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Othman MI, Mustafa EM, Alfayoumi M, Khatib MY, Nashwan AJ. Impact of different intravenous bolus rates on fluid and electrolyte balance and mortality in critically ill patients. World J Crit Care Med 2024; 13:95781. [DOI: 10.5492/wjccm.v13.i3.95781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/23/2024] [Accepted: 08/09/2024] [Indexed: 08/30/2024] Open
Abstract
The effect of intravenous bolus rates on patient outcomes is a complex and crucial aspect of critical care. Fluid challenges are commonly used in critically ill patients to manage their hemodynamic status, but there is limited information available on the specifics of when, how much, and at what rate fluids should be administered during these challenges. The aim of this review is to thoroughly examine the relationship between intravenous bolus rates, fluid-electrolyte balance, and mortality and to analyze key research findings and methodologies to understand these complex dynamics better. Fluid challenges are commonly employed in managing hemodynamic status in this population, yet there is limited information on the optimal timing, volume, and rate of fluid administration. Utilizing a narrative review approach, the analysis identified nine relevant studies that investigate these variables. The findings underscore the importance of a precise and individualized approach in clinical settings, highlighting the need to tailor intravenous bolus rates to each patient's specific needs to maximize outcomes. This review provides valuable insights that can inform and optimize clinical practices in critical care, emphasizing the necessity of meticulous and exact strategies in fluid administration.
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Affiliation(s)
- Mutaz I Othman
- Department of Nursing, Hamad Medical Corporation, Doha 3050, Qatar
| | - Emad M Mustafa
- Department of Nursing, Hamad Medical Corporation, Doha 3050, Qatar
| | - Moayad Alfayoumi
- Department of Pharmacy, Hamad Medical Corporation, Doha 3050, Qatar
| | - Mohamad Y Khatib
- Department of Critical Care, Hamad Medical Corporation, Doha 3050, Qatar
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Alves JAM, Magalhães MR, Zampieri FG, Veiga VC, Maia IS, Cavalcanti AB. Physiological and linical ffects of ifferent nfusion ates of ntravenous luids for olume xpansion: A coping eview. J Crit Care 2023; 76:154295. [DOI: 10.1016/j.jcrc.2023.154295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/16/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023]
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Hemodynamic effects of intravenous bolus injection of iopromide 370 twice in abdominal contrast-enhanced CT and coronary CTA dual-site sequential examinations. Med Biol Eng Comput 2023; 61:179-194. [PMID: 36342597 DOI: 10.1007/s11517-022-02705-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022]
Abstract
Little information is available about how intravenous bolus injection of iopromide 370 twice in a short time will affect hemodynamics and whether the changes reach clinically relevant levels. In the present study, 31 healthy adult volunteers received abdominal contrast-enhanced CT and coronary CTA sequential examinations. The same dose and rate of normal saline was injected 30 min in advance as self-control. Hemodynamic data were noninvasively collected at selected time points from 1 min prior to injection to 30 min post-injection. The results showed that after iopromide 370 injection, except for stroke volume, all other indicators changed immediately during the first injection, changed most significantly during the second injection (P < 0.05), and returned to baseline within 10 min. Heart rate and cardiac output exhibited the most pronounced changes, with an increasing rate of 33.5% and 33.8%, respectively. For indicators with a change range of > 15% during the second injection, except for mean arterial pressure and total peripheral resistance, the proportions of subjects for the other indicators between the two groups were statistically different (P < 0.05). In conclusion, intravenous bolus injection of iopromide 370 twice in dual-site sequential examinations induced dose-cumulative and time-dependent hemodynamic effects, which all fluctuated within the normal ranges.
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Zampieri FG, Machado FR, Biondi RS, Freitas FGR, Veiga VC, Figueiredo RC, Lovato WJ, Amêndola CP, Assunção MSC, Serpa-Neto A, Paranhos JLR, Andrade J, Godoy MMG, Romano E, Dal Pizzol F, Silva EB, Silva MML, Machado MCV, Malbouisson LMS, Manoel ALO, Thompson MM, Figueiredo LM, Soares RM, Miranda TA, de Lima LM, Santucci EV, Corrêa TD, Azevedo LCP, Kellum JA, Damiani LP, Silva NB, Cavalcanti AB. Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial. JAMA 2021; 326:830-838. [PMID: 34547081 PMCID: PMC8356145 DOI: 10.1001/jama.2021.11444] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Slower intravenous fluid infusion rates could reduce the formation of tissue edema and organ dysfunction in critically ill patients; however, there are no data to support different infusion rates during fluid challenges for important outcomes such as mortality. OBJECTIVE To determine the effect of a slower infusion rate vs control infusion rate on 90-day survival in patients in the intensive care unit (ICU). DESIGN, SETTING, AND PARTICIPANTS Unblinded randomized factorial clinical trial in 75 ICUs in Brazil, involving 11 052 patients requiring at least 1 fluid challenge and with 1 risk factor for worse outcomes were randomized from May 29, 2017, to March 2, 2020. Follow-up was concluded on October 29, 2020. Patients were randomized to 2 different infusion rates (reported in this article) and 2 different fluid types (balanced fluids or saline, reported separately). INTERVENTIONS Patients were randomized to receive fluid challenges at 2 different infusion rates; 5538 to the slower rate (333 mL/h) and 5514 to the control group (999 mL/h). Patients were also randomized to receive balanced solution or 0.9% saline using a factorial design. MAIN OUTCOMES AND MEASURES The primary end point was 90-day survival. RESULTS Of all randomized patients, 10 520 (95.2%) were analyzed (mean age, 61.1 years [SD, 17.0 years]; 44.2% were women) after excluding duplicates and consent withdrawals. Patients assigned to the slower rate received a mean of 1162 mL on the first day vs 1252 mL for the control group. By day 90, 1406 of 5276 patients (26.6%) in the slower rate group had died vs 1414 of 5244 (27.0%) in the control group (adjusted hazard ratio, 1.03; 95% CI, 0.96-1.11; P = .46). There was no significant interaction between fluid type and infusion rate (P = .98). CONCLUSIONS AND RELEVANCE Among patients in the intensive care unit requiring fluid challenges, infusing at a slower rate compared with a faster rate did not reduce 90-day mortality. These findings do not support the use of a slower infusion rate. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02875873.
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Affiliation(s)
- Fernando G Zampieri
- HCor Research Institute, São Paulo, Brazil
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
| | - Flávia R Machado
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
- Department of Anesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Rodrigo S Biondi
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
- Instituto de Cardiologia do Distrito Federal, Brasília, Brazil
| | - Flávio G R Freitas
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
- Hospital SEPACO, São Paulo, Brazil
| | - Viviane C Veiga
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
- BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Rodrigo C Figueiredo
- Hospital Maternidade São José, Centro Universitário do Espírito Santo (UNESC), Colatina, Brazil
| | - Wilson J Lovato
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | - Ary Serpa-Neto
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jorge L R Paranhos
- Santa Casa de Misericórdia de São João Del Rei, São João Del Rei, Brazil
| | - José Andrade
- Hospital Geral de Vitória da Conquista, Vitória da Conquista, Brazil
| | - Michele M G Godoy
- Hospital das Clínicas da Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Felipe Dal Pizzol
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
- Hospital São José, Criciúma, Brazil
| | | | | | | | | | | | - Marlus M Thompson
- Hospital Evangélico Cachoeiro do Itapemirim, Cachoeiro do Itapemirim, Brazil
| | | | | | | | | | | | - Thiago D Corrêa
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Luciano C P Azevedo
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Nilton B Silva
- School of Medicine, Federal University of Health Sciences, Porto Alegre, Brazil
| | - Alexandre B Cavalcanti
- HCor Research Institute, São Paulo, Brazil
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
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Saoraya J, Wongsamita L, Srisawat N, Musikatavorn K. The effects of a limited infusion rate of fluid in the early resuscitation of sepsis on glycocalyx shedding measured by plasma syndecan-1: a randomized controlled trial. J Intensive Care 2021; 9:1. [PMID: 33402229 PMCID: PMC7784279 DOI: 10.1186/s40560-020-00515-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/14/2020] [Indexed: 12/29/2022] Open
Abstract
Background Aggressive fluid administration is recommended in the resuscitation of septic patients. However, the delivery of a rapid fluid bolus might cause harm by inducing degradation of the endothelial glycocalyx. This research aimed to examine the effects of the limited infusion rate of fluid on glycocalyx shedding as measured by syndecan-1 in patients with sepsis-induced hypoperfusion. Methods A prospective, randomized, controlled, open-label trial was conducted between November 2018 and February 2020 in an urban academic emergency department. Patients with sepsis-induced hypoperfusion, defined as hypotension or hyperlactatemia, were randomized to receive either the standard rate (30 ml/kg/h) or limited rate (10 ml/kg/h) of fluid for the first 30 ml/kg fluid resuscitation. Subsequently, the fluid rate was adjusted according to the physician’s discretion but not more than that of the designated fluid rate for the total of 6 h. The primary outcome was differences in change of syndecan-1 levels at 6 h compared to baseline between standard and limited rate groups. Secondary outcomes included adverse events, organ failure, and 90-day mortality. Results We included 96 patients in the intention-to-treat analysis, with 48 assigned to the standard-rate strategy and 48 to the limited-rate strategy. The median fluid volume in 6 h in the limited-rate group was 39 ml/kg (interquartile range [IQR] 35–52 ml/kg) vs. 53 ml/kg (IQR 46–64 ml/kg) in the standard-rate group (p < 0.001). Patients in the limited-rate group were less likely to received vasopressors (17% vs 42%; p = 0.007) and mechanical ventilation (20% vs 41%; p = 0.049) during the first 6 h. There were no significantly different changes in syndecan-1 levels at 6 h between the two groups (geometric mean ratio [GMR] in the limited-rate group, 0.82; 95% confidence interval [CI], 0.66–1.02; p = 0.07). There were no significant differences in adverse events, organ failure outcomes, or mortality between the two groups. Conclusions In sepsis resuscitation, the limited rate of fluid resuscitation compared to the standard rate did not significantly reduce changes in syndecan-1 at 6 h. Trial registration Thai Clinical Trials Registry number: TCTR20181010001. Registered 8 October 2018, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=4064 Supplementary Information The online version contains supplementary material available at 10.1186/s40560-020-00515-7.
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Affiliation(s)
- Jutamas Saoraya
- Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Emergency Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Lipda Wongsamita
- Department of Emergency Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, and Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellent Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Academy of Science, Royal Society of Thailand, Bangkok, Thailand
| | - Khrongwong Musikatavorn
- Department of Emergency Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand. .,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Inkinen N, Selander T, Pettilä V, Valkonen M, Bäcklund M, Wennervirta J, Pulkkinen A, Hästbacka J, Vaara ST. Noninterventional follow-up vs fluid bolus in RESPONSE to oliguria-The RESPONSE trial protocol and statistical analysis plan. Acta Anaesthesiol Scand 2020; 64:1210-1217. [PMID: 32270496 PMCID: PMC7496618 DOI: 10.1111/aas.13599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/01/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oliguria is a frequent trigger for administering a fluid bolus, but the effect of fluid bolus in improving urine output is inadequately demonstrated. Here, we summarize the protocol and detailed statistical analysis plan of the randomized, controlled RESPONSE trial comparing follow-up as the experimental group and a 500 mL crystalloid fluid bolus as the control group for oliguria in critically ill oliguric patients. METHODS Our trial is an investigator-initiated, randomized, controlled, pilot trial conducted in three ICUs in two centers. We aim to randomize 1:1 altogether 130 hemodynamically stable oliguric patients either to a 2-hour follow-up without interventions or to receive a crystalloid bolus of 500 mL over 30 minutes. The primary outcome is the change in individual urine output during the 2-hour period compared to 2 hours preceding randomization. Doubling of the urine output is considered clinically significant. Additionally, we record the duration of oliguria, physiological and biochemical variables, adverse events, and the incidences of acute kidney injury and renal replacement therapy. CONCLUSIONS Oliguria is a frequent trigger for potentially harmful fluid loading. Therefore, the RESPONSE trial will give information of the potential effect of fluid bolus on oliguria in critically ill patients. TRIAL REGISTRATION clinical.trials.gov, NCT02860572.
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Affiliation(s)
- Nina Inkinen
- Department of Anesthesia and Intensive Care Central Finland Central Hospital Central Finland Health Care District Jyväskylä Finland
- Division of Intensive Care Medicine Department of Anesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Tuomas Selander
- Science Service Center Kuopio University Hospital Kuopio Finland
| | - Ville Pettilä
- Division of Intensive Care Medicine Department of Anesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Miia Valkonen
- Division of Intensive Care Medicine Department of Anesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Minna Bäcklund
- Division of Intensive Care Medicine Department of Anesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Johanna Wennervirta
- Division of Intensive Care Medicine Department of Anesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Anni Pulkkinen
- Department of Anesthesia and Intensive Care Central Finland Central Hospital Central Finland Health Care District Jyväskylä Finland
| | - Johanna Hästbacka
- Division of Intensive Care Medicine Department of Anesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Suvi T. Vaara
- Division of Intensive Care Medicine Department of Anesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
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Janz DR, Casey JD, Semler MW, Russell DW, Dargin J, Vonderhaar DJ, Dischert KM, West JR, Stempek S, Wozniak J, Caputo N, Heideman BE, Zouk AN, Gulati S, Stigler WS, Bentov I, Joffe AM, Rice TW, Janz DR, Vonderhaar DJ, Hoffman R, Turlapati N, Samant S, Clark P, Krishnan A, Gresens J, Hill C, Matthew B, Henry J, Miller J, Paccione R, Majid-Moosa A, Santanilla JI, Semler MW, Rice TW, Casey JD, Heideman BE, Wilfong EM, Hewlett JC, Halliday SJ, Kerchberger VE, Brown RM, Huerta LE, Merrick CM, Atwater T, Kocurek EG, McKown AC, Winters NI, Habegger LE, Mart MF, Berg JZ, Noblit CC, Flemmons LN, Dischert K, Joffe A, Bentov I, Archibald T, Arenas A, Baldridge C, Bansal G, Barnes C, Bishop N, Bryce B, Byrne L, Clement R, DeLaCruz C, Deshpande P, Gong Z, Green J, Henry A, Herstein A, Huang J, Heier J, Jenson B, Johnston L, Langeland C, Lee C, Nowlin A, Reece-Nguyen T, Schultz H, Segal G, Slade I, Solomon S, Stehpey S, Thompson R, Trausch D, Welker C, Zhang R, Russell D, Zouk A, Gulati S, Stigler W, Fain J, Garcia B, Lafon D, He C, O'Connor J, Campbell D, Powner J, McElwee S, Bardita C, D'Souza K, Pereira GB, Robinson S, Blumhof S, Dargin J, Stempek S, Wozniak J, Pataramekin P, Desai D, Yayarovich E, DeMatteo R, Somalaraiu S, Adler C, Reid C, Plourde M, Winnicki J, Noland T, Geva T, Gazourian L, Patel A, Eissa K, Giacotto J, Fitelson D, Colancecco M, Gray A, West JR, Caputo N, Ryan M, Parry T, Azan B, Khairat A, Morton R, Lewandowski D, Vaca C. Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial. THE LANCET RESPIRATORY MEDICINE 2019; 7:1039-1047. [DOI: 10.1016/s2213-2600(19)30246-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/29/2019] [Accepted: 06/13/2019] [Indexed: 01/17/2023]
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Effect of bolus administration of non-ionic radiopaque contrast media on blood pressure variation. Radiography (Lond) 2019; 25:346-348. [PMID: 31582243 DOI: 10.1016/j.radi.2019.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/09/2019] [Accepted: 04/18/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Haemodynamic changes may occur with the rapid intravenous injection of contrast media due to the osmolality of such pharmaceuticals. This study sought to evaluate the effect of bolus administration of intravenous contrast media on blood pressure variation during the Contrast-Enhanced Computed Tomography (CECT) of the abdomen. METHODS The study included 74 patients who underwent abdominal CECT and they were placed in the first group receiving a maximum of 80 ml of iodinated contrast via pressure injector (4 ml/s). A further 74 patients, who underwent non-contrast enhanced abdominal CT, were placed in the second group in which 80 ml of normal saline was administered via the same manner. Patients with hypertension and who were on anti-hypertensive drugs were excluded from the study. Non-invasive blood pressure was monitored before the injection of contrast media/saline and immediately after the portal venous phase for the CECT scan and after 45 s following the administration of normal saline in the non-contrast CT group. Mean systolic and diastolic blood pressures from both groups were compared to find out the effect of contrast bolus administration on blood pressure variation. RESULTS Both systolic and diastolic blood pressure increased with the injection of contrast media among CECT scan group. No significant changes in systolic and diastolic blood pressure were found before and after the scan in the non-contrast group. CONCLUSION Bolus administration of 80 ml saline has no effect on blood pressure. The increased blood pressure in contrast enhanced studies was induced by the iodinated contrast media and not by the bolus effect.
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Bihari S, Wiersema UF, Perry R, Schembri D, Bouchier T, Dixon D, Wong T, Bersten AD. Efficacy and safety of 20% albumin fluid loading in healthy subjects: a comparison of four resuscitation fluids. J Appl Physiol (1985) 2019; 126:1646-1660. [DOI: 10.1152/japplphysiol.01058.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Recently, buffered salt solutions and 20% albumin (small volume resuscitation) have been advocated as an alternative fluid for intravenous resuscitation. The relative comparative efficacy and potential adverse effects of these solutions have not been evaluated. In a randomized, double blind, cross-over study of six healthy male subjects we compared the pulmonary and hemodynamic effects of intravenous administration of 30 ml/kg of 0.9% saline, Hartmann's solution and 4% albumin, and 6 ml/kg of 20% albumin (albumin dose equivalent). Lung tests (spirometry, ultrasound, impulse oscillometry, diffusion capacity, and plethysmography), two- to three-dimensional Doppler echocardiography, carotid applanation tonometry, blood gases, serum/urine markers of endothelial, and kidney injury were measured before and after each fluid bolus. Data were analyzed with repeated measures ANOVA with effect of fluid type examined as an interaction. Crystalloids caused lung edema [increase in ultrasound B line ( P = 0.006) and airway resistance ( P = 0.009)], but evidence of lung injury [increased angiopoietin-2 ( P = 0.019)] and glycocalyx injury [increased syndecan ( P = 0.026)] was only observed with 0.9% saline. The colloids caused greater left atrial stretch, decrease in lung volumes, and increase in diffusion capacity than the crystalloids, but without pulmonary edema. Stroke work increased proportionally to increase in preload with all four fluids ( R2 = 0.71). There was a greater increase in cardiac output and stroke volume after colloid administration, associated with a reduction in afterload. Hartmann’s solution did not significantly alter ventricular performance. Markers of kidney injury were not affected by any of the fluids administrated. Bolus administration of 20% albumin is both effective and safe in healthy subjects. NEW & NOTEWORTHY Bolus administration of 20% albumin is both effective and safe in healthy subjects when compared with other commonly available crystalloids and colloidal solution.
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Affiliation(s)
- Shailesh Bihari
- Intensive and Critical Care Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ubbo F Wiersema
- Intensive and Critical Care Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Rebecca Perry
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Department of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - David Schembri
- Department of Respiratory Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Tara Bouchier
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Dani Dixon
- Intensive and Critical Care Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Teresa Wong
- Intensive and Critical Care Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Andrew D Bersten
- Intensive and Critical Care Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Part III: Minimum Quality Threshold in Preclinical Sepsis Studies (MQTiPSS) for Fluid Resuscitation and Antimicrobial Therapy Endpoints. Shock 2019; 51:33-43. [DOI: 10.1097/shk.0000000000001209] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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11
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Pouska J, Tegl V, Astapenko D, Cerny V, Lehmann C, Benes J. Impact of Intravenous Fluid Challenge Infusion Time on Macrocirculation and Endothelial Glycocalyx in Surgical and Critically Ill Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8925345. [PMID: 30519590 PMCID: PMC6241356 DOI: 10.1155/2018/8925345] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/15/2018] [Accepted: 10/01/2018] [Indexed: 01/24/2023]
Abstract
(i) Purpose. The fluid challenge (FC) is a well-established test of preload reserve. Only limited data exist in regard to the FC efficacy based on infusion time. Slow administration may be associated with lack of effect based on fluid redistribution and external conditions changes. On the contrary, fast administration may lead to brisk fluid overload and damage to the endothelium and endothelial glycocalyx (EG). The aim of this trial was to compare the FC infusion time on its hemodynamic effects and EG. (ii) Methods. Prospective randomized single-center trial of fast (5-10 minutes) versus slow (20-30 minutes) administration of 500ml balanced crystalloid FC in spinal surgery (cohort OR) and septic shock (cohort SEP) patients. Hemodynamic response was assessed using standard monitoring and blood flow measurements; damage to EG was assessed using the perfused boundary region (PBR) via intravital microscopy monitoring in the sublingual region within relevant time points ranging up to 120 minutes. (iii) Results. Overall, 66 FCs in 50 surgical and 16 septic patients were assessed. Fluid administration was associated with increase of PBR in general (1.9 (1.8-2.1) vs. 2.0 (1.8-2.2); p= 0.008). These changes were transient in OR cohort whereas they were long-lasting in septic fluid responders. The rate of fluid responsiveness after fast versus slow administration was comparable in global population (15 (47%) vs. 17 (50%); p=0.801) as well as in both cohorts. (iv) Conclusions. Fluid challenge administration was associated with increased PBR (and presumable EG volume changes) which normalized within the next 60 minutes in surgical patients but remained impeded in septic fluid responders. The fluid responsiveness rate after fast and slow FC was comparable, but fast administration tended to induce higher, though transient, response in blood pressure.
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Affiliation(s)
- Jiri Pouska
- Dpt. of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
- Dpt. of Anesthesiology and Intensive Care Medicine, University Hospital in Plzen, Plzen, Czech Republic
| | - Vaclav Tegl
- Dpt. of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
- Dpt. of Anesthesiology and Intensive Care Medicine, University Hospital in Plzen, Plzen, Czech Republic
- Biomedical Center, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - David Astapenko
- Department of Anaesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Vladimir Cerny
- Department of Anaesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care, J. E. Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic
- Centrum for Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Christian Lehmann
- Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jan Benes
- Dpt. of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
- Dpt. of Anesthesiology and Intensive Care Medicine, University Hospital in Plzen, Plzen, Czech Republic
- Biomedical Center, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
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Bellomo R, Ukor IF. Response to the letter by Sion Jo et al. J Crit Care 2017; 43:396. [PMID: 29137834 DOI: 10.1016/j.jcrc.2017.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, 3081 Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Alfred Centre, Prahran, 3181 Melbourne, Victoria, Australia
| | - Ida F Ukor
- Department of Intensive Care, Austin Hospital, Heidelberg, 3081 Melbourne, Victoria, Australia; Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, Clayton, 3168 Melbourne, Victoria, Australia.
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Jo S, Jin YH, Lee JB, Jeong T, Yoon JC. Hemodynamic effect of bolus versus slower infusion of intravenous crystalloid. J Crit Care 2017; 43:395. [PMID: 29132979 DOI: 10.1016/j.jcrc.2017.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 11/06/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sion Jo
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Chonbuk National University Hospital, Jeonju-si, Republic of Korea
| | - Young Ho Jin
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Chonbuk National University Hospital, Jeonju-si, Republic of Korea.
| | - Jae Baek Lee
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Chonbuk National University Hospital, Jeonju-si, Republic of Korea
| | - Taeoh Jeong
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Chonbuk National University Hospital, Jeonju-si, Republic of Korea
| | - Jae Chol Yoon
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Chonbuk National University Hospital, Jeonju-si, Republic of Korea
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