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Alves MRD, Saturnino SF, Zen AB, de Albuquerque DGS, Diegoli H. Goal-directed therapy guided by the FloTrac sensor in major surgery: a systematic review and meta-analysis. CRITICAL CARE SCIENCE 2024; 36:e20240196en. [PMID: 38775544 PMCID: PMC11098079 DOI: 10.62675/2965-2774.20240196-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/08/2023] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To provide insights into the potential benefits of goal-directed therapy guided by FloTrac in reducing postoperative complications and improving outcomes. METHODS We performed a systematic review and meta-analysis of randomized controlled trials to evaluate goal-directed therapy guided by FloTrac in major surgery, comparing goal-directed therapy with usual care or invasive monitoring in cardiac and noncardiac surgery subgroups. The quality of the articles and evidence were evaluated with a risk of bias tool and GRADE. RESULTS We included 29 randomized controlled trials with 3,468 patients. Goal-directed therapy significantly reduced the duration of hospital stay (mean difference -1.43 days; 95%CI 2.07 to -0.79; I2 81%), intensive care unit stay (mean difference -0.77 days; 95%CI -1.18 to -0.36; I2 93%), and mechanical ventilation (mean difference -2.48 hours, 95%CI -4.10 to -0.86, I2 63%). There was no statistically significant difference in mortality, myocardial infarction, acute kidney injury or hypotension, but goal-directed therapy significantly reduced the risk of heart failure or pulmonary edema (RR 0.46; 95%CI 0.23 - 0.92; I2 0%). CONCLUSION Goal-directed therapy guided by the FloTrac sensor improved clinical outcomes and shortened the length of stay in the hospital and intensive care unit in patients undergoing major surgery. Further research can validate these results using specific protocols and better understand the potential benefits of FloTrac beyond these outcomes.
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Affiliation(s)
| | - Saulo Fernandes Saturnino
- Universidade Federal de Minas GeraisBelo HorizonteMGBrazilUniversidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.
| | - Ana Beatriz Zen
- Academia VBHC Educação e ConsultoriaSão PauloSPBrazilAcademia VBHC Educação e Consultoria - São Paulo (SP), Brazil.
| | | | - Henrique Diegoli
- Academia VBHC Educação e ConsultoriaSão PauloSPBrazilAcademia VBHC Educação e Consultoria - São Paulo (SP), Brazil.
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Lorente JV, Hahn RG, Jover JL, Del Cojo E, Hervías M, Jiménez I, Uña R, Clau-Terré F, Monge MI, Llau JV, Colomina MJ, Ripollés-Melchor J. Role of Crystalloids in the Perioperative Setting: From Basics to Clinical Applications and Enhanced Recovery Protocols. J Clin Med 2023; 12:5930. [PMID: 37762871 PMCID: PMC10531658 DOI: 10.3390/jcm12185930] [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: 07/31/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Perioperative fluid management, a critical aspect of major surgeries, is characterized by pronounced stress responses, altered capillary permeability, and significant fluid shifts. Recognized as a cornerstone of enhanced recovery protocols, effective perioperative fluid management is crucial for optimizing patient recovery and preventing postoperative complications, especially in high-risk patients. The scientific literature has extensively investigated various fluid infusion regimens, but recent publications indicate that not only the volume but also the type of fluid infused significantly influences surgical outcomes. Adequate fluid therapy prescription requires a thorough understanding of the physiological and biochemical principles that govern the body's internal environment and the potential perioperative alterations that may arise. Recently published clinical trials have questioned the safety of synthetic colloids, widely used in the surgical field. A new clinical scenario has arisen in which crystalloids could play a pivotal role in perioperative fluid therapy. This review aims to offer evidence-based clinical principles for prescribing fluid therapy tailored to the patient's physiology during the perioperative period. The approach combines these principles with current recommendations for enhanced recovery programs for surgical patients, grounded in physiological and biochemical principles.
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Affiliation(s)
- Juan V. Lorente
- Department of Anesthesiology and Critical Care, Juan Ramón Jiménez University Hospital, 21005 Huelva, Spain
- Fluid Therapy and Haemodynamics Working Group of the Haemostasis, Fluid Therapy and Transfusional Medicine of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), 28003 Madrid, Spain
| | - Robert G. Hahn
- Karolinska Institute, Danderyds Hospital (KIDS), 171 77 Stockholm, Sweden
| | - José L. Jover
- Fluid Therapy and Haemodynamics Working Group of the Haemostasis, Fluid Therapy and Transfusional Medicine of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), 28003 Madrid, Spain
- Department of Anesthesiology and Critical Care, Verge del Lliris Hospital, 03802 Alcoy, Spain
| | - Enrique Del Cojo
- Fluid Therapy and Haemodynamics Working Group of the Haemostasis, Fluid Therapy and Transfusional Medicine of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), 28003 Madrid, Spain
- Department of Anesthesiology and Critical Care, Don Benito-Villanueva de la Serena Health District, 06400 Don Benito, Spain
| | - Mónica Hervías
- Department of Anesthesiology and Critical Care, Gregorio Marañón General University Hospital, 28007 Madrid, Spain
- Paediatric Anaesthesiology Section, Spanish Society of Anesthesiology and Resuscitation (SEDAR), 28003 Madrid, Spain
| | - Ignacio Jiménez
- Fluid Therapy and Haemodynamics Working Group of the Haemostasis, Fluid Therapy and Transfusional Medicine of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), 28003 Madrid, Spain
- Department of Anesthesiology and Critical Care, Virgen del Rocío University Hospital, 41013 Seville, Spain
| | - Rafael Uña
- Department of Anesthesiology and Critical Care, La Paz University General Hospital, 28046 Madrid, Spain
| | - Fernando Clau-Terré
- Fluid Therapy and Haemodynamics Working Group of the Haemostasis, Fluid Therapy and Transfusional Medicine of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), 28003 Madrid, Spain
- Vall d’Hebron Institut Recerca, Vall d’Hebrón University Hospital, 08035 Barcelona, Spain
| | - Manuel I. Monge
- Fluid Therapy and Haemodynamics Working Group of the Haemostasis, Fluid Therapy and Transfusional Medicine of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), 28003 Madrid, Spain
| | - Juan V. Llau
- Department of Anesthesiology and Critical Care, Doctor Peset Hospital, 46017 Valencia, Spain
| | - Maria J. Colomina
- Fluid Therapy and Haemodynamics Working Group of the Haemostasis, Fluid Therapy and Transfusional Medicine of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), 28003 Madrid, Spain
- Department of Anesthesiology and Critical Care, Bellvitge University Hospital, University of Barcelona, 08907 Barcelona, Spain
| | - Javier Ripollés-Melchor
- Fluid Therapy and Haemodynamics Working Group of the Haemostasis, Fluid Therapy and Transfusional Medicine of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), 28003 Madrid, Spain
- Department of Anesthesiology and Critical Care, Infanta Leonor Hospital, 28031 Madrid, Spain
- Department of Toxicology, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Ripollés-Melchor J, Colomina MJ, Aldecoa C, Alonso-Cabello J, Alonso-Íñigo JM, Aya H, Basora M, Clau-Terre F, Del Cojo-Peces E, Cota-Delgado F, Ferrandis-Comes R, Galán-Menéndez P, García-López D, Garruti I, López IJ, Jover-Pinillos JL, Llau-Pitarch JV, Lorente JV, Mesquida J, Mojarro I, Monge-García MI, Montesinos-Fadrique SC, Muñoz-Rodes JL, de Nadal M, Ramasco F, Tomé-Roca JL, Pérez A, Uña-Orejón R, Yanes G, Zorrilla-Vaca A, Escarraman D, García-Fernández J. Research priorities in perioperative fluid therapy and hemodynamic monitoring: A Delphi Consensus Survey from the Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section (SHTF) of the Spanish Society of Anesthesiology and Critical Care (SEDAR). REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:319-326. [PMID: 37279834 DOI: 10.1016/j.redare.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/23/2022] [Indexed: 06/08/2023]
Abstract
BACKGROUND Research in fluid therapy and perioperative hemodynamic monitoring is difficult and expensive. The objectives of this study were to summarize these topics and to prioritize these topics in order of research importance. METHODS Electronic structured Delphi questionnaire over three rounds among 30 experts in fluid therapy and hemodynamic monitoring identified through the Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Critical Care. RESULTS 77 topics were identified and ranked in order of prioritization. Topics were categorized into themes of crystalloids, colloids, hemodynamic monitoring and others. 31 topics were ranked as essential research priority. To determine whether intraoperative hemodynamic optimization algorithms based on the invasive or noninvasive Hypotension Prediction Index versus other management strategies could decrease the incidence of postoperative complications. As well as whether the use of renal stress biomarkers together with a goal-directed fluid therapy protocol could reduce hospital stay and the incidence of acute kidney injury in adult patients undergoing non-cardiac surgery, reached the highest consensus. CONCLUSIONS The Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Critical Care will use these results to carry out the research.
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Affiliation(s)
- J Ripollés-Melchor
- Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (ReDGERM), Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain.
| | - M J Colomina
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; Universidad de Barcelona, Barcelona, Spain
| | - C Aldecoa
- Spanish Perioperative Audit and Research Network (ReDGERM), Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | - H Aya
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - M Basora
- Hospital Clínico de Barcelona, Barcelona, Spain
| | - F Clau-Terre
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - E Del Cojo-Peces
- Hospital Área de Salud Don Benito y Villanueva, Don Benito, Badajoz, Spain
| | - F Cota-Delgado
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | | | - D García-López
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - I Garruti
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - I J López
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L Jover-Pinillos
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Virgen de los Lirios, Alcoy, Alicante, Spain
| | | | - J V Lorente
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - J Mesquida
- Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain
| | - I Mojarro
- Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - M I Monge-García
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain
| | - S C Montesinos-Fadrique
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Independent Researcher, Córdoba, Spain
| | | | - M de Nadal
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - F Ramasco
- Hospital Universitario La Princesa, Madrid, Spain
| | - J L Tomé-Roca
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - A Pérez
- Hospital Universitario de Elche, Elche, Alicante, Spain
| | | | - G Yanes
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Virgen de los Lirios, Alcoy, Alicante, Spain
| | - A Zorrilla-Vaca
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Brigham and Women's Hospital, Boston, United States
| | - D Escarraman
- Centro Médico Nacional La Raza, Mexico City, Mexico
| | - J García-Fernández
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Colomina MJ, Ripollés-Melchor J, Guilabert P, Jover JL, Basora M, Cassinello C, Ferrandis R, Llau JV, Peñafiel J. Observational study on fluid therapy management in surgical adult patients. BMC Anesthesiol 2021; 21:316. [PMID: 34903176 PMCID: PMC8667365 DOI: 10.1186/s12871-021-01518-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/04/2021] [Indexed: 11/24/2022] Open
Abstract
Background Perioperative fluid therapy management is changing due to the incorporation of different fluids, surgical techniques, and minimally invasive monitoring systems. The objective of this study was to explore fluid therapy management during the perioperative period in our country. Methods We designed the Fluid Day study as a cross-sectional, multicentre, observational study. The study was performed in 131 Spanish hospitals in February 2019. We included adult patients undergoing general anaesthesia for either elective or non-elective surgery. Demographic variables were recorded, as well as the type and total volume of fluid administered during the perioperative period and the monitorization used. To perform the analysis, patients were categorized by risk group. Results We recruited 7291 patients, 6314 of which were included in the analysis; 1541 (24.4%) patients underwent high-risk surgery, 1497 (23. 7%) were high risk patients, and 554 (8.7%) were high-risk patients and underwent high-risk surgery; 98% patients received crystalloids (80% balanced solutions); intraoperative colloids were used in 466 patients (7.51%). The hourly intraoperative volume in mL/kg/h and the median [Q1; Q3] administered volume (mL/kg) were, respectively, 6.67 [3.83; 8.17] ml/Kg/h and 13.9 [9.52;5.20] ml/Kg in low-risk patients undergoing low- or intermediate-risk surgery, 6 [4.04; 9.08] ml/Kg/h and 15.7 [10.4;24.5] ml/Kg in high- risk patients undergoing low or intermediate-risk surgery, 6.41 [4.36; 9.33] ml/Kg/h and 20.2 [13.3;32.4] ml/Kg in low-risk patients undergoing high-risk surgery, and 5.46 [3.83; 8.17] ml/Kg/h and 22.7[14.1;40.9] ml/Kg in high-risk patients undergoing high- risk surgery . We used advanced fluid monitoring strategies in 5% of patients in the intraoperative period and in 10% in the postoperative period. Conclusions The most widely used fluid was balanced crystalloids. Colloids were used in a small number of patients. Hourly surgery volume tended to be more restrictive in high-risk patients but confirms a high degree of variation in the perioperatively administered volume. Scarce monitorization was observed in fluid therapy management. Trial registration Clinical Trials: NCT03630744. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01518-z.
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Affiliation(s)
- Maria J Colomina
- Department of Anesthesia, Critical care and Pain Clinic, Hospital Universitari de Bellvitge, Barcelona, Spain. .,Barcelona University, Barcelona, Spain. .,Bellvitge Research Institute, IDIBELL, Barcelona, Spain.
| | | | - Patricia Guilabert
- Department of Anaesthesia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - José Luis Jover
- Department of Anaesthesia, Hospital Verge dels Lliris, Alcoi, Alicante, Spain
| | | | - Concha Cassinello
- Department of Anaesthesia, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Raquel Ferrandis
- Department of Anaesthesia, Hospital Universitari Politèncic La Fe, Valencia, Spain
| | - Juan V Llau
- Department of Anaesthesia, Hospital Universitari Dr. Peset, València, Spain
| | - Judith Peñafiel
- Barcelona University, Barcelona, Spain.,Bellvitge Research Institute, IDIBELL, Barcelona, Spain.,Biostatistics Unit, Bellvitge University Hospital, Barcelona, Spain
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5
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Chappell D, van der Linden P, Ripollés-Melchor J, James MFM. Safety and efficacy of tetrastarches in surgery and trauma: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth 2021; 127:556-568. [PMID: 34330414 DOI: 10.1016/j.bja.2021.06.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hydroxyethyl starch (HES) 130 is a frequently used fluid to replace intravascular losses during surgery or trauma. In the past years, several trials performed in critically ill patients have raised questions regarding the safety of this product. Our aim in this meta-analysis was to evaluate the safety and efficacy of 6% HES during surgery and in trauma. METHODS This systematic review and meta-analysis was registered at PROSPERO (CRD42018100379). We included 85 fully published articles from 1980 to June 2018 according to the protocol and three additional recent articles up to June 2020 in English, French, German, and Spanish reporting on prospective, randomised, and controlled clinical trials applying volume therapy with HES 130/0.4 or HES 130/0.42, including combinations with crystalloids, to patients undergoing surgery. Comparators were albumin, gelatin, and crystalloids only. A meta-analysis could not be performed for the two trauma studies as there was only one study that reported data on endpoints of interest. RESULTS Surgical patients treated with HES had lower postoperative serum creatinine (P<0.001) and showed no differences in renal dysfunction, renal failure, or renal replacement therapy. Although there was practically no further difference in the colloids albumin or gelatin, the use of HES improved haemodynamic stability, reduced need for vasopressors (P<0.001), and decreased length of hospital stay (P<0.001) compared with the use of crystalloids alone. CONCLUSIONS HES was shown to be safe and efficacious in the perioperative setting. Results of the present meta-analysis suggest that when used with adequate indication, a combination of intravenous fluid therapy with crystalloids and volume replacement with HES as colloid has clinically beneficial effects over using crystalloids only.
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Affiliation(s)
- Daniel Chappell
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Frankfurt Höchst, Frankfurt, Germany.
| | - Philippe van der Linden
- Department of Anaesthesiology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Javier Ripollés-Melchor
- Department of Anesthesiology and Critical Care, Infanta Leonor University Hospital, Madrid, Spain; Fluid Therapy and Hemodynamic Group of the Hemostasia, Transfusion Medicine, Fluid Therapy Section of the Spanish Society of Anesthesia and Critical Care (SEDAR), Madrid, Spain
| | - Michael F M James
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
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Ścieżyńska A, Soszyńska M, Szpak P, Krześniak N, Malejczyk J, Kalaszczyńska I. Influence of Hypothermic Storage Fluids on Mesenchymal Stem Cell Stability: A Comprehensive Review and Personal Experience. Cells 2021; 10:cells10051043. [PMID: 33925059 PMCID: PMC8146384 DOI: 10.3390/cells10051043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
Mesenchymal stem cells have generated a great deal of interest due to their potential use in regenerative medicine and tissue engineering. Examples illustrating their therapeutic value across various in vivo models are demonstrated in the literature. However, some clinical trials have not proved their therapeutic efficacy, showing that translation into clinical practice is considerably more difficult and discrepancies in clinical protocols can be a source of failure. Among the critical factors which play an important role in MSCs’ therapeutic efficiency are the method of preservation of the stem cell viability and various characteristics during their storage and transportation from the GMP production facility to the patient’s bedside. The cell storage medium should be considered a key factor stabilizing the environment and greatly influencing cell viability and potency and therefore the effectiveness of advanced therapy medicinal product (ATMP) based on MSCs. In this review, we summarize data from 826 publications concerning the effect of the most frequently used cell preservation solutions on MSC potential as cell-based therapeutic medicinal products.
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Affiliation(s)
- Aneta Ścieżyńska
- Department of Histology and Embryology, Medical University of Warsaw, 02-004 Warsaw, Poland; (A.Ś.); (M.S.); (P.S.); (J.M.)
- Laboratory of Experimental Immunology, Military Institute of Hygiene and Epidemiology, 01-163 Warsaw, Poland
| | - Marta Soszyńska
- Department of Histology and Embryology, Medical University of Warsaw, 02-004 Warsaw, Poland; (A.Ś.); (M.S.); (P.S.); (J.M.)
- Laboratory of Experimental Immunology, Military Institute of Hygiene and Epidemiology, 01-163 Warsaw, Poland
| | - Patrycja Szpak
- Department of Histology and Embryology, Medical University of Warsaw, 02-004 Warsaw, Poland; (A.Ś.); (M.S.); (P.S.); (J.M.)
| | - Natalia Krześniak
- Department of Plastic Surgery, Medical Centre for Postgraduate Education, 00-416 Warsaw, Poland;
| | - Jacek Malejczyk
- Department of Histology and Embryology, Medical University of Warsaw, 02-004 Warsaw, Poland; (A.Ś.); (M.S.); (P.S.); (J.M.)
- Laboratory of Experimental Immunology, Military Institute of Hygiene and Epidemiology, 01-163 Warsaw, Poland
| | - Ilona Kalaszczyńska
- Department of Histology and Embryology, Medical University of Warsaw, 02-004 Warsaw, Poland; (A.Ś.); (M.S.); (P.S.); (J.M.)
- Laboratory for Cell Research and Application, Medical University of Warsaw, 02-097 Warsaw, Poland
- Correspondence:
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Colomina MJ, Guilabert P, Ripollés-Melchor J, Jover JL, Basora M, Llau JV, Casinello C, Ferrandis R. Fluid therapy in the surgical patient in our environment. Reporting on the Fluid Day Study. ACTA ACUST UNITED AC 2019; 66:119-121. [PMID: 30665797 DOI: 10.1016/j.redar.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- M J Colomina
- Servicio de Anestesiología y Reanimación, Hospital Universitari Bellvitge, Barcelona, España.
| | - P Guilabert
- Servicio de Anestesiología y Reanimación, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España
| | - J L Jover
- Servicio de Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoy (Alicante), España
| | - M Basora
- Servicio de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España
| | - J V Llau
- Servicio de Anestesiología y Reanimación, Hospital Universitari Dr. Peset, Valencia, España
| | - C Casinello
- Servicio de Anestesiología y Reanimación, Hospital Miguel Servet, Zaragoza, España
| | - R Ferrandis
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España
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González-Castro A, Ortiz-Lasa M, Rodriguez-Borregan JC, Escudero-Acha P, Chicote E, Suberviola B, Blanco C, Peñasco Y, Jiménez Alfonso A, Llorca J, Dierssen-Soto T. Meta-analysis of the effects of normal saline on mortality in intensive care. ACTA ACUST UNITED AC 2018; 66:3-9. [PMID: 30100089 DOI: 10.1016/j.redar.2018.06.007] [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: 02/26/2018] [Revised: 06/15/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND OBJECTIVE To evaluate, by means of a meta-analysis, the effect of normal saline on mortality in intensive care patients, when compared with the use of balanced crystalloids. MATERIAL AND METHOD Published controlled clinical trials, randomised and sequential prospective studies in time, evaluating the mortality when physiological saline was used in patients admitted to intensive care units. Electronic search was performed in Medline, Embase, Cochrane Library, ISI Proceedings, and Web of Science, as well as a manual search of selected references. An independent evaluation was performed by 2 investigators. Discrepancies were resolved by consensus in the working group. Contingency tables were performed, and the OR with confidence intervals of each study were obtained. Heterogeneity was assessed by I2. Publication bias was assessed using funnel plot and Egger test. RESULTS A total of 8 articles were selected for the meta-analysis of mortality, which included a total of 20,684 patients. A significant association was observed between the use of saline and mortality in intensive care patients (OR 1.0972; 95% CI 1.0049-1.1979), when compared to the use of balanced crystalloids. No statistical evidence of publication bias (Egger, P=.5349) was found. In the sensitivity analysis, none of the studies substantially modified the overall outcome if it was eliminated from the meta-analysis. CONCLUSIONS There may be an increase in mortality associated with the use of saline in patients admitted to intensive care when comparing with the use of balanced crystalloids.
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Affiliation(s)
- A González-Castro
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - M Ortiz-Lasa
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J C Rodriguez-Borregan
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - P Escudero-Acha
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - E Chicote
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - B Suberviola
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - C Blanco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Y Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - A Jiménez Alfonso
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Llorca
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina de la Universidad de Cantabria, Santander, España
| | - T Dierssen-Soto
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina de la Universidad de Cantabria, Santander, España
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Calvo-Vecino J, Ripollés-Melchor J, Mythen M, Casans-Francés R, Balik A, Artacho J, Martínez-Hurtado E, Serrano Romero A, Fernández Pérez C, Asuero de Lis S, Errazquin AT, Gil Lapetra C, Motos AA, Reche EG, Medraño Viñas C, Villaba R, Cobeta P, Ureta E, Montiel M, Mané N, Martínez Castro N, Horno GA, Salas RA, Bona García C, Ferrer Ferrer ML, Franco Abad M, García Lecina AC, Antón JG, Gascón GH, Peligro Deza J, Pascual LP, Ruiz Garcés T, Roberto Alcácer AT, Badura M, Terrer Galera E, Fernández Casares A, Martínez Fernández MC, Espinosa Á, Abad-Gurumeta A, Feldheiser A, López Timoneda F, Zuleta-Alarcón A, Bergese S. Effect of goal-directed haemodynamic therapy on postoperative complications in low–moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial). Br J Anaesth 2018; 120:734-744. [DOI: 10.1016/j.bja.2017.12.018] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 11/20/2017] [Accepted: 12/11/2017] [Indexed: 02/06/2023] Open
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