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Long B, Gottlieb M. Fluid volumes in adults with sepsis. Acad Emerg Med 2024; 31:716-717. [PMID: 38567645 DOI: 10.1111/acem.14912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
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2
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Iba T, Maier CL, Helms J, Ferrer R, Thachil J, Levy JH. Managing sepsis and septic shock in an endothelial glycocalyx-friendly way: from the viewpoint of surviving sepsis campaign guidelines. Ann Intensive Care 2024; 14:64. [PMID: 38658435 PMCID: PMC11043313 DOI: 10.1186/s13613-024-01301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
Maintaining tissue perfusion in sepsis depends on vascular integrity provided by the endothelial glycocalyx, the critical layer covering the luminal surface of blood vessels. The glycocalyx is composed of proteoglycans, glycosaminoglycans, and functional plasma proteins that are critical for antithrombogenicity, regulating tone, controlling permeability, and reducing endothelial interactions with leukocytes and platelets. Degradation of the glycocalyx in sepsis is substantial due to thromboinflammation, and treatments for sepsis and septic shock may exacerbate endotheliopathy via additional glycocalyx injury. As a result, therapeutic strategies aimed at preserving glycocalyx integrity should be considered, including modifications in fluid volume resuscitation, minimizing catecholamine use, controlling hyperglycemia, and potential use of corticosteroids and anticoagulants. In this review, we explore treatment strategies aligned with the recommendations outlined in the Surviving Sepsis Campaign Guidelines 2021 with a special emphasis on evidence regarding glycocalyx protection.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan.
| | - Cheryl L Maier
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Julie Helms
- Strasbourg University Hospital, Medical Intensive Care Unit-NHC, INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg University (UNISTRA), Strasbourg, France
| | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jecko Thachil
- Department of Haematology, Manchester University Hospitals, Oxford Road, Manchester, UK
| | - Jerrold H Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA
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3
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Gendreau S, Frapard T, Carteaux G, Kwizera A, Adhikari NKJ, Mer M, Hernandez G, Mekontso Dessap A. Geo-economic Influence on the Effect of Fluid Volume for Sepsis Resuscitation: A Meta-Analysis. Am J Respir Crit Care Med 2024; 209:517-528. [PMID: 38259196 DOI: 10.1164/rccm.202309-1617oc] [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] [Received: 09/14/2023] [Accepted: 01/22/2024] [Indexed: 01/24/2024] Open
Abstract
Rationale: Sepsis management relies on fluid resuscitation avoiding fluid overload and its related organ congestion. Objectives: To explore the influence of country income group on risk-benefit balance of fluid management strategies in sepsis. Methods: We searched e-databases for all randomized controlled trials on fluid resuscitation in patients with sepsis or septic shock up to January 2023, excluding studies on hypertonic fluids, colloids, and depletion-based interventions. The effect of fluid strategies (higher versus lower volumes) on mortality was analyzed per income group (i.e., low- and middle-income countries [LMICs] or high-income countries [HICs]). Measurements and Main Results: Twenty-nine studies (11,798 patients) were included in the meta-analysis. There was a numerically higher mortality in studies of LMICs as compared with those of HICs: median, 37% (interquartile range [IQR]: 26-41) versus 29% (IQR: 17-38; P = 0.06). Income group significantly interacted with the effect of fluid volume on mortality: Higher fluid volume was associated with higher mortality in LMICs but not in HICs: odds ratio (OR), 1.47; 95% confidence interval (95% CI): 1.14-1.90 versus 1.00 (95% CI: 0.87-1.16), P = 0.01 for subgroup differences. Higher fluid volume was associated with increased need for mechanical ventilation in LMICs (OR, 1.24 [95% CI: 1.08-1.43]) but not in HICs (OR, 1.02 [95% CI: 0.80-1.29]). Self-reported access to mechanical ventilation also significantly influenced the effect of fluid volume on mortality, which increased with higher volumes only in settings with limited access to mechanical ventilation (OR: 1.45 [95% CI: 1.09-1.93] vs. 1.09 [95% CI: 0.93-1.28], P = 0.02 for subgroup differences). Conclusions: In sepsis trials, the effect of fluid resuscitation approach differed by setting, with higher volume of fluid resuscitation associated with increased mortality in LMICs and in settings with restricted access to mechanical ventilation. The precise reason for these differences is unclear and may be attributable in part to resource constraints, participant variation between trials, or other unmeasured factors.
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Affiliation(s)
- Ségolène Gendreau
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Medecine Intensive Réanimation, Créteil, France
- Institut Mondor de Recherche Biomédicale, Groupe de recherche clinique CARMAS, Faculté de Santé de Créteil, Université Paris est Créteil, Créteil, France
| | - Thomas Frapard
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Medecine Intensive Réanimation, Créteil, France
- Institut Mondor de Recherche Biomédicale, Groupe de recherche clinique CARMAS, Faculté de Santé de Créteil, Université Paris est Créteil, Créteil, France
| | - Guillaume Carteaux
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Medecine Intensive Réanimation, Créteil, France
- Institut Mondor de Recherche Biomédicale, Groupe de recherche clinique CARMAS, Faculté de Santé de Créteil, Université Paris est Créteil, Créteil, France
- INSERM U955, Faculté de Santé de Créteil, Université Paris Est Créteil, Créteil, France
| | - Arthur Kwizera
- Department of Anaesthesia and Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Neill K J Adhikari
- Sunnybrook Health Sciences Centre and Interdepartmental Division of Critical Care Medicine, Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mervyn Mer
- Divisions of Critical Care and Pulmonology, Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and
| | - Glenn Hernandez
- Facultad de Medicina, Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Armand Mekontso Dessap
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Medecine Intensive Réanimation, Créteil, France
- Institut Mondor de Recherche Biomédicale, Groupe de recherche clinique CARMAS, Faculté de Santé de Créteil, Université Paris est Créteil, Créteil, France
- INSERM U955, Faculté de Santé de Créteil, Université Paris Est Créteil, Créteil, France
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4
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Tackaert T, Van Moorter N, De Mey N, Demeyer I, De Decker K. The association between increasing fluid balance, acute kidney injury and mortality in patients with sepsis and septic shock: A retrospective single center audit. J Crit Care 2023; 78:154367. [PMID: 37494863 DOI: 10.1016/j.jcrc.2023.154367] [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] [Received: 01/08/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To determine whether a positive fluid balance is associated with AKI and mortality in sepsis and septic shock patients. METHODS A retrospective chart review of 482 patients treated for sepsis or septic shock. Patients were stratified according to quartiles of cumulative fluid balance on days 1 and 3. Logistic models were built to explore the association between fluid balance, AKI, and ICU mortality. RESULTS During the first days of ICU admission, fluid input did not differ between survivors and non-survivors, yet a significant difference in output resulted in a more positive fluid balance in non-survivors on day 1 (37.24 ± 31.98 ml/kg vs. 24.97 ± 23.76 ml/kg, p < 0.001) and day 3 (83.33 ± 70.86 ml/kg vs. 62.20 ± 45.90 ml/kg, P = 0.005). Using a logistic regression model, a positive fluid balance on day three was independently associated with higher ICU mortality (odds ratio 1.007 for every one ml/kg, P = 0038) and AKIN stage III (odds ratio 1.006 for every one ml/kg, p = 0.031). CONCLUSION In patients with sepsis and septic shock, a more positive fluid balance is associated with an increased incidence of acute kidney injury and death after correction for possible confounders.
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Affiliation(s)
- Thomas Tackaert
- Department of Emergency Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium.
| | - Nina Van Moorter
- Department of Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Nathalie De Mey
- Department of Anesthesiology and Intensive Care, Hospital OLV Aalst, Aalst, Belgium
| | - Ignace Demeyer
- Department of Emergency Medicine, Hospital OLV Aalst, Aalst, Belgium
| | - Koen De Decker
- Department of Anesthesiology and Intensive Care, Hospital OLV Aalst, Aalst, Belgium
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5
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Bauer SR, Gellatly RM, Erstad BL. Precision fluid and vasoactive drug therapy for critically ill patients. Pharmacotherapy 2023; 43:1182-1193. [PMID: 36606689 PMCID: PMC10323046 DOI: 10.1002/phar.2763] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/03/2022] [Accepted: 10/30/2022] [Indexed: 01/07/2023]
Abstract
There are several clinical practice guidelines concerning the use of fluid and vasoactive drug therapies in critically ill adult patients, but the recommendations in these guidelines are often based on low-quality evidence. Further, some were compiled prior to the publication of landmark clinical trials, particularly in the comparison of balanced crystalloid and normal saline. An important consideration in the treatment of critically ill patients is the application of precision medicine to provide the most effective care to groups of patients most likely to benefit from the therapy. Although not currently widely integrated into these practice guidelines, the utility of precision medicine in critical illness is a recognized research priority for fluid and vasoactive therapy management. The purpose of this narrative review was to illustrate the evaluation and challenges of providing precision fluid and vasoactive therapies to adult critically ill patients. The review includes a discussion of important investigations published after the release of currently available clinical practice guidelines to provide insight into how recommendations and research priorities may change future guidelines and bedside care for critically ill patients.
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Affiliation(s)
- Seth R Bauer
- Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rochelle M Gellatly
- Pharmacy Department, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | - Brian L Erstad
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona, USA
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6
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Sivapalan P, Ellekjaer KL, Jessen MK, Meyhoff TS, Cronhjort M, Hjortrup PB, Wetterslev J, Granholm A, Møller MH, Perner A. Lower vs Higher Fluid Volumes in Adult Patients With Sepsis: An Updated Systematic Review With Meta-Analysis and Trial Sequential Analysis. Chest 2023; 164:892-912. [PMID: 37142091 PMCID: PMC10567931 DOI: 10.1016/j.chest.2023.04.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/06/2023] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND IV fluids are recommended for adults with sepsis. However, the optimal strategy for IV fluid management in sepsis is unknown, and clinical equipoise exists. RESEARCH QUESTION Do lower vs higher fluid volumes improve patient-important outcomes in adult patients with sepsis? STUDY DESIGN AND METHODS We updated a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials assessing lower vs higher IV fluid volumes in adult patients with sepsis. The coprimary outcomes were all-cause mortality, serious adverse events, and health-related quality of life. We followed the recommendations from the Cochrane Handbook and used the Grading of Recommendations Assessment, Development and Evaluation approach. Primary conclusions were based on trials with low risk of bias if available. RESULTS We included 13 trials (N = 4,006) with four trials (n = 3,385) added to this update. The meta-analysis of all-cause mortality in eight trials with low risk of bias showed a relative risk of 0.99 (97% CI, 0.89-1.10; moderate certainty evidence). Six trials with predefined definitions of serious adverse events showed a relative risk of 0.95 (97% CI, 0.83-1.07; low certainty evidence). Health-related quality of life was not reported. INTERPRETATION Among adult patients with sepsis, lower IV fluid volumes probably result in little to no difference in all-cause mortality compared with higher IV fluid volumes, but the interpretation is limited by imprecision in the estimate, which does not exclude potential benefit or harm. Similarly, the evidence suggests lower IV fluid volumes result in little to no difference in serious adverse events. No trials reported on health-related quality of life. TRIAL REGISTRATION PROSPERO; No.: CRD42022312572; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Praleene Sivapalan
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.
| | - Karen L Ellekjaer
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Marie K Jessen
- Research Center for Emergency Medicine, Aarhus University and University Hospital, Aarhus N, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Tine S Meyhoff
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Maria Cronhjort
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Section of Anaesthesia and Intensive Care, Stockholm, Sweden
| | - Peter B Hjortrup
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark; Department of Cardiothoracic Anaesthesia and Intensive Care, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Anders Granholm
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Morten H Møller
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
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7
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Shahnoor H, Divi R, Addi Palle LR, Sharma A, Contractor B, Krupanagaram S, Batool S, Ali N. The Effects of Restrictive Fluid Resuscitation on the Clinical Outcomes in Patients with Sepsis or Septic Shock: A Meta-Analysis of Randomized-Controlled Trials. Cureus 2023; 15:e45620. [PMID: 37868575 PMCID: PMC10588294 DOI: 10.7759/cureus.45620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
This study aims to assess the impact of a restrictive resuscitation strategy on the outcomes of patients with sepsis and septic shock. This meta-analysis was conducted in accordance with the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidelines. A systematic search was performed in databases, including PubMed, Web of Science, EMBASE, and the Cochrane Library, covering the period from the inception of the database to August 2023, with no limitations on the language of publication. Outcomes assessed in the meta-analysis included mortality, duration of intensive care unit (ICU) stay in days, duration of mechanical ventilation in days, acute kidney injury (AKI) or the need for renal replacement therapy (RRT), and length of hospital stay in days. Overall, 12 studies met the inclusion criteria and were included in the present meta-analysis. The findings of this study indicate that although the risk of mortality was lower in fluid restriction compared to the control group, the difference was statistically insignificant (risk ratio (RR): 0.98; 95% confidence interval (CI): 0.9-1.05; P value: 0.61). Additionally, the duration of mechanical ventilation was significantly shorter in the restrictive fluid group compared to its counterparts (mean difference (MD): -1.02; 95% CI: -1.65 to -0.38; P value: 0.003). There were no significant differences found in relation to the duration of ICU stays, the incidence of AKI, the requirement for RRT, or the length of hospital stays measured in days.
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Affiliation(s)
- Husna Shahnoor
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
| | - Rachana Divi
- Medicine and Surgery, GSL Medical College, Hyderabad, IND
| | | | - Ashutosh Sharma
- Medicine, Kathmandu Medical College and Teaching Hospital, Kathmandu, NPL
| | - Bianca Contractor
- Internal Medicine, Smt. NHL Municipal Medical College, Ahmedabad, IND
| | | | - Saima Batool
- Internal Medicine, Hameed Latif Hospital, Lahore, PAK
| | - Neelum Ali
- Internal Medicine, University of Health Sciences, Lahore, PAK
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8
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Qayyum S, Shahid K. Fluid Resuscitation in Septic Patients. Cureus 2023; 15:e44317. [PMID: 37779759 PMCID: PMC10537347 DOI: 10.7759/cureus.44317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Sepsis is a life-threatening organ failure caused by a dysregulated response to infection. Fluid resuscitation and vasopressors are used to maintain systolic blood pressure and organ perfusion. Fluid resuscitation can be done with liberal or restricted fluids as well as colloids or crystalloid fluids. This review analyses the evidence for the use of liberal or restrictive fluids and colloids or crystalloids for the management of sepsis. A methodical search was conducted across PubMed, Cochrane Library, and ScienceDirect, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were followed for this study. Randomized controlled trials and retrospective observational studies were included in this study. Liberal and restrictive fluid strategies were found to be comparable in efficacy, but restrictive fluid regimens had the added benefit of a lower incidence of fluid overload. Balanced crystalloids were safer and more effective when compared to normal saline. Albumin replacement was found to be safe and showed efficacy in reducing mortality in patients with sepsis and septic shock.
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Affiliation(s)
- Shahid Qayyum
- Nephrology, Diaverum Dialysis Center, Wadi Al Dawasir, SAU
| | - Kamran Shahid
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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9
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Munroe ES, Hyzy RC, Semler MW, Shankar-Hari M, Young PJ, Zampieri FG, Prescott HC. Evolving Management Practices for Early Sepsis-induced Hypoperfusion: A Narrative Review. Am J Respir Crit Care Med 2023; 207:1283-1299. [PMID: 36812500 PMCID: PMC10595457 DOI: 10.1164/rccm.202209-1831ci] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/22/2023] [Indexed: 02/24/2023] Open
Abstract
Sepsis causes significant morbidity and mortality worldwide. Resuscitation is a cornerstone of management. This review covers five areas of evolving practice in the management of early sepsis-induced hypoperfusion: fluid resuscitation volume, timing of vasopressor initiation, resuscitation targets, route of vasopressor administration, and use of invasive blood pressure monitoring. For each topic, we review the seminal evidence, discuss the evolution of practice over time, and highlight questions for additional research. Intravenous fluids are a core component of early sepsis resuscitation. However, with growing concerns about the harms of fluid, practice is evolving toward smaller-volume resuscitation, which is often paired with earlier vasopressor initiation. Large trials of fluid-restrictive, vasopressor-early strategies are providing more information about the safety and potential benefit of these approaches. Lowering blood pressure targets is a means to prevent fluid overload and reduce exposure to vasopressors; mean arterial pressure targets of 60-65 mm Hg appear to be safe, at least in older patients. With the trend toward earlier vasopressor initiation, the need for central administration of vasopressors has been questioned, and peripheral vasopressor use is increasing, although it is not universally accepted. Similarly, although guidelines suggest the use of invasive blood pressure monitoring with arterial catheters in patients receiving vasopressors, blood pressure cuffs are less invasive and often sufficient. Overall, the management of early sepsis-induced hypoperfusion is evolving toward fluid-sparing and less-invasive strategies. However, many questions remain, and additional data are needed to further optimize our approach to resuscitation.
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Affiliation(s)
- Elizabeth S. Munroe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Robert C. Hyzy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Matthew W. Semler
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Manu Shankar-Hari
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, United Kingdom
- Department of Intensive Care Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Paul J. Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Fernando G. Zampieri
- Hospital do Coração (HCor) Research Institute, São Paulo, Brazil
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and
| | - Hallie C. Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
- VA Center for Clinical Management Research, Ann Arbor, Michigan
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Kletečka J, Zatloukal J, Smékalová O, Beneš J. Year 2022 in Review - Intensive care medicine - Cardiovascular and general issues. ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA 2022. [DOI: 10.36290/aim.2022.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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11
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Škulec R. Year 2022 in review - Emergency medicine. ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA 2022. [DOI: 10.36290/aim.2022.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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12
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Erstad BL, Barletta JF. Challenges With Using a Weight-Based Approach to Bolus Fluid Dosing in Obese Critically Ill Patients. Ann Pharmacother 2022; 57:609-616. [PMID: 36086809 DOI: 10.1177/10600280221125169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
At least 30 mL/kg of crystalloid fluid administration within the first 3 hours of resuscitation is suggested by the current Surviving Sepsis Campaign guidelines for management of sepsis and septic shock. This commentary discusses the challenges with using a weight-based approach to bolus fluid dosing during the early phase of resuscitation of adult, obese patients. Based on the available literature, arguments can be made for the use of either ideal or adjusted body weight for weight-based fluid dosing, but there are concerns with fluid overload if using actual body weight to dose patients with more severe forms of obesity.
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Affiliation(s)
- Brian L. Erstad
- Department of Pharmacy Practice & Science, The University of Arizona, Tucson, AZ, USA
| | - Jeffrey F. Barletta
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale, AZ, USA
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