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Fredrickson KA, Carver TW. Trauma-related electrolyte disturbances: From resuscitation to rhabdomyolysis. Nutr Clin Pract 2022; 37:1004-1014. [PMID: 36036224 DOI: 10.1002/ncp.10908] [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: 04/20/2022] [Revised: 07/20/2022] [Accepted: 08/04/2022] [Indexed: 11/08/2022] Open
Abstract
Traumatic injury results in drastic changes to a patient's normal physiology. The hormonal stress response, as well as some treatment strategies, lead to significant disruptions in electrolyte homeostasis that are important for clinicians to understand. In addition, advances in fluid resuscitation and modern transfusion practices have led to their own unique set of consequences, which we are just beginning to appreciate. Special attention is placed on rhabdomyolysis, as this distinct entity represents an extreme example of injury induced electrolyte derangements. This review describes the physiologic response to trauma and highlights some of the important electrolyte abnormalities that can be encountered while caring for the injured patient.
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Affiliation(s)
- Kyla A Fredrickson
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas W Carver
- Department of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Owen A, Patel JM, Parekh D, Bangash MN. Mechanisms of Post-critical Illness Cardiovascular Disease. Front Cardiovasc Med 2022; 9:854421. [PMID: 35911546 PMCID: PMC9334745 DOI: 10.3389/fcvm.2022.854421] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Prolonged critical care stays commonly follow trauma, severe burn injury, sepsis, ARDS, and complications of major surgery. Although patients leave critical care following homeostatic recovery, significant additional diseases affect these patients during and beyond the convalescent phase. New cardiovascular and renal disease is commonly seen and roughly one third of all deaths in the year following discharge from critical care may come from this cluster of diseases. During prolonged critical care stays, the immunometabolic, inflammatory and neurohumoral response to severe illness in conjunction with resuscitative treatments primes the immune system and parenchymal tissues to develop a long-lived pro-inflammatory and immunosenescent state. This state is perpetuated by persistent Toll-like receptor signaling, free radical mediated isolevuglandin protein adduct formation and presentation by antigen presenting cells, abnormal circulating HDL and LDL isoforms, redox and metabolite mediated epigenetic reprogramming of the innate immune arm (trained immunity), and the development of immunosenescence through T-cell exhaustion/anergy through epigenetic modification of the T-cell genome. Under this state, tissue remodeling in the vascular, cardiac, and renal parenchymal beds occurs through the activation of pro-fibrotic cellular signaling pathways, causing vascular dysfunction and atherosclerosis, adverse cardiac remodeling and dysfunction, and proteinuria and accelerated chronic kidney disease.
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Affiliation(s)
- Andrew Owen
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Jaimin M. Patel
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Dhruv Parekh
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Mansoor N. Bangash
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Mansoor N. Bangash
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Myers AA, Geldmaker LE, Haehn DA, Ball CT, Thiel DD. Evaluation of Routine Postoperative Labs Following Robotic Assisted Partial Nephrectomy in Patients With Normal Preoperative Renal Function. Urology 2021; 160:117-123. [PMID: 34818522 DOI: 10.1016/j.urology.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/28/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate predictors of abnormal routine postoperative day 1 (POD1) labs in patients with normal pre-operative renal function following robotic assisted partial nephrectomy (RAPN) and the associated clinical outcomes of these lab results. METHODS We analyzed 500 consecutive RAPN from a single surgeon series. Patients with chronic kidney disease (CKD) III or greater were excluded from the study. Three hundred ninty-three RAPN were included in the analysis. Routine POD1 lab tests including hemoglobin (Hgb), creatinine, potassium, and sodium were evaluated to determine rates of abnormal values and rates of clinical intervention. Abnormal Hgb at POD1 was defined as <8 g/dL or ≥3 g/dL decrease from the preoperative (baseline) value. Abnormal sodium (Na) preoperatively and postoperatively was defined as <135 mEq/L or >145 mEq/L. Abnormal potassium (K) was defined preoperatively and POD1 as <3.5 mEq/L or >5 mEq/L. RESULTS Of 37.4% (147/393) had one or more abnormal labs at POD1. Of the 101 patients with abnormal Hgb, 15 patients required blood transfusion. Twenty-six patients had abnormal sodium for which two were treated with IV fluids. Twenty-seven patients had potassium abnormalities (12/25 were hypokalemia). Acute kidney injury stage I was seen in 27 patients (6.9%) and stage II in 3 (0.8%). Patients with abnormal labs were more likely to have larger renal mass, higher R.E.N.A.L. scores, intraoperative complications, longer operative times, and higher EBL on multivariate analysis. CONCLUSION POD1 serum laboratory tests appear to be necessary following RAPN in patients with normal pre-operative renal function.
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Affiliation(s)
| | | | | | - Colleen T Ball
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL.
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Sabbatini G, Caccioppola A, Lusardi AC, Pozzi T, Bianco C, Baio S, Chiumello D. Electrolytes, albumin and acid base equilibrium during laparoscopic surgery. Minerva Anestesiol 2021; 87:1300-1308. [PMID: 34633165 DOI: 10.23736/s0375-9393.21.15465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Surgery, causing inflammation, disrupts endothelial permeability leading to movement of fluids and albumin across the vascular barrier. Fluid therapy for restoring circulatory homeostasis may lead to positive fluid balance which has been shown to increase morbidity and mortality in surgical patients. The current investigation aims to describe physio-pathological changes in circulating albumin, fluid and electrolyte balance, and acidbase equilibrium in a cohort of patients undergoing laparoscopic surgery under general anesthesia. METHODS Single-center prospective observational study. Patients undergoing laparoscopic colorectal surgery were screened for eligibility.. Before surgery the baseline fasting conditions were homogenized. Hemoglobin, urinary and plasmatic were collected before surgery and then at pre-defined timepoints. Albumin/Creatinine ratio was measured before and after surgery. Expected and actual circulating Sodium concentrations were compared according to a physiological theoretical model. Assessment and quantification of changes in major electrolytes, albumin and acid-base balance was defined as the primary outcome of the study. RESULTS 38 patients were enrolled in the protocol. Patients had a positive electrolytes (Na+ 295 [244-375] mmol, Cl- 234 [195-295] mmol, K+ 16.8 [12.0-21.4] mmol) and fluid balance (2165 [1727-2728] ml). The positive fluid balance was associated with stable chloride (105 [103-107], end study vs 103 [102-106] mmol/L, baseline, p=ns) and potassium (4.2 [3.8-4.4], end study vs 4.1 [3.6-4.4] mmol/L, baseline, p=ns) levels, but sodium concentrations decreased over time (138 [137-140], end study vs 139 [138-141] mmol/L, baseline, p<0.05). The Albumin/Creatinine ratio was higher at the end of surgery 134 [61-267] vs 7 [4-14], p<0.001). CONCLUSIONS Data from patients undergoing colorectal laparoscopic surgery showed a positive fluid balance, decreased circulating albumin and increased albuminuria. A positive sodium balance was not always associated with an increase in sodium plasma concentration.
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Affiliation(s)
- Giovanni Sabbatini
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Alessio Caccioppola
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Andrea C Lusardi
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Tommaso Pozzi
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Claudia Bianco
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Serena Baio
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Davide Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy - .,Department of Health Sciences, University of Milan, Milan, Italy.,Coordinated Research Center on Respiratory Failure, University of Milan, Milan, Italy
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Low- versus High-Chloride Content Intravenous Solutions for Perioperative Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3571397. [PMID: 33490269 PMCID: PMC7801087 DOI: 10.1155/2021/3571397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/16/2020] [Accepted: 12/24/2020] [Indexed: 11/23/2022]
Abstract
Background Studies have shown complications of normal saline infusion because of its high-chloride content. Therefore, in the present study, we aimed to explore whether the use of low- versus high-chloride solutions benefited the unselected and specifically perioperative patients and was associated with different outcomes. Methods Studies on the use of low- versus high-chloride content intravenous solutions for perioperative patients, published up to July 15, 2019, were systematically reviewed, and primary and secondary outcomes were quantitatively summarized. Results A total of 14 eligible randomized controlled trials with 943 perioperative patients were included. Five studies reported all-cause mortality, and eight studies provided detailed data on renal replacement therapy (RRT). The pooled result suggested no statistically significant difference in the effect of low- versus high-chloride solutions on all-cause mortality (risk ratio (RR) = 1.39; 95%confidence interval (CI) = 0.23–8.26) and RRT (RR = 1.05; 95%CI = 0.63–1.76). The pooled results on acute kidney injury (AKI) and the use of allogenic blood transfusion (P > 0.05) were similar. Conclusion Among specific perioperative patients, the use of low- versus high-chloride content intravenous solutions did not reduce the all-cause mortality, risk of severe AKI, or rate of RRT use. Further large randomized clinical trials are needed to confirm or refute this finding.
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Cagini L, Andolfi M, Potenza R, Ceccarelli S, Vannucci J, Berti V, Reboldi G, Puma F. Microalbuminuria assessment after thoracic surgery: Early identification of complication risks. CLINICAL RESPIRATORY JOURNAL 2020; 14:564-570. [PMID: 32056371 DOI: 10.1111/crj.13169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 01/23/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Microalbuminuria (MA) is considered a reflection of systemic capillary leak and an early marker of acute stress reaction to the surgical insult, proportional to the severity of the initiating condition and predictive of the individual response to surgical stress. OBJECTIVES We conducted a prospective study to assess for the variation of MA within 4 days after thoracic surgery. We correlated observed MA levels with both their respective PaO2 /FiO2 respiratory ratio and the onset of postoperative complications. METHODS This single-centre study enrolled 255 consecutive patients having an American Society of Anaesthesiologists (ASA) score ≤ 3. The mean age was 62 years with 67% male. All patients were scheduled for elective pulmonary resection. MA was measured in urine samples as the albumin-to-creatinine ratio (A/C), prior to, at and after extubation up to 96 hours. PaO2 /FiO2 was measured at extubation and on the first postoperative day. RESULTS Overall, preoperative A/C levels resulted normal, with a significant average increase at extubation which peaked 6 hours later (P < 0.001). Larger postoperative A/C increases were observed in patients who developed postoperative complications, compared to those without these complications (P < 0.019). Moreover, patients undergoing major open pulmonary resections had larger postoperative A/C increases, compared to those undergoing minor video-assisted thoracic surgery resections (P < 0.006). At the time of extubation, A/C was inversely related to the PaO2 /FiO2 ratio (r = -0.25; P = 0.038). Peak A/C > 61 mg/g (P = 0.0003) was associated with postoperative cardio-pulmonary complications (OR 3.85; P = 0.003). CONCLUSION Within 6 hours after extubation, MA assessment may be a rapid and relatively inexpensive method for better predicting perioperative risk in an ASA score ≤ 3 population.
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Affiliation(s)
- Lucio Cagini
- Department of Medicine, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy.,Thoracic Surgery Unit, Department of Surgical Science, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Marco Andolfi
- Department of Medicine, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy.,Thoracic Surgery Unit, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Rossella Potenza
- Thoracic Surgery Unit, Department of Surgical Science, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Silvia Ceccarelli
- Thoracic Surgery Unit, Department of Surgical Science, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Jacopo Vannucci
- Thoracic Surgery Unit, Department of Surgical Science, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Valeria Berti
- Thoracic Surgery Unit, Department of Surgical Science, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Gianpaolo Reboldi
- Department of Medicine, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Francesco Puma
- Thoracic Surgery Unit, Department of Surgical Science, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
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Mukartihal R, Puranik HG, Patil SS, Dhanasekaran SR, Menon VK. Electrolyte imbalance after total joint arthroplasty: risk factors and impact on length of hospital stay. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1467-1472. [DOI: 10.1007/s00590-019-02471-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
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Plant V, Parrish DW, Limkemann A, Ferrada P, Aboutanos M, Mangino MJ. Low-Volume Resuscitation for Hemorrhagic Shock: Understanding the Mechanism of PEG-20k. J Pharmacol Exp Ther 2017; 361:334-340. [DOI: 10.1124/jpet.116.239822] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Hessels L, Oude Lansink A, Renes MH, van der Horst ICC, Hoekstra M, Touw DJ, Nijsten MW. Postoperative fluid retention after heart surgery is accompanied by a strongly positive sodium balance and a negative potassium balance. Physiol Rep 2016; 4:4/10/e12807. [PMID: 27225629 PMCID: PMC4886173 DOI: 10.14814/phy2.12807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/25/2016] [Indexed: 01/09/2023] Open
Abstract
The conventional model on the distribution of electrolyte infusions states that water will distribute proportionally over both the intracellular (ICV) and extracellular (ECV) volumes, while potassium homes to the ICV and sodium to the ECV. Therefore, total body potassium is the most accurate measure of ICV and thus potassium balances can be used to quantify changes in ICV. In cardiothoracic patients admitted to the ICU we performed complementary balance studies to measure changes in ICV and ECV. In 39 patients, fluid, sodium, potassium, and electrolyte‐free water (EFW) balances were determined to detect changes in ICV and ECV. Cumulatively over 4 days, these patients received a mean ± SE infusion of 14.0 ± 0.6 L containing 1465 ± 79 mmol sodium, 196 ± 11 mmol potassium and 2.1 ± 0.1 L EFW. This resulted in strongly positive fluid (4.0 ± 0.6 L) and sodium (814 ± 75 mmol) balances but in negative potassium (−101 ± 14 mmol) and EFW (−1.1 ± 0.2 L) balances. We subsequently compared potassium balances (528 patients) and fluid balances (117 patients) between patients who were assigned to either a 4.0 or 4.5 mmol/L blood potassium target. Although fluid balances were similar in both groups, the additionally administered potassium (76 ± 23 mmol) in the higher target group was fully excreted by the kidneys (70 ± 23 mmol). These findings indicate that even in the context of rapid and profound volume expansion neither water nor potassium moves into the ICV.
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Affiliation(s)
- Lara Hessels
- Department of Critical Care, University of Groningen University Medical Center Groningen, Groningen, The Netherlands
| | - Annemieke Oude Lansink
- Department of Critical Care, University of Groningen University Medical Center Groningen, Groningen, The Netherlands
| | - Maurits H Renes
- Department of Critical Care, University of Groningen University Medical Center Groningen, Groningen, The Netherlands
| | - Iwan C C van der Horst
- Department of Critical Care, University of Groningen University Medical Center Groningen, Groningen, The Netherlands
| | - Miriam Hoekstra
- Department of Critical Care, University of Groningen University Medical Center Groningen, Groningen, The Netherlands Department of Anesthesiology, University of Groningen University Medical Center Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten W Nijsten
- Department of Critical Care, University of Groningen University Medical Center Groningen, Groningen, The Netherlands
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Dugdale AHA, Taylor PM. Equine anaesthesia-associated mortality: where are we now? Vet Anaesth Analg 2016; 43:242-55. [PMID: 26970940 DOI: 10.1111/vaa.12372] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 01/12/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To review the literature concerning mortality associated with general anaesthesia in horses and to assess whether there is evidence for a reduction in mortality over the 20 years since the Confidential Enquiry into Perioperative Equine Fatalities (CEPEF). DATABASES USED PubMed, Scopus, Google Scholar. Search terms used: horse; pony; equine; anaesthesia; anesthesia; recovery; morbidity, and mortality. CONCLUSIONS The most recent studies, in which isoflurane and sevoflurane have been more commonly used for anaesthesia maintenance, report fewer intraoperative cardiac arrests than older studies in which halothane was favoured. Catastrophic fractures, however, have become the greatest cause of recovery-associated mortality.
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Affiliation(s)
- Alexandra H A Dugdale
- Faculty of Health and Life Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
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Trentini A, Bellini T, Manfrinato MC, Dallocchio F, Fainardi E, Alvisi R, Alvisi V, Volta CA. Balanced and unbalanced solutions modulate the release of Matrix Metalloproteinase-9 (MMP-9) from neutrophils in response to inflammatory stimuli: an in vitro study. Inflamm Res 2014; 63:325-8. [PMID: 24458309 PMCID: PMC3983875 DOI: 10.1007/s00011-014-0709-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 01/07/2014] [Accepted: 01/12/2014] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES AND DESIGN We investigated the effect of balanced (BS) and unbalanced (UBS) solutions in the absence or presence of hydroxyethyl starch (HES) on neutrophil functionality, evaluating the release of matrix metalloproteinase (MMP)-9, myeloperoxidase (MPO), and MMP-8. MATERIALS AND METHODS Neutrophils were isolated by gradient centrifugation and dextran sedimentation and incubated in BS or UBS without or with HES, in the absence or presence of Interleukin-8 (IL-8) or Lipopolysaccharide (LPS). MMP-9, MPO, and MMP-8 were assayed by commercially available ELISA kits. RESULTS There was not any influence of volume replacement solutions on the release of the enzymes from resting neutrophils. After IL-8 stimulation, the release of MMP-9 was higher in BS than in UBS or RPMI-1640, whereas HES enhanced its release regardless of the composition. After LPS stimulation, the release of MMP-9 was higher in both UBS and BS than RPMI-1640, but HES brought its release back to physiological conditions. No difference was found in the release of MPO and MMP-8 after stimulation with IL-8 or LPS. CONCLUSION Volume replacement solutions might have an impact on the release of MMP-9 depending on the inflammatory milieu, suggesting that the use of balanced or unbalanced solutions is not a neutral choice.
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Affiliation(s)
- Alessandro Trentini
- Department of Biomedical and Specialty Surgery Sciences, University of Ferrara, Luigi Borsari 46, 44121, Ferrara, Italy
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Volta CA, Trentini A, Farabegoli L, Manfrinato MC, Alvisi V, Dallocchio F, Marangoni E, Alvisi R, Bellini T. Effects of two different strategies of fluid administration on inflammatory mediators, plasma electrolytes and acid/base disorders in patients undergoing major abdominal surgery: a randomized double blind study. JOURNAL OF INFLAMMATION-LONDON 2013; 10:29. [PMID: 24059479 PMCID: PMC4015738 DOI: 10.1186/1476-9255-10-29] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 09/20/2013] [Indexed: 10/31/2022]
Abstract
BACKGROUND Administration of normal saline might increase circulating levels of pro-inflammatory cytokines and may cause variation of plasmatic electrolytic and hyperchloremic acidosis, which in turn can impair renal function. Hence the use of balanced solutions could influence the inflammatory cascade triggered by the surgical procedures, the plasmatic electrolyte concentration, the acid-base equilibrium, and the renal function. METHODS This is a double blind randomized trial. Forty patients undergoing major abdominal surgery (bowel cancer) were allocated in two groups, the balanced solution (BS) group in which the fluids administered were balanced solutions (colloids and crystalloids); and the unbalanced solution (UBS) group in which the fluids administered were unbalanced solutions (colloids and crystalloids). Measurements were performed after anaesthesia induction (T0), at the end of surgery (T1), within 2 h after surgery (T2) and 24 h after the beginning of surgery (T3). The following data were collected: 1) active matrix metalloproteinase 9 (MMP-9) and its tissue inhibitor (TIMP-1), IL-6, IL-8, IL-10; 2) blood gases variables; 3) electrolytes, albumin, total serum protein and the strong ion difference; 4) neutrophil gelatinase-associated lipocalin (NGAL) from urinary sample. RESULTS The BS group exhibited higher circulating level of IL-10 and TIMP-1 and lower level of active MMP-9. The UBS group experienced hypercloremia, hypocalcemia, hypomagnesemia, worse acid-base equilibrium and higher level of NGAL. CONCLUSIONS The use of balanced solutions was responsible of less alteration of plasmatic electrolytes, acid-base equilibrium, kidney function and it might be associated with an early anti-inflammatory mechanisms triggering. TRIAL REGISTRATION ClinicalTrials.gov (Ref: NCT01320891).
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Affiliation(s)
- Carlo Alberto Volta
- Department of Surgical, Anaesthesiological and Radiological Science, Section of Anaesthesia and Intensive Care, S, Anna Hospital, University of Ferrara, Via Aldo Moro n, 8-44124 Cona, Ferrara, Italy.
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Conti-Patara A, de Araújo Caldeira J, de Mattos-Junior E, de Carvalho HDS, Reinoldes A, Pedron BG, Patara M, Francisco Talib MS, Faustino M, de Oliveira CM, Cortopassi SRG. Changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization at admission to ICU and the relation to outcome. J Vet Emerg Crit Care (San Antonio) 2012; 22:409-18. [PMID: 22731982 DOI: 10.1111/j.1476-4431.2012.00769.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 05/14/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization in the ICU and their relation to outcome. DESIGN Prospective observational study. SETTING ICU of a veterinary university medical center. ANIMALS Thirty dogs with severe sepsis or septic shock caused by pyometra who underwent surgery and were admitted to the ICU. MEASUREMENTS AND MAIN RESULTS Severe sepsis was defined as the presence of sepsis and sepsis-induced dysfunction of one or more organs. Septic shock was defined as the presence of severe sepsis plus hypotension not reversed with fluid resuscitation. After the presumptive diagnosis of sepsis secondary to pyometra, blood samples were collected and clinical findings were recorded. Volume resuscitation with 0.9% saline solution and antimicrobial therapy were initiated. Following abdominal ultrasonography and confirmation of increased uterine volume, dogs underwent corrective surgery. After surgery, the animals were admitted to the ICU, where resuscitation was guided by the clinical parameters, central venous oxygen saturation (ScvO(2)), lactate, and base deficit. Between survivors and nonsurvivors it was observed that the ScvO(2), lactate, and base deficit on ICU admission were each related independently to death (P = 0.001, P = 0.030, and P < 0.001, respectively). ScvO(2) and base deficit were found to be the best discriminators between survivors and nonsurvivors as assessed via receiver operator characteristic curve analysis. CONCLUSION Our study suggests that ScvO(2) and base deficit are useful in predicting the prognosis of dogs with severe sepsis and septic shock; animals with a higher ScvO(2) and lower base deficit at admission to the ICU have a lower probability of death.
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Affiliation(s)
- Andreza Conti-Patara
- Department of Veterinary Surgery, School of Veterinary Medicine and Zootechnics, University of São Paulo, São Paulo, SP, Brazil
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15
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Findlay JM, Spencer S, Bosworth K, J Keogh M. Abnormal saline: redressing the balance. Br J Hosp Med (Lond) 2011; 72:M2-3. [PMID: 21240127 DOI: 10.12968/hmed.2011.72.sup1.m2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- John M Findlay
- Department of General Surgery, Royal Berkshire Hospital, Reading
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Affiliation(s)
- Richard Leach
- Department of Medicine, Guy's and St Thomas' Hospital Trust, London.
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Jousi M, Reitala J, Lund V, Katila A, Leppäniemi A. The role of pre-hospital blood gas analysis in trauma resuscitation. World J Emerg Surg 2010; 5:10. [PMID: 20412593 PMCID: PMC2873276 DOI: 10.1186/1749-7922-5-10] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 04/22/2010] [Indexed: 11/13/2022] Open
Abstract
Background To assess, whether arterial blood gas measurements during trauma patient's pre-hospital shock resuscitation yield useful information on haemodynamic response to fluid resuscitation by comparing haemodynamic and blood gas variables in patients undergoing two different fluid resuscitation regimens. Methods In a prospective randomised study of 37 trauma patients at risk for severe hypovolaemia, arterial blood gas values were analyzed at the accident site and on admission to hospital. Patients were randomised to receive either conventional fluid therapy or 300 ml of hypertonic saline. The groups were compared for demographic, injury severity, physiological and outcome variables. Results 37 patients were included. Mean (SD) Revised Trauma Score (RTS) was 7.3427 (0.98) and Injury Severity Score (ISS) 15.1 (11.7). Seventeen (46%) patients received hypertonic fluid resuscitation and 20 (54%) received conventional fluid therapy, with no significant differences between the groups concerning demographic data or outcome. Base excess (BE) values decreased significantly more within the hypertonic saline (HS) group compared to the conventional fluid therapy group (mean BE difference -2.1 mmol/l vs. -0.5 mmol/l, p = 0.003). The pH values on admission were significantly lower within the HS group (mean 7.31 vs. 7.40, p = 0.000). Haemoglobin levels were in both groups lower on admission compared with accident site. Lactate levels on admission did not differ significantly between the groups. Conclusion Pre-hospital use of small-volume resuscitation led to significantly greater decrease of BE and pH values. A portable blood gas analyzer was found to be a useful tool in pre-hospital monitoring for trauma resuscitation.
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Affiliation(s)
- Milla Jousi
- Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, PL 340, FIN-00029 HUS, Finland.
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Hilton AK, Pellegrino VA, Scheinkestel CD. Avoiding common problems associated with intravenous fluid therapy. Med J Aust 2008; 189:509-13. [DOI: 10.5694/j.1326-5377.2008.tb02147.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 08/24/2008] [Indexed: 11/17/2022]
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Driessen B, Brainard B. Fluid therapy for the traumatized patient. J Vet Emerg Crit Care (San Antonio) 2006. [DOI: 10.1111/j.1476-4431.2005.00184.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Thompson R, Greaves I. Hypertonic Saline- Hydroxyethyl Starch In Trauma Resuscitation. J ROY ARMY MED CORPS 2006; 152:6-12. [PMID: 16749463 DOI: 10.1136/jramc-152-01-02] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- R Thompson
- James Cook University Hospital, Teesside
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Reaney S. Small volume resuscitation with 7.5% hypertonic saline solution--treatment of haemorrhagic shock in the tropics. Trop Doct 2004; 34:190. [PMID: 15267064 DOI: 10.1177/004947550403400330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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