therefore, BC should be preferred, especially in patients at increased risk of acute kidney injury, with acidemia and/or hyperchloremia. Except for specific indications (e.g., in patients with cirrhosis, sepsis resuscitation after initial volume therapy with BC), albumin should not be used. There is clear evidence of harm from hydroxyethyl starch in intensive care patients.
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Affiliation(s)
- Timo Mayerhöfer
- Gemeinsame Einrichtung für Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Georg F Lehner
- Gemeinsame Einrichtung für Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Michael Joannidis
- Gemeinsame Einrichtung für Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
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2
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Greenhalgh DG. Current Thoughts on Burn Resuscitation. Adv Surg 2024; 58:1-17. [PMID: 39089770 DOI: 10.1016/j.yasu.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
The optimal treatment of burn shock is still unresolved. The problem of "fluid creep" continues despite modern devices that fail to improve outcomes over hourly urine output. Colloids, especially albumin, reduce fluid requirements. Albumin can be used either immediately at the start of resuscitation, or as a "rescue" when crystalloid use is excessive. Several studies confirm that when crystalloid resuscitation is "out of control" the majority of caregivers will add albumin to reduce fluid rates. A multi-center trial is underway comparing crystalloids with albumin to confirm the benefit of colloids. The next question is whether albumin or plasma is as the better colloid choice.
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Affiliation(s)
- David G Greenhalgh
- Burn Department, Shriners Children's Northern California, 2425 Stockton Boulevard, Sacramento, CA 95817, USA; Emeritus, Department of Surgery, University of California, Davis, CA, USA.
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Li L, Liu H, Zhao Y, Liu X, Dong Y, Luo J, Jiang X, Zhang Y, Zhu Q, Yuan X, Pei X, Zhang L, Li B, Yang S, Gou M. 3D Printing of Maturable Tissue Constructs Using a Cell‐Adaptable Nanocolloidal Hydrogel. ADVANCED FUNCTIONAL MATERIALS 2024; 34. [DOI: 10.1002/adfm.202402341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Indexed: 01/06/2025]
Abstract
Abstract3D‐printed cell‐laden hydrogels as tissue constructs show great promise in generating living tissues for medicine. Currently, the maturation of 3D‐printed constructs into living tissues remains challenge, since commonly used hydrogels struggle to provide an ideal microenvironment for the seeded cells. In this study, a cell‐adaptable nanocolloidal hydrogel is created for 3D printing of maturable tissue constructs. The nanocolloidal hydrogel is composed of interconnected nanoparticles, which is prepared by the self‐assembly and subsequent photocrosslinking of the gelatin methacryloyl solutions. Cells can get enough space to grow and migrate within the hydrogel through squeezing the flexible nanocolloidal networks. Meanwhile, the nanostructure can promote the seeded cells to proliferate and produce matrix proteins through mechanotransduction. Using digital light process‐based 3D printing technology, it can rapidly customize cartilage tissue constructs. After implantation, these tissue constructs efficiently matured into cartilage tissues for the articular cartilage defect repair and ear cartilage reconstruction in vivo. The 3D printing of maturable tissue constructs using the nanocolloidal hydrogel shows potential for future clinical applications.
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Affiliation(s)
- Li Li
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Haofan Liu
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Yongchao Zhao
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Xuan Liu
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces College of Pharmacy Hunan University of Chinese Medicine Changsha 410208 P. R. China
| | - Yinchu Dong
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Jing Luo
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Xuebing Jiang
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Yi Zhang
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Qi Zhu
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Xin Yuan
- Department of Plastic and Burn Surgery West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Xuan Pei
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Li Zhang
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Boya Li
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Shuai Yang
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
| | - Maling Gou
- Department of Biotherapy Cancer Center and State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu 610041 P. R. China
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Hyperoncotic human albumin solutions for intravenous fluid therapy: Effectiveness of pathogen safety and purification methods, and clinical safety. BIOSAFETY AND HEALTH 2022. [DOI: 10.1016/j.bsheal.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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5
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Choix du soluté pour le remplissage vasculaire en situation critique. ANESTHÉSIE & RÉANIMATION 2022. [DOI: 10.1016/j.anrea.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Joannes-Boyau O, Le Conte P, Bonnet MP, Cesareo E, Chousterman B, Chaiba D, Douay B, Futier E, Harrois A, Huraux C, Ichai C, Meaudre Desgouttes E, Mimoz O, Muller L, Oberlin M, Peschanski N, Quintard H, Rousseau G, Savary D, Tran-Dinh A, Villoing B, Chauvin A, Weiss E. Guidelines for the choice of intravenous fluids for vascular filling in critically ill patients, 2021. Anaesth Crit Care Pain Med 2022; 41:101058. [PMID: 35526312 DOI: 10.1016/j.accpm.2022.101058] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To provide recommendations for the appropriate choice of fluid therapy for resuscitation of critically ill patients. DESIGN A consensus committee of 24 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Emergency Medicine (Société française de médecine d'urgence, SFMU) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline elaboration process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide their assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Some recommendations were left ungraded. METHODS Four fields were defined: patients with sepsis or septic shock, patients with haemorrhagic shock, patients with acute brain failure, and patients during the peripartum period. For each field, the panel focused on two questions: (1) Does the use of colloids, as compared to crystalloids, reduce morbidity and mortality, and (2) Does the use of some specific crystalloids effectively reduce morbidity and mortality. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE methodology. RESULTS The SFAR/SFMU guideline panel provided nine statements on the appropriate choice of fluid therapy for resuscitation of critically ill patients. After two rounds of rating and various amendments, strong agreement was reached for 100% of the recommendations. Out of these recommendations, two have a high level of evidence (Grade 1 +/-), six have a moderate level of evidence (Grade 2 +/-), and one is based on expert opinion. Finally, no recommendation was formulated for two questions. CONCLUSIONS Substantial agreement among experts has been obtained to provide a sizable number of recommendations aimed at optimising the choice of fluid therapy for resuscitation of critically ill patients.
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Affiliation(s)
- Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation SUD, CHU de Bordeaux, Hôpital Magellan, Bordeaux, France.
| | - Philippe Le Conte
- Nantes Université, Faculté de Médecine, CHU de Nantes, Service des Urgences, Nantes, France
| | - Marie-Pierre Bonnet
- Sorbonne Université, Service d'Anesthésie-Réanimation, Hôpital Trousseau, DMU DREAM, GRC 29, APHP, Paris, France; INSERM U1153, Equipe de Recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité, Paris, France
| | - Eric Cesareo
- Samu 69, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d'Arsonval, F-69437 Lyon Cedex 03, France
| | - Benjamin Chousterman
- APHP, CHU Lariboisière, Département d'Anesthésie-Réanimation, DMU PARABOL, FHU, PROMICE, Paris, France; Université de Paris, INSERM U942 MASCOT, Paris, France
| | - Djamila Chaiba
- Service des Urgences Médico-Chirurgicales, Hôpital Simone Veil, Eaubonne, France
| | - Bénédicte Douay
- SMUR/Service des Urgences, Hôpital Beaujon, AP-HP Nord, Clichy, France
| | - Emmanuel Futier
- Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Département Anesthésie et Réanimation, Hôpital Estaing, Clermont-Ferrand, France; Université Clermont Auvergne, CNRS, Inserm U-1103, Clermont-Ferrand, France
| | - Anatole Harrois
- Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Université Paris-Saclay, Paris, France
| | | | - Carole Ichai
- Université Côte D'Azur, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Service de Réanimation Polyvalente, Nice, France
| | - Eric Meaudre Desgouttes
- Service Anesthésiologie-Réanimation Chirurgicale, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France
| | - Olivier Mimoz
- Service des Urgences Adultes & SAMU 86, CHU de Poitiers, Poitiers, France; Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France; Inserm U1070, Pharmacology of Antimicrobial Agents, Poitiers, France
| | - Laurent Muller
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, CHU Nîmes, Montpellier, France
| | - Mathieu Oberlin
- Structure des Urgences, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Peschanski
- Service des Urgences-SAMU-SMUR-CHU Rennes, Rennes, France; Faculté de Médecine-Université Rennes-1, Rennes, France
| | - Hervé Quintard
- Service des Soins Intensifs Adultes, Hôpitaux Universitaires de Genève, Switzerland
| | | | | | - Alexy Tran-Dinh
- Service d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Barbara Villoing
- SAU-SMUR, CHU Cochin Hôtel Dieu, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Anthony Chauvin
- Services des Urgences/SMUR, Hôpital Lariboisière, Université de Paris Cité, Paris, France
| | - Emmanuel Weiss
- Service Anesthésie-Réanimation, Hôpital Beaujon, DMU PARABOL, AP-HP Nord, Clichy, France; Centre de Recherche sur l'Inflammation, UMR_S1149, Université de Paris, Paris, France
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Fluidoterapia en la sepsis y el shock séptico. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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8
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Sa MB, Salaverría I, Cabas AC. [Fluid therapy in sepsis and septic shock]. Med Intensiva 2022; 46 Suppl 1:14-25. [PMID: 38341257 DOI: 10.1016/j.medine.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 02/12/2024]
Abstract
Fluid resuscitation is a crucial part of the treatment of hypotension and shock of any etiology. Particularly in septic shock, it is an essential element of the initial care bundle. Like all treatments in sepsis, it is also subject to multiple controversies: what type of fluid, how much, how long to administer it, potential risks, toxicity? The main guideline, the Surviving Sepsis Campaign, continues to indicate crystalloids as the main fluid in resuscitation. But the possibility of crystalloids balanced on 0.9% saline or combined use with albumin in the resuscitation of the septic patient is still under debate. This is probably another point where we should always consider individualizing both the type and amount of fluids to be administered in both the initial and maintenance phases of the management of sepsis and septic shock.
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Affiliation(s)
- Marcio Borges Sa
- Unidad Multidisciplinar de Sepsis, Servicio Medicina Intensiva, Hospital Universitario Son Llàtzer, Palma de Mallorca, España.
| | - Iñigo Salaverría
- Grupo Multidisciplinar de Sepsis. Instituto de Investigación Sanitaria de las Islas Baleares (IDISBA), Palma de Mallorca, España; Director del Comité de Sepsis, Federación Ibérica y Panamericana de Medicina Intensiva (FEPIMCTI)
| | - Antonio Couto Cabas
- Unidad Multidisciplinar de Sepsis, Servicio Medicina Intensiva, Hospital Universitario Son Llàtzer, Palma de Mallorca, España; Servicio de Medicina Intensiva, Hospital General, León, México
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Koponen T, Musialowicz T, Lahtinen P. Gelatin and the risk of acute kidney injury after cardiac surgery. Acta Anaesthesiol Scand 2022; 66:215-222. [PMID: 34811729 DOI: 10.1111/aas.14004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gelatin has been used as a plasma volume expander because of its ability to preserve intravascular volume more effectively than crystalloids. However, gelatin may have detrimental effects on kidney function and increase the risk of acute kidney injury (AKI). METHOD We investigated by retrospective analysis of prospectively collected data whether the administration of 4% succinyl gelatin is associated with an increased risk of AKI after cardiac surgery. We compared two propensity score-matched groups of 1,187 patients (crystalloid group and gelatin group). RESULTS The incidence of AKI was similar in both groups (gelatin 21% and crystalloid 20%) (p = 0.414). The incidence of moderate AKI (8% vs. 6%) was higher in the gelatin group, but there was no difference in mild or severe AKI. Postoperative serum creatine on the first (70 vs. 70 μmol L-1 , p = 0.689) or fourth (71 vs. 70, p = 0.313) postoperative day was similar between groups and there was no difference in the need for new renal replacement therapy (p = 0.999). Patients in the gelatin group received less crystalloids (2080 ml vs. 4130 ml, p = 0.001) and total fluids (3760 ml vs. 4180 ml, p = 0.001), their fluid balance was less positive (p = 0.001) and they required less vasoactive and inotropic medication (p = 0.001). Gelatin was not associated with increased mortality compared to the crystalloid group. CONCLUSION Gelatin was not associated with AKI after cardiac surgery.
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Affiliation(s)
- Timo Koponen
- Department of Anaesthesia and Intensive Care Medicine North Karelia Central Hospital Joensuu Finland
| | - Tadeusz Musialowicz
- Department of Anaesthesia and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
| | - Pasi Lahtinen
- Anesthesiology and Intensive Care Department Central Hospital of South Ostrobothnia Seinäjoki Finland
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Joannes-Boyau O, Roquilly A, Constantin JM, Duracher-Gout C, Dahyot-Fizelier C, Langeron O, Legrand M, Mirek S, Mongardon N, Mrozek S, Muller L, Orban JC, Virat A, Leone M. Choice of fluid for critically ill patients: An overview of specific situations. Anaesth Crit Care Pain Med 2020; 39:837-845. [PMID: 33091593 DOI: 10.1016/j.accpm.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000 Bordeaux, France.
| | - Antoine Roquilly
- CHU Nantes, Université de Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, 44093 Nantes, France
| | - Jean-Michel Constantin
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Caroline Duracher-Gout
- Département d'Anesthésie Réanimation Chirurgicale et SAMU de Paris, Université René Descartes Paris, 75006 Paris Cedex, France
| | - Claire Dahyot-Fizelier
- Anaesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France. INSERM UMR1070 - Pharmacology of Anti-infective Agents, University of Poitiers, 86000 Poitiers, France
| | - Olivier Langeron
- Service d'Anesthésie-Réanimation, Hôpital Henri Mondor Assistance Publique - Hôpitaux de Paris Université Paris-Est, 94 Créteil, France
| | - Matthieu Legrand
- Department of Anaesthesia and Perioperative Care, University of California, 500 Parnassus Avenue, San Francisco, USA
| | - Sébastien Mirek
- Service d'Anesthésie Réanimation, CHU Dijon, 21000 Dijon Cedex, France
| | - Nicolas Mongardon
- Service d'Anesthésie-Réanimation, Hôpital Henri Mondor Assistance Publique - Hôpitaux de Paris Université Paris-Est, 94 Créteil, France
| | - Ségolène Mrozek
- Département d'Anesthésie-Réanimation, CHU Toulouse, Hôpital Pierre Paul Riquet, 31000 Toulouse, France
| | - Laurent Muller
- Service des réanimations et Surveillance Continue, Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes Caremeau, Place Du Pr Debré, 30000 Nîmes, France
| | | | - Antoine Virat
- Clinique Pont De Chaume, 330, Avenue Marcel Unal, 82000 Montauban, France
| | - Marc Leone
- Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Service d'Anesthésie et de Réanimation, Hôpital Nord, 13005 Marseille, France
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Kasekar NM, Singh S, Jadhav KR, Kadam VJ. BCS class II drug loaded protein nanoparticles with enhanced oral bioavailability:in vitroevaluation andin vivopharmacokinetic study in rats. Drug Dev Ind Pharm 2020; 46:955-962. [DOI: 10.1080/03639045.2020.1764021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | | | - Kisan R. Jadhav
- Bharati Vidyapeeth’s College of Pharmacy, Navi Mumbai, India
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Contemporary resuscitation of hemorrhagic shock: What will the future hold? Am J Surg 2020; 220:580-588. [PMID: 32409009 PMCID: PMC7211588 DOI: 10.1016/j.amjsurg.2020.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
Abstract
Resuscitation of the critically ill patient with fluid and blood products is one of the most widespread interventions in medicine. This is especially relevant for trauma patients, as hemorrhagic shock remains the most common cause of preventable death after injury. Consequently, the study of the ideal resuscitative product for patients in shock has become an area of great scientific interest and investigation. Recently, the pendulum has swung towards increased utilization of blood products for resuscitation. However, pathogens, immune reactions and the limited availability of this resource remain a challenge for clinicians. Technologic advances in pathogen reduction and innovations in blood product processing will allow us to increase the safety profile and efficacy of blood products, ultimately to the benefit of patients. The purpose of this article is to review the current state of blood product based resuscitative strategies as well as technologic advancements that may lead to safer resuscitation.
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Degoul S, Chazard E, Lamer A, Lebuffe G, Duhamel A, Tavernier B. lntraoperative administration of 6% hydroxyethyl starch 130/0.4 is not associated with acute kidney injury in elective non-cardiac surgery: A sequential and propensity-matched analysis. Anaesth Crit Care Pain Med 2020; 39:199-206. [PMID: 32068135 DOI: 10.1016/j.accpm.2019.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 07/18/2019] [Accepted: 08/29/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intraoperative use of hydroxyethyl starch (HES) may increase the risk of postoperative acute kidney injury (AKI). Data from large populations are lacking. We aimed to assess whether intraoperative administration of 6% HES 130/0.4 is associated with AKI in non-cardiac surgery. METHODS This retrospective study used the electronic records concerning elective abdominal, urologic, thoracic and peripheral vascular surgeries from 2010 to 2015. HES and non-HES patients were compared using a propensity score matching. Postoperative AKI, defined by stage 3 of the Kidney Disease Improving Global Outcomes (KDIGO) score, was the primary outcome. Because the use of HES markedly decreased in 2013, additional analyses, restricted to the 2010-2012 period, were also performed. RESULTS In total, 23,045, and 11,691 patients were included in the whole, and restricted periods, respectively. The reduction in HES use was not accompanied by any change in the incidence of AKI. Unadjusted association between HES and KDIGO 3 AKI was significant (OR [95% CI] of 2.13 [1.67, 2.71]). For the whole period, 6460 patients were matched. Odd ratios for KDIGO 3 and all-stage AKI when using HES (10.3±4.7mL.kg-1) were 1.20 (95% CI [0.74, 1.95]), and 1.21 (95% CI [0.95, 1.54]), respectively. There was no association with the initiation of renal replacement therapy or in-hospital mortality either. Similar results were found for the restricted period. CONCLUSION The intraoperative use of moderate doses of 6% HES 130/0.4 was not associated with increased risk of AKI. No conclusion can be drawn for higher doses of HES.
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Affiliation(s)
- Samuel Degoul
- CHU de Lille, Pôle d'anesthésie-réanimation, 59000 Lille, France.
| | - Emmanuel Chazard
- Université de Lille, EA 2694 Centre d Étude et de Recherche en Informatique Médicale, 59000 Lille, France; CHU de Lille, Pôle de santé publique, 59000 Lille, France
| | - Antoine Lamer
- CHU de Lille, Pôle de santé publique, 59000 Lille, France
| | - Gilles Lebuffe
- CHU de Lille, Pôle d'anesthésie-réanimation, 59000 Lille, France
| | - Alain Duhamel
- Université de Lille, EA 2694 Centre d Étude et de Recherche en Informatique Médicale, 59000 Lille, France; CHU de Lille, Pôle de santé publique, 59000 Lille, France
| | - Benoît Tavernier
- CHU de Lille, Pôle d'anesthésie-réanimation, 59000 Lille, France
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Weiss AV, Koch M, Schneider M. Combining cryo-TEM and energy-filtered TEM for imaging organic core-shell nanoparticles and defining the polymer distribution. Int J Pharm 2019; 570:118650. [DOI: 10.1016/j.ijpharm.2019.118650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 12/17/2022]
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Rotational thromboelastometry assessment of ballanced crystalloid, hydroxyethyl starch and gelatin effects on coagulation: a randomized trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2019. [PMID: 31405567 PMCID: PMC9391864 DOI: 10.1016/j.bjane.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background and objectives Methods Results Conclusion
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Sevcikova S, Durila M, Vymazal T. Tromboelastometria rotacional na avaliação dos efeitos de cristaloides balanceados, hidroxietilamido e gelatina na coagulação: estudo randômico. Braz J Anesthesiol 2019; 69:383-389. [DOI: 10.1016/j.bjan.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/04/2019] [Accepted: 03/17/2019] [Indexed: 12/21/2022] Open
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17
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Hydroxyethyl starch and fluid resuscitation: Patient-oriented outcome is the "right way". Authors' reply. J Crit Care 2019; 51:228. [PMID: 30824224 DOI: 10.1016/j.jcrc.2019.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/14/2019] [Indexed: 11/22/2022]
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18
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Martin GS, Bassett P. Controversial supremacy: Are colloids better than crystalloids? Authors' reply. J Crit Care 2019; 58:116-117. [PMID: 30797611 DOI: 10.1016/j.jcrc.2019.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Greg S Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine and Grady Memorial Hospital, Atlanta, GA, USA.
| | - Paul Bassett
- Meridian HealthComms, Plumley Moor Road, Plumley, UK.
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19
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Adamik KN, Yozova ID. Starch Wars-New Episodes of the Saga. Changes in Regulations on Hydroxyethyl Starch in the European Union. Front Vet Sci 2019; 5:336. [PMID: 30713845 PMCID: PMC6345713 DOI: 10.3389/fvets.2018.00336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/14/2018] [Indexed: 01/23/2023] Open
Abstract
After a safety review of hydroxyethyl starch (HES) solutions in 2013, restrictions on the use of HES were introduced in the European Union (EU) to reduce the risk of kidney injury and death in certain patient populations. Similar restrictions were introduced by the Food and Drug Administration in the United States and other countries. In October 2017, a second safety review of HES solutions was triggered by the European pharmacovigilance authorities based on a request by the Swedish Medical Products Agency to completely suspend HES. After several meetings and repeated evaluations, the recommendation to ban HES was ultimately not endorsed by the responsible committee; however, there was a vote for more restricted access to the drug and rigorous monitoring of policy adherence. This review delineates developments in the European pharmacovigilance risk assessment of HES solutions between 2013 and 2018. In addition, the divergent experts' opinions and the controversy surrounding this official assessment are described. As the new decisions might influence the availability of HES products for veterinary patients, potential alternatives to HES solutions, such as albumin solutions and gelatin, are briefly discussed.
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Affiliation(s)
- Katja-Nicole Adamik
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Ivayla D. Yozova
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
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20
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MacDonald N, Pearse RM. Are we close to the ideal intravenous fluid? Br J Anaesth 2019; 119:i63-i71. [PMID: 29161385 DOI: 10.1093/bja/aex293] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 01/01/2023] Open
Abstract
The approach to i.v. fluid therapy for hypovolaemia may significantly influence outcomes for patients who experience a systemic inflammatory response after sepsis, trauma, or major surgery. Currently, there is no single i.v. fluid agent that meets all the criteria for the ideal treatment for hypovolaemia. The physician must choose the best available agent(s) for each patient, and then decide when and how much to administer. Findings from large randomized trials suggest that some colloid-based fluids, particularly starch-based colloids, may be harmful in some situations, but it is unclear whether they should be withdrawn from use completely. Meanwhile, crystalloid fluids, such as saline 0.9% and Ringer's lactate, are more frequently used, but debate continues over which preparation is preferable. Perhaps most importantly, it remains unclear how to select the optimal dose of fluid in different patients and different clinical scenarios. There is good reason to believe that both inadequate and excessive i.v. fluid administration may lead to poor outcomes, including increased risk of infection and organ dysfunction, for hypovolaemic patients. In this review, we summarize the current knowledge on this topic and identify some key pitfalls and some areas of agreed best practice.
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Affiliation(s)
- N MacDonald
- Department of Perioperative and Pain Medicine, Barts Health NHS Trust, London E1 1BB, UK
| | - R M Pearse
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
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21
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Abstract
Background Fluids are by far the most commonly administered intravenous treatment in patient care. During critical illness, fluids are widely administered to maintain or increase cardiac output, thereby relieving overt tissue hypoperfusion and hypoxia. Main text Until recently, because of their excellent safety profile, fluids were not considered “medications”. However, it is now understood that intravenous fluid should be viewed as drugs. They affect the cardiovascular, renal, gastrointestinal and immune systems. Fluid administration should therefore always be accompanied by careful consideration of the risk/benefit ratio, not only of the additional volume being administered but also of the effect of its composition on the physiology of the patient. Apart from the need to constantly assess fluid responsiveness, it is also important to periodically reconsider the type of fluid being administered and the evidence regarding the relationship between specific disease states and different fluid solutions. Conclusions The current review presents the state of the art regarding fluid solutions and presents the existing evidence on routine fluid management of critically ill patients in specific clinical settings (sepsis, Adult Respiratory Distress Syndrome, major abdominal surgery, acute kidney injury and trauma). Electronic supplementary material The online version of this article (10.1186/s12871-018-0669-3) contains supplementary material, which is available to authorized users.
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22
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Farooque S, Kenny M, Marshall SD. Anaphylaxis to intravenous gelatin-based solutions: a case series examining clinical features and severity. Anaesthesia 2018; 74:174-179. [DOI: 10.1111/anae.14497] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S. Farooque
- Chest and Allergy Clinic; St Mary's Hospital; London UK
| | - M. Kenny
- Chest and Allergy Clinic; St Mary's Hospital; London UK
| | - S. D. Marshall
- Department of Anaesthesia and Peri-operative Medicine; Monash University; Melbourne Vic. Australia
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23
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Wang T, Wang X, Liu J, Zou L, Wang J, Zhao M, Cui Y. Substitution of artificial colloids for fresh frozen plasma in pediatric cardiopulmonary bypass surgery. Paediatr Anaesth 2018; 28:914-923. [PMID: 30207420 DOI: 10.1111/pan.13473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 05/08/2018] [Accepted: 06/18/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND In many centers, fresh frozen plasma is generally used as the main component of pump prime in pediatric cardiopulmonary bypass. However, many factors have resulted in stringent control of plasma transfusion and prompted the study of safe and efficient substitutes. AIMS The aim of this study was to investigate the feasibility of a priming strategy with gelatin during cardiopulmonary bypass in pediatric patients undergoing cardiac surgery and identify the factors associated with postoperative chest-tube drainage. METHODS We reviewed 1164 pediatric patients who underwent cardiac surgery with cardiopulmonary bypass between January 2012 and April 2013 in Fuwai hospital. Infants and children were primed with different types of solution: plasma or gelatin. Clinical data included postoperative coagulation function (pharmacological agents, chest-tube drainage, and transfusion requirements), recovery indicators (mechanical ventilator time, ICU stay and hospital stay), incidence of in-hospital mortality, and morbidity. Multivariate linear regression analysis was used to identify factors correlated with postoperative chest-tube drainage. RESULTS No difference in mortality or morbidity was found between the plasma and gelatin groups. In infants, increased chest-tube drainage (postoperation 12 hours, median difference -0.046 ml/kg/hr, 95%CI: -0.105 to -0.007, P = 0.001; postoperation 24 hours, median difference -0.047 ml/kg/hr, 95%CI: -0.081 to -0.025, P < 0.001), and decreased transfusion (red blood cell, median difference 0.00 ml/kg/hr, 95%CI: 0.000-100, P < 0.001; fresh frozen plasma, median difference 5.556 ml/kg/hr, 95%CI: 2.30-8.333, P = 0.001), and recovery time (mechanical ventilator time, median difference 3.00 hours, 95%CI: 1.00-5.500, P < 0.001; ICU stay, median difference 17.00 hours, 95%CI: 1.00-22.000, P = 0.001; hospital stay, median difference 1.00 day, 95%CI: 0.00-2.000, P = 0.038) were demonstrated in the gelatin group. In children, the transfusion requirements (red blood cell, median difference 100 ml, P < 0.001;fresh frozen plasma, median difference 1.11 ml/kg, 95%CI: 0.000-2.42, P = 0.001) were decreased in the gelatin group. Multivariate linear regression analysis revealed that the type of priming solution (β = 1.940,95%CI: 1.057-2.823,P < 0.001), bypass time (β = 0.024, 95%CI: 0.013-0.036, P < 0.001), and age (β = -0.257, 95%CI: -0.422 to -0.09, P = 0.002) were independent variables correlating with chest-tube drainage in infants. CONCLUSION In the general pediatric patients undergoing elective cardiac surgery, substitution of gelatin for fresh frozen plasma in cardiopulmonary bypass is feasible.
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Affiliation(s)
- Tian Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xiangyu Wang
- Department of Breast Surgical Oncology, Chinese Academy of Medical Science and Peking Union Medical College, National Cancer Center/Cancer Hospital, Beijing, China
| | - Jinping Liu
- Department of Cardiopulmonary Bypass, Chinese Academy of Medical Science and Peking Union Medical College, Fuwai Hospital and National Center for Cardiovascular Diseases, Beijing, China
| | - Lihua Zou
- Department of Cardiopulmonary Bypass, Chinese Academy of Medical Science and Peking Union Medical College, Fuwai Hospital and National Center for Cardiovascular Diseases, Beijing, China
| | - Jingtao Wang
- Department of biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Mingxia Zhao
- Department of Cardiopulmonary Bypass, Chinese Academy of Medical Science and Peking Union Medical College, Fuwai Hospital and National Center for Cardiovascular Diseases, Beijing, China
| | - Yongli Cui
- Department of Cardiopulmonary Bypass, Chinese Academy of Medical Science and Peking Union Medical College, Fuwai Hospital and National Center for Cardiovascular Diseases, Beijing, China
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24
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Geh KJ, Hubert M, Winter G. Progress in formulation development and sterilisation of freeze-dried oligodeoxynucleotide-loaded gelatine nanoparticles. Eur J Pharm Biopharm 2018; 129:10-20. [PMID: 29777773 DOI: 10.1016/j.ejpb.2018.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/02/2018] [Accepted: 05/15/2018] [Indexed: 11/25/2022]
Abstract
Oligodeoxynucleotide (ODN)-loaded gelatine nanoparticles (GNPs) have proven their outstanding potential in the treatment of allergic diseases such as equine asthma and canine atopic dermatitis, which are appropriate models for the corresponding human diseases. To encourage the development of a marketable product, long term stability and sterility needs to be ensured. In this work, we aimed to advance freeze-drying options to stabilise ODN-loaded GNPs. Matrix-assisted laser desorption/ionisation mass spectrometry time-of-flight was implemented as a versatile tool to assess ODN stability. With this method long-term storage stability of lyophilised ODN-loaded GNPs formulated in sucrose or trehalose was achieved. Controlled nucleation was further introduced to optimise the lyophilisation approach. This allowed shortening of the process in comparison to standard freeze-drying procedures. Particle sizes, polydispersity indices, ODN stability, residual moisture and glass transition temperature were maintained upon storage. Excipient portfolio was enlarged by novel amino acid containing formulations for lyophilisates. His emerged as an excellent excipient in stabilising lyophilised ODN-loaded GNPs, whereas addition of Arg and Gly revealed to be inadequate at accelerated conditions. Lastly, gamma irradiation was evaluated as a suitable sterilisation method of ODN-loaded GNPs.
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Affiliation(s)
- Katharina J Geh
- Department of Pharmacy, Pharmaceutical Technology and Biopharmaceutics, Ludwig-Maximilians-Universität München, Butenandtstr. 5-13, 81377 Munich, Germany.
| | - Madlen Hubert
- Department of Integrative Medical Biology, Umeå University, 901 87 Umeå, Sweden.
| | - Gerhard Winter
- Department of Pharmacy, Pharmaceutical Technology and Biopharmaceutics, Ludwig-Maximilians-Universität München, Butenandtstr. 5-13, 81377 Munich, Germany.
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Abstract
Recognition of fluid creep has driven a large amount of the scientific investigation in the area of acute fluid resuscitation for burn patients. The role of colloids in ameliorating fluid creep is controversial, despite the fact that a fluid-sparing effect of colloids has been recognized for some time. All but one of the available prospective studies using colloids are more than a decade old, and a modern randomized controlled trial (RCT) comparing crystalloids to colloids is long overdue. While urinary output continues to be the main endpoint for fluid titration, there has been a moderate amount of interest in the use of transpulmonary thermodilution to guide fluid resuscitation. The available studies have found that transpulmonary thermodilution has had an inconsistent effect on limiting fluid resuscitation volumes and improving clinical outcomes. Computerized Decision Support Systems show great promise in optimizing fluid titration and reducing fluid resuscitation volumes, and an RCT comparing Computerized Decision Support Systems with conventional titration approaches will be the important next step. Use of high-dose vitamin C (ascorbic acid) has become a popular approach to limit fluid resuscitation volumes and edema formation, but it has been investigated in only two clinical studies: one a pseudo-randomized prospective study and the other a retrospective study. Improvements in clinical outcome have not been convincingly demonstrated, and concerns persist surrounding the possibility of induction of an osmotic diuresis, leading to intravascular volume depletion. An RCT is urgently required to evaluate high-dose vitamin C as an adjunct to crystalloid resuscitation compared with the use of crystalloids alone.
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26
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Acute Effect of Hypervolemic Hemodilution on Retrobulbar Hemodynamics in Anterior Ischemic Optic Neuropathy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4756313. [PMID: 29546060 PMCID: PMC5818917 DOI: 10.1155/2018/4756313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/20/2017] [Accepted: 11/26/2017] [Indexed: 11/23/2022]
Abstract
Purpose Ischemic ocular disorders may be treated by hypervolemic hemodilution. The presumed therapeutic benefit is based on a volume effect and improved rheological factors. The aim was to investigate the acute effect of intravenous hydroxyethyl starch on retrobulbar hemodynamics in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods 24 patients with acute NAION were included. Retrobulbar hemodynamics were measured using color Doppler imaging before and 15 min after intravenous infusion of 250 cc 10% hydroxyethyl starch (HES). Peak systolic velocity (PSV), end diastolic velocity (EDV), and Pourcelot's resistive index (RI) were measured in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (PCAs). Results After infusion of HES blood flow velocities significantly increased in the CRA (PSV from 7.53 ± 2.33 to 8.32 ± 2.51 (p < 0.001); EDV from 2.16 ± 0.56 to 2.34 ± 0.55 (p < 0.05)) and in the PCAs (PSV from 7.18 ± 1.62 to 7.56 ± 1.55 (p < 0.01); EDV from 2.48 ± 0.55 to 2.66 ± 0.6 cm/sec (p < 0.01)). The RI of all retrobulbar vessels remained unaffected. Blood pressure and heart rate remained unchanged. Conclusions Hypervolemic hemodilution has an acute effect on blood flow velocities in the CRA and PCAs in NAION patients. Increased blood flow in the arteries supplying the optic nerve head may lead to a better perfusion in NAION patients. This trial is registered with DRKS00012603.
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27
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Yoshino O, Perini MV, Christophi C, Weinberg L. Perioperative fluid management in major hepatic resection: an integrative review. Hepatobiliary Pancreat Dis Int 2017; 16:458-469. [PMID: 28992877 DOI: 10.1016/s1499-3872(17)60055-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 04/10/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Fluid intervention and vasoactive pharmacological support during hepatic resection depend on the preference of the attending clinician, institutional resources, and practice culture. Evidence-based recommendations to guide perioperative fluid management are currently limited. Therefore, we provide a contemporary clinical integrative overview of the fundamental principles underpinning fluid intervention and hemodynamic optimization for adult patients undergoing major hepatic resection. DATA SOURCES A literature review was performed of MEDLINE, EMBASE and the Cochrane Central Registry of Controlled Trials using the terms "surgery", "anesthesia", "starch", "hydroxyethyl starch derivatives", "albumin", "gelatin", "liver resection", "hepatic resection", "fluids", "fluid therapy", "crystalloid", "colloid", "saline", "plasma-Lyte", "plasmalyte", "hartmann's", "acetate", and "lactate". Search results for MEDLINE and EMBASE were additionally limited to studies on human populations that included adult age groups and publications in English. RESULTS A total of 113 articles were included after appropriate inclusion criteria screening. Perioperative fluid management as it relates to various anesthetic and surgical techniques is discussed. CONCLUSIONS Clinicians should have a fundamental understanding of the surgical phases of the resection, hemodynamic goals, and anesthesia challenges in attempts to individualize therapy to the patient's underlying pathophysiological condition. Therefore, an ideal approach for perioperative fluid therapy is always individualized. Planning and designing large-scale clinical trials are imperative to define the optimal type and amount of fluid for patients undergoing major hepatic resection. Further clinical trials evaluating different intraoperative goal-directed strategies are also eagerly awaited.
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Affiliation(s)
- Osamu Yoshino
- Department of Surgery, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia.
| | - Marcos Vinicius Perini
- Department of Surgery, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Christophi
- Department of Surgery, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Laurence Weinberg
- Department of Surgery, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia; Anaesthesia Perioperative Pain Medicine Unit, University of Melbourne, Melbourne, Victoria, Australia
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28
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Abstract
Colloids have been used in varying capacities throughout the history of formula-based burn resuscitation. There is sound experimental evidence that demonstrates colloids' ability to improve intravascular colloid osmotic pressure, expand intravascular volume, reduce resuscitation requirements, and limit edema in unburned tissue following a major burn. Fresh frozen plasma appears to be a useful and effective immediate burn resuscitation fluid but its benefits must be weighed against its costs, and risks of viral transmission and acute lung injury. Albumin, in contrast, is less expensive and safer and has demonstrated ability to reduce resuscitation requirements and possibly limit edema-related morbidity.
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Affiliation(s)
- Robert Cartotto
- Department of Surgery, Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Room D712, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
| | - David Greenhalgh
- Department of Surgery, Shriners Hospitals for Children Northern California, University of California, Davis, 2425 Stockton Boulevard, Sacramento, CA 95817, USA
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Rehm M, Hulde N, Kammerer T, Meidert AS, Hofmann-Kiefer K. State of the art in fluid and volume therapy. Anaesthesist 2017; 68:1-14. [DOI: 10.1007/s00101-017-0290-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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30
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Rehm M, Hulde N, Kammerer T, Meidert AS, Hofmann-Kiefer K. [State of the art in fluid and volume therapy : A user-friendly staged concept]. Anaesthesist 2017; 66:153-167. [PMID: 28213648 DOI: 10.1007/s00101-017-0272-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adequate fluid therapy is highly important for the perioperative outcome of our patients. Both, hypovolemia and hypervolemia can lead to an increase in perioperative complications and can impair the outcome. Therefore, perioperative infusion therapy should be target-oriented. The main target is to maintain the patient's preoperative normovolemia by using a sophisticated, rational infusion strategy.Perioperative fluid losses should be discriminated from volume losses (surgical blood loss or interstitial volume losses containing protein). Fluid losses as urine or perspiratio insensibilis (0.5-1.0 ml/kg/h) should be replaced by balanced crystalloids in a ratio of 1:1. Volume therapy step 1: Blood loss up to a maximum value of 20% of the patient's blood volume should be replaced by balanced crystalloids in a ratio of 4(-5):1. Volume therapy step 2: Higher blood losses should be treated by using iso-oncotic, preferential balanced colloids in a ratio of 1:1. For this purpose hydroxyethyl starch can also be used perioperatively if there is no respective contraindication, such as sepsis, burn injuries, critically ill patients, renal impairment or renal replacement therapy, and severe coagulopathy. Volume therapy step 3: If there is an indication for red cell concentrates or coagulation factors, a differentiated application of blood and blood products should be performed.
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Affiliation(s)
- M Rehm
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - N Hulde
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - T Kammerer
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - A S Meidert
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - K Hofmann-Kiefer
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
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Moeller C, Fleischmann C, Thomas-Rueddel D, Vlasakov V, Rochwerg B, Theurer P, Gattinoni L, Reinhart K, Hartog CS. How safe is gelatin? A systematic review and meta-analysis of gelatin-containing plasma expanders vs crystalloids and albumin. J Crit Care 2016; 35:75-83. [DOI: 10.1016/j.jcrc.2016.04.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 12/22/2022]
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Guilabert P, Usúa G, Martín N, Abarca L, Barret JP, Colomina MJ. Fluid resuscitation management in patients with burns: update. Br J Anaesth 2016; 117:284-96. [PMID: 27543523 DOI: 10.1093/bja/aew266] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Since 1968, when Baxter and Shires developed the Parkland formula, little progress has been made in the field of fluid therapy for burn resuscitation, despite advances in haemodynamic monitoring, establishment of the 'goal-directed therapy' concept, and the development of new colloid and crystalloid solutions. Burn patients receive a larger amount of fluids in the first hours than any other trauma patients. Initial resuscitation is based on crystalloids because of the increased capillary permeability occurring during the first 24 h. After that time, some colloids, but not all, are accepted. Since the emergence of the Pharmacovigilance Risk Assessment Committee alert from the European Medicines Agency concerning hydroxyethyl starches, solutions containing this component are not recommended for burns. But the question is: what do we really know about fluid resuscitation in burns? To provide an answer, we carried out a non-systematic review to clarify how to quantify the amount of fluids needed, what the current evidence says about the available solutions, and which solution is the most appropriate for burn patients based on the available knowledge.
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Affiliation(s)
| | - G Usúa
- Anesthesia and Critical Care Department
| | - N Martín
- Anesthesia and Critical Care Department
| | - L Abarca
- Anesthesia and Critical Care Department
| | - J P Barret
- Plastic Surgery Department and Burn Centre, Hospital Universitari Vall d'Hebron, Barcelona 08035, Spain
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Reddy S, McGuinness S, Parke R, Young P. Choice of Fluid Therapy and Bleeding Risk After Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 30:1094-103. [DOI: 10.1053/j.jvca.2015.12.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Indexed: 02/07/2023]
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35
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Abstract
The range of intravenous fluids available for therapeutic use and the differing indications are diverse. A solid understanding of the composition of different types of fluids is essential to understanding the physiologic effects following administration and the appropriate clinical application. In this review, the authors describe the different fluids commonly available and discuss the potential benefits and harms depending on the clinical circumstances.
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Affiliation(s)
- Matt Varrier
- King's College London, Guy's and St Thomas Hospital, Department of Critical Care, London, UK
| | - Marlies Ostermann
- King's College London, Guy's and St Thomas Hospital, Department of Critical Care, London, UK.
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36
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Reply to: crystalloids and hydroxyethyl starches in noncardiac surgical patients. Eur J Anaesthesiol 2016; 34:29-30. [PMID: 27153209 DOI: 10.1097/eja.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cross-Sectional Guidelines for Therapy with Blood Components and Plasma Derivatives: Chapter 5 Human Albumin - Revised. Transfus Med Hemother 2016; 43:223-32. [PMID: 27403094 PMCID: PMC4924448 DOI: 10.1159/000446043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/12/2016] [Indexed: 12/21/2022] Open
Abstract
Chapter 5 'Human Albumin' that was suspended on January 10, 2011 has been completed and updated in the present version.
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38
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Adamik KN, Yozova ID, Regenscheit N. Controversies in the use of hydroxyethyl starch solutions in small animal emergency and critical care. J Vet Emerg Crit Care (San Antonio) 2016; 25:20-47. [PMID: 25655725 DOI: 10.1111/vec.12283] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/14/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To (1) review the development and medical applications of hydroxyethyl starch (HES) solutions with particular emphasis on its physiochemical properties; (2) critically appraise the available evidence in human and veterinary medicine, and (3) evaluate the potential risks and benefits associated with their use in critically ill small animals. DATA SOURCES Human and veterinary original research articles, scientific reviews, and textbook sources from 1950 to the present. HUMAN DATA SYNTHESIS HES solutions have been used extensively in people for over 30 years and ever since its introduction there has been a great deal of debate over its safety and efficacy. Recently, results of seminal trials and meta-analyses showing increased risks related to kidney dysfunction and mortality in septic and critically ill patients, have led to the restriction of HES use in these patient populations by European regulatory authorities. Although the initial ban on the use of HES in Europe has been eased, proof regarding the benefits and safety profile of HES in trauma and surgical patient populations has been requested by these same European regulatory authorities. VETERINARY DATA SYNTHESIS The veterinary literature is limited mostly to experimental studies and clinical investigations with small populations of patients with short-term end points and there is insufficient evidence to generate recommendations. CONCLUSIONS Currently, there are no consensus recommendations regarding the use of HES in veterinary medicine. Veterinarians and institutions affected by the HES restrictions have had to critically reassess the risks and benefits related to HES usage based on the available information and sometimes adapt their procedures and policies based on their reassessment. Meanwhile, large, prospective, randomized veterinary studies evaluating HES use are needed to achieve relevant levels of evidence to enable formulation of specific veterinary guidelines.
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Affiliation(s)
- Katja N Adamik
- Department of Veterinary Clinical Medicine, Division of Small Animal Emergency and Critical Care, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Comparison of hydroxyethyl starch colloids with crystalloids for surgical patients. Eur J Anaesthesiol 2016; 33:42-8. [DOI: 10.1097/eja.0000000000000328] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Wu CY, Chan KC, Cheng YJ, Yeh YC, Chien CT. Effects of different types of fluid resuscitation for hemorrhagic shock on splanchnic organ microcirculation and renal reactive oxygen species formation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:434. [PMID: 26651994 PMCID: PMC4699328 DOI: 10.1186/s13054-015-1135-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Fluid resuscitation is an indispensable procedure in the acute management of hemorrhagic shock for restoring tissue perfusion, particularly microcirculation in splanchnic organs. Resuscitation fluids include crystalloids, hypertonic saline (HTS), and synthetic colloids, and their selection affects the recovery of microcirculatory blood flow and reactive oxygen species (ROS) formation, which is often evident in the kidney, following reperfusion. In this study, the effects of acute resuscitation with 0.9% saline (NS), 3% HTS, 4% succinylated gelatin (GEL), and 6% hydroxyethyl starch (HES) 130/0.4 were compared in a hemorrhagic shock rat model to analyze restoration of microcirculation among various splanchnic organs and the gracilis muscle and reperfusion-induced renal ROS formation. METHODS A total of 96 male Wistar rats were subjected to sham operation (sham group), hemorrhagic shock (control group), and resuscitation with NS, HTS, GEL and HES. Two hours after resuscitation, changes in the mean arterial pressure (MAP), serum lactate level and the microcirculatory blood flow among various splanchnic organs, namely the liver, kidney, and intestine (mucosa, serosal muscular layer, and Peyer's patch), and the gracilis muscle, were compared using laser speckle contrast imaging. Renal ROS formation after reperfusion was investigated using an enhanced in vivo chemiluminescence (CL) method. RESULTS Microcirculatory blood flow was less severely affected by hemorrhaging in the liver and gracilis muscle. Impairment of microcirculation in the kidney was restored in all resuscitation groups. Resuscitation in the NS group failed to restore intestinal microcirculation. Resuscitation in the HTS, GEL, and HES groups restored intestinal microcirculatory blood flow. By comparison, fluid resuscitation restored hemorrhagic shock-induced hypotension and decreased lactatemia in all resuscitation groups. Reperfusion-induced in vivo renal ROS formation was significantly higher in the GEL and HES groups than in the other groups. CONCLUSION Although fluid resuscitation with NS restored the MAP and decreased lactatemia following hemorrhagic shock, intestinal microcirculation was restored only by other volume expanders, namely 3% HTS, GEL, and HES. However, reperfusion-induced renal ROS formation was significantly higher when synthetic colloids were used.
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Affiliation(s)
- Chun-Yu Wu
- Department of Anesthesiology, National Taiwan University Hospital, No 7, Chung-Shan S. Road, Taipei, Taiwan, R.O.C. .,Department of Life Science, National Taiwan Normal University, No. 88, Tingzhou Road, Taipei City, Taiwan, 11677, R.O.C.
| | - Kuang-Cheng Chan
- Department of Anesthesiology, National Taiwan University Hospital, No 7, Chung-Shan S. Road, Taipei, Taiwan, R.O.C.
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital, No 7, Chung-Shan S. Road, Taipei, Taiwan, R.O.C.
| | - Yu-Chang Yeh
- Department of Anesthesiology, National Taiwan University Hospital, No 7, Chung-Shan S. Road, Taipei, Taiwan, R.O.C.
| | - Chiang-Ting Chien
- Department of Life Science, National Taiwan Normal University, No. 88, Tingzhou Road, Taipei City, Taiwan, 11677, R.O.C.
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Bayer O, Reinhart K. Faulty risk-of-bias assessment in a meta-analysis of hydroxyethyl starch for nonseptic ICU patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:357. [PMID: 26446864 PMCID: PMC4597439 DOI: 10.1186/s13054-015-1080-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Ole Bayer
- Department of Anaesthesiology and Intensive Care, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany.
| | - Konrad Reinhart
- Department of Anaesthesiology and Intensive Care, Center for Sepsis Control and Care, Chairman Global Sepsis Alliance, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany.
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Muñoz Gómez M, Bisbe Vives E, Basora Macaya M, García Erce JA, Gómez Luque A, Leal-Noval SR, Colomina MJ, Comin Colet J, Contreras Barbeta E, Cuenca Espiérrez J, Garcia de Lorenzo Y Mateos A, Gomollón García F, Izuel Ramí M, Moral García MV, Montoro Ronsano JB, Páramo Fernández JA, Pereira Saavedra A, Quintana Diaz M, Remacha Sevilla Á, Salinas Argente R, Sánchez Pérez C, Tirado Anglés G, Torrabadella de Reinoso P. Forum for debate: Safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient. Med Intensiva 2015; 39:552-62. [PMID: 26183121 DOI: 10.1016/j.medin.2015.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/28/2023]
Abstract
In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use. The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues.
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Affiliation(s)
- M Muñoz Gómez
- Medicina Transfusional Perioperatoria, Facultad de Medicina, Universidad de Málaga, Málaga, España.
| | - E Bisbe Vives
- Servicio de Anestesiología y Reanimación, Hospital Universitario del Mar, Barcelona, España
| | - M Basora Macaya
- Servicio de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España
| | | | - A Gómez Luque
- Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - S R Leal-Noval
- Servicio de Cuidados Críticos y Urgencias, Hospital Virgen del Rocío, Sevilla, España
| | - M J Colomina
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - J Comin Colet
- Servicio de Cardiología, Hospital Universitario del Mar, Barcelona, España
| | - E Contreras Barbeta
- Banc de Sang i Teixits, Hospital Universitari de Tarragona Joan XXIII, Tarragona, España
| | - J Cuenca Espiérrez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - F Gomollón García
- Servicio de Gastroenterología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M Izuel Ramí
- Servicio de Farmacia, Hospital Miguel Servet, Zaragoza, España
| | - M V Moral García
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J B Montoro Ronsano
- Servicio de Farmacia, Hospital Universitario Vall d'Hebron, Barcelona, España
| | | | - A Pereira Saavedra
- Servicio de Hemoterapia y Hemostasia, Hospital Clínic de Barcelona, Barcelona, España
| | - M Quintana Diaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España
| | - Á Remacha Sevilla
- Servicio de Laboratorio de Hematología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - R Salinas Argente
- Territorial Banc de Sang i Teixits Catalunya Central, Barcelona, España
| | - C Sánchez Pérez
- Servicio de Anestesiología y Reanimación, Hospital General Universitario de Elda, Elda, Alicante, España
| | - G Tirado Anglés
- Unidad de Cuidados Intensivos, Hospital Royo Villanova, Zaragoza, España
| | - P Torrabadella de Reinoso
- Unidad de Cuidados Intensivos, Hospital Universitario Germans Trías i Pujol, Badalona, Barcelona, España
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Garnacho-Montero J, Fernández-Mondéjar E, Ferrer-Roca R, Herrera-Gutiérrez M, Lorente J, Ruiz-Santana S, Artigas A. Cristaloides y coloides en la reanimación del paciente crítico. Med Intensiva 2015; 39:303-15. [DOI: 10.1016/j.medin.2014.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/14/2014] [Accepted: 12/18/2014] [Indexed: 12/22/2022]
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PERNER A, JUNTTILA E, HANEY M, HREINSSON K, KVÅLE R, VANDVIK PO, MØLLER MH. Scandinavian clinical practice guideline on choice of fluid in resuscitation of critically ill patients with acute circulatory failure. Acta Anaesthesiol Scand 2015; 59:274-85. [PMID: 25363535 DOI: 10.1111/aas.12429] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 09/17/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND The task force on Acute Circulatory Failure of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine produced this guideline with recommendations concerning the use of crystalloid vs. colloid solutions in adult critically ill patients with acute circulatory failure. METHODS Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to grade the quality of evidence and to determine the strengths of the recommendations. As efficacy and harm may vary in different subpopulations of patients with acute circulatory failure, we produced recommendations for general intensive care unit (ICU) patients and those with sepsis, trauma and burn injury. RESULTS For general ICU patients and those with sepsis, we recommend using crystalloids for resuscitation rather than hydroxyethyl starch and we suggest using crystalloids rather than gelatin and albumin. For patients with trauma we recommend to use crystalloids for resuscitation rather than colloid solutions. For patients with burn injury we provide no recommendations as there are very limited data from randomised trials on fluid resuscitation in this patient population. CONCLUSIONS We recommend using crystalloid solutions rather than colloid solutions for resuscitation in the majority of critically ill patients with acute circulatory failure.
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Affiliation(s)
- A. PERNER
- Department of Intensive Care Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - E. JUNTTILA
- Department of Anaesthesiology Division of Intensive Care Oulu University Hospital and Department of Anaesthesiology Tampere University Hospital Tampere Finland
| | - M. HANEY
- Anaesthesiology and Intensive Care Medicine Umeå University Umeå Sweden
| | - K. HREINSSON
- Department of Anaesthesiology and Intensive Care Medicine Landspitali University Hospital Reykjavik Iceland
| | - R. KVÅLE
- Department of Intensive Care Haukeland University Hospital Bergen Norway
| | - P. O. VANDVIK
- Department of Medicine Innlandet Hospital Trust‐Division Gjøvik Norway and Norwegian Knowledge Centre for the Health Services Oslo Norway
| | - M. H. MØLLER
- Department of Intensive Care Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
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Duranteau J, Asehnoune K, Pierre S, Ozier Y, Leone M, Lefrant JY. Recommandations sur la réanimation du choc hémorragique. ANESTHESIE & REANIMATION 2015. [DOI: 10.1016/j.anrea.2014.12.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Lira A, Pinsky MR. Choices in fluid type and volume during resuscitation: impact on patient outcomes. Ann Intensive Care 2014; 4:38. [PMID: 25625012 PMCID: PMC4298675 DOI: 10.1186/s13613-014-0038-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/14/2014] [Indexed: 01/19/2023] Open
Abstract
We summarize the emerging new literature regarding the pathophysiological principles underlying the beneficial and deleterious effects of fluid administration during resuscitation, as well as current recommendations and recent clinical evidence regarding specific colloids and crystalloids. This systematic review allows us to conclude that there is no clear benefit associated with the use of colloids compared to crystalloids and no evidence to support the unique benefit of albumin as a resuscitation fluid. Hydroxyethyl starch use has been associated with increased acute kidney injury (AKI) and use of renal replacement therapy. Other synthetic colloids (dextran and gelatins) though not well studied do not appear superior to crystalloids. Normal saline (NS) use is associated with hyperchloremic metabolic acidosis and increased risk of AKI. This risk is decreased when balanced salt solutions are used. Balanced crystalloid solutions have shown no harmful effects, and there is evidence for benefit over NS. Finally, fluid resuscitation should be applied in a goal-directed manner and targeted to physiologic needs of individual patients. The evidence supports use of fluids in volume-responsive patients whose end-organ perfusion parameters have not been met.
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Affiliation(s)
- Alena Lira
- Department of Critical Care Medicine, University of Pittsburgh, 606 Scaife Hall, 3550 Terrace Street, Pittsburgh 15261, PA, USA
| | - Michael R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh, 606 Scaife Hall, 3550 Terrace Street, Pittsburgh 15261, PA, USA
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Witt L, Glage S, Schulz K, Lichtinghagen R, Simann A, Pape L, Sümpelmann R. Impact of 6% hydroxyethyl starch 130/0.42 and 4% gelatin on renal function in a pediatric animal model. Paediatr Anaesth 2014; 24:974-9. [PMID: 24916275 DOI: 10.1111/pan.12445] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Artificial colloids, frequently used to prevent hemorrhagic shock in children, may induce serious renal side effects in critically ill adult patients. The impact of perioperative colloid infusion on the renal function in adults and children remains unclear. AIM To determine the impact of single doses of artificial colloids on renal function tests, we conducted an experimental animal study. We hypothesized that neither the infusion of moderate doses of 6% hydroxyethyl starch (HES) nor of 4% gelatin (GEL) would have a serious impact on the renal function of healthy piglets. METHODS Fifteen sedated piglets were randomly assigned to receive an infusion of either 20 ml·kg(-1) HES or GEL or a balanced electrolyte solution (BS, control group) over 30 min. Before and 7 days after infusion, serum and urine renal function tests were recorded and renal biopsies were taken. RESULTS Serum and urine renal function tests (e.g., creatinine, urea, cystatin C, and neutrophil gelatinase-associated lipocalin) were within normal ranges, and a microscopic examination of the renal tissue in all groups revealed no major alterations such as tubular necrosis, interstitial bleeding, interstitial inflammation, or vacuoles. CONCLUSIONS In this pediatric animal model, the infusion of moderate doses of artificial colloids was not found to have any relevant impact on renal function. Further clinical investigations are necessary to provide a conclusive assessment of the risk for renal impairment after HES and GEL administration during major pediatric surgery.
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Affiliation(s)
- Lars Witt
- Clinic of Anaesthesiology, Hanover Medical School, Hanover, Germany
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Patel A, Laffan MA, Waheed U, Brett SJ. Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality. BMJ 2014; 349:g4561. [PMID: 25099709 PMCID: PMC4106199 DOI: 10.1136/bmj.g4561] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of pooled human albumin solutions as part of fluid volume expansion and resuscitation (with or without improvement of baseline hypoalbuminaemia) in critically unwell adults with sepsis of any severity. DESIGN Systematic review and meta-analysis of randomised clinical trials, with trial sequential analysis, subgroup, and meta-regression analyses. DATA SOURCES PubMed, PubMed Central, Web of Science (includes Medline, Conference Proceedings Citation Index, Data Citation Index, Chinese Science Citation Database, CAB abstracts, Derwent Innovations Index), OvidSP (includes Embase, Ovid Medline, HMIC, PsycINFO, Maternity and Infant Care, Transport Database), Cochrane Library, clinicaltrials.gov, controlled-trials.com, online material, relevant conference proceedings, hand searching of reference lists, and contact with authors as necessary. ELIGIBILITY CRITERIA Prospective randomised clinical trials of adults with sepsis of any severity (with or without baseline hypoalbuminaemia) in critical or intensive care who received pooled human albumin solutions as part of fluid volume expansion and resuscitation (with or without improvement of hypoalbuminaemia) compared with those who received control fluids (crystalloid or colloid), were included if all-cause mortality outcome data were available. No restriction of language, date, publication status, or primary study endpoint was applied. DATA EXTRACTION Two reviewers independently assessed articles for inclusion, extracted data to assess risk of bias, trial methods, patients, interventions, comparisons, and outcome. The relative risk of all-cause mortality was calculated using a random effects model accounting for clinical heterogeneity. PRIMARY OUTCOME MEASURE All-cause mortality at final follow-up. RESULTS Eighteen articles reporting on 16 primary clinical trials that included 4190 adults in critical or intensive care with sepsis, severe sepsis, or septic shock. A median of 70.0 g daily of pooled human albumin was received over a median of 3 days by adults with a median age of 60.8 years as part of fluid volume expansion and resuscitation, with or without correction of hypoalbuminaemia. The relative risk of death was similar between albumin groups (that received a median of 175 g in total) and control fluid groups (relative risk 0.94; 95% confidence interval 0.87 to 1.01; P=0.11; I(2)=0%). Trial sequential analysis corrected the 95% confidence interval for random error (0.85 to 1.02; D(2)=0%). Eighty eight per cent of the required information size (meta-analysis sample size) of 4894 patients was achieved, and the cumulative effect size measure (z score) entered the futility area, supporting the notion of no relative benefit of albumin (GRADE quality of evidence was moderate). Evidence of no difference was also found when albumin was compared with crystalloid fluid (relative risk 0.93; 0.86 to 1.01; P=0.07; I(2)=0%) in 3878 patents (GRADE quality of evidence was high; 79.9% of required information size) or colloid fluids in 299 patients (relative risk 1.04; 0.79 to 1.38; P=0.76; I(2)=0%) (GRADE quality of evidence was very low; 5.8% of required information size). When studies at high risk of bias were excluded in a predefined subgroup analysis, the finding of no mortality benefit remained, and the cumulative z score was just outside the boundary of futility. Overall, the meta-analysis was robust to sensitivity, subgroup, meta-regression, and trial sequential analyses. CONCLUSIONS In this analysis, human albumin solutions as part of fluid volume expansion and resuscitation for critically unwell adults with sepsis of any severity (with or without baseline hypoalbuminaemia) were not robustly effective at reducing all-cause mortality. Albumin seems to be safe in this setting, as a signal towards harm was not detected, but this analysis does not support a recommendation for use.
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Affiliation(s)
- Amit Patel
- Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK MRC Clinical Sciences Centre, Hammersmith Hospital, Imperial College London, London, UK Centre for Haematology, Hammersmith Hospital, Imperial College London, London, UK
| | - Michael A Laffan
- Centre for Haematology, Hammersmith Hospital, Imperial College London, London, UK
| | - Umeer Waheed
- Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Stephen J Brett
- Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
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Editor's picks, 2012–2013: sixteen articles in free access in Intensive Care Medicine. Intensive Care Med 2014. [DOI: 10.1007/s00134-014-3330-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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