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Imran M, Khlidj Y, Naeem A, Tanveer A, Fakih N, Kamran A, Abuelazm M. Perioperative balanced crystalloids versus normal saline during kidney transplantation: a systematic review and meta-analysis of randomized controlled trials. Int Urol Nephrol 2024; 56:2195-2213. [PMID: 38349600 DOI: 10.1007/s11255-023-03936-z] [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: 11/29/2023] [Accepted: 12/27/2023] [Indexed: 06/21/2024]
Abstract
BACKGROUND In kidney transplant (KT) surgery, the perioperative administration of intravenous (IV) fluids plays a crucial role, with potential effects on graft function. Our meta-analysis aims to assess the post-KT outcomes of perioperative balanced crystalloids (BC) versus normal saline (NS). METHODS We conducted a comprehensive search across five databases to identify relevant randomized controlled trials (RCTs). The search results were imported into Covidence for article eligibility screening, and all relevant outcome data were synthesized using risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CIs) in meta-analysis models within RevMan 5.4. PROSPERO ID CRD42023448457. RESULTS Pooled data from 15 RCTs with 2,008 participants showed that the rate of delayed graft function (DGF) was significantly lower with BC (RR: 0.78, 95% CI [0.68, 0.91], P = 0.0009). Also, BC was associated with significantly higher post-op blood pH (MD: 0.05, 95% CI [0.03, 0.07], P < 0.01), lower serum chloride (MD: - 7.31, 95% CI [- 10.58, - 3.77], P < 0.01), and sodium (MD: - 1.94, 95% CI [- 3.32, - 0.55], P = 0.006) as compared to NS. However, serum potassium, serum creatinine, and urine output at POD 1 to 7 did not differ between the two groups. CONCLUSION BC significantly reduced the incidence of DGF, resulting in more stable post-operative acid-base parameters, and lower chloride levels compared to NS. Hence, substituting NS with BC offers a strategy to protect grafts from acidotic and hyperchloremic insults, optimizing KT outcomes.
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Affiliation(s)
- Muhammad Imran
- University College of Medicine and Dentistry, The University of Lahore, Lahore, Pakistan
| | - Yehya Khlidj
- Faculty of Medicine, University of Algiers, Algiers 16000, Algeria
| | | | - Aiman Tanveer
- University College of Medicine and Dentistry, The University of Lahore, Lahore, Pakistan
| | - Nour Fakih
- Department of Natural Sciences, Lebanese American University, Beirut, Lebanon.
| | - Ateeba Kamran
- Karachi Medical and Dental College, Karachi, Pakistan
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Gianolli F, Kutter APN. Hypotension and tachycardia following an intravenous bolus of Ringer’s acetate in an anaesthetized cat. Vet Anaesth Analg 2023; 50:306-307. [PMID: 37003916 DOI: 10.1016/j.vaa.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
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Henze IS, Hilpert L, Kutter APN. Development and comparison of an esophageal Doppler monitoring-based treatment algorithm with a heart rate and blood pressure-based treatment algorithm for goal-directed fluid therapy in anesthetized dogs: A pilot study. Front Vet Sci 2022; 9:1008240. [PMID: 36262533 PMCID: PMC9574010 DOI: 10.3389/fvets.2022.1008240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/16/2022] [Indexed: 11/04/2022] Open
Abstract
The objective of this pilot study was to determine the feasibility of a study comparing the efficacy of an esophageal Doppler monitor (EDM)-based fluid therapy algorithm with a heart rate (HR)- and mean arterial blood pressure (MAP)-based algorithm in reducing hypotension and fluid load in anesthetized dogs. Client-owned dogs undergoing general anesthesia for surgical procedures were randomized to two groups. An EDM probe for monitoring blood flow in the descending aorta was placed in each dog before receiving a crystalloid bolus (5 mL/kg) over 5 min. Fluids were repeated in case of fluid responsiveness defined by increasing Velocity Time Integral (VTI) ≥ 10% in group EDM and by decreasing HR ≥ 5 beats/min and/or increasing MAP ≥ 3 mmHg in group standard. The feasibility outcomes included the proportion of dogs completing the study and the clinical applicability of the algorithms. The clinical outcomes were the total administered fluid volume and the duration of hypotension defined as MAP < 60 mmHg. Data was compared between groups with Mann-Whitney U-test. p < 0.05 were deemed significant. Of 25 dogs screened, 14 completed the study (56%). There were no differences in the proportion of recorded time spent in hypotension in group standard [2 (0–39)% (median (range))] and EDM [0 (0–63) %, p = 1], or the total volume of fluids [standard 8 (5–14) mL/kg/h, EDM 11 (4–20) mL/kg/h, p = 0.3]. This study declined the feasibility of a study comparing the impact of two newly developed fluid therapy algorithms on hypotension and fluid load in their current form. Clinical outcome analyses were underpowered and no differences in treatment efficacy between the groups could be determined. The conclusions drawn from this pilot study provide important information for future study designs.
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4
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Heitland A, Klein-Richers U, Hartmann K, Dörfelt R. Influence of acetate containing fluid versus lactate containing fluid on acid-base status, electrolyte level, and blood lactate level in dehydrated dogs. Vet World 2021; 14:2714-2718. [PMID: 34903930 PMCID: PMC8654756 DOI: 10.14202/vetworld.2021.2714-2718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM Acetate or lactate buffered, balanced isotonic rehydration fluids are commonly used for fluid therapy in dogs and may influence acid-base and electrolyte status. This study aimed to assess acid-base status, electrolyte levels, and lactate levels in dehydrated dogs after receiving acetate or lactate-containing intravenous rehydration fluids. MATERIALS AND METHODS In this prospective, randomized study, 90 dehydrated dogs were included and randomized to receive acetate [Sterofundin® ISO B. Braun Vet Care (STERO), Germany) or lactate (Ringer-Lactat-Lösung nach Hartmann B. Braun Vet Care (RL), Germany] containing intravenous fluids for rehydration. The exclusion criteria were as follows: Age <6 months, liver failure, congestive heart failure, and extreme electrolyte deviation. Physical examination, venous blood gas, and lactate levels were analyzed before and after rehydration. The two groups were compared using t-test and Chi-square test. The significance level was set at p≤0.05. RESULTS Post-rehydration heart rate decreased in the STERO group (p<0.001) but not in the RL group (p=0.090). Lactate levels decreased in both groups STERO (p<0.001) and in group RL (p=0.014). Sodium and chloride levels increased during rehydration in group STERO (p<0.001; p<0.001) and group RL (p=0.002; p<0.001). There was a larger decrease in lactate levels in group STERO compared to group RL (p=0.047). CONCLUSION Both solutions led to a mild increase in sodium and chloride levels and decreased lactate levels. The acetate-containing solution had an inferior effect on the decrease in lactate level.
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Affiliation(s)
| | - Ute Klein-Richers
- Centre of Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Katrin Hartmann
- Centre of Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - René Dörfelt
- Centre of Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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Salinero A, Mitzova-Vladinov G. Battle of the Crystalloids in the Operating Room: A Literature Review. J Perianesth Nurs 2021; 36:629-637. [PMID: 34479770 DOI: 10.1016/j.jopan.2021.03.012] [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: 11/16/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this article is to synthesize the evidence regarding the commonalities and differences between the three most common crystalloid solutions used in the operating room (normal saline [NS], lactated Ringer's [LR], and Plasmalyte [PL]) in order to determine best practice. DESIGN This study is an integrative review of literature. METHODS A review of the literature was conducted using the PubMed, CINAHL Plus, and Cochrane Library databases. The inclusion criteria included adult patients undergoing surgery who received either NS, LR, and/or PL (or similar solutions) for fluid maintenance therapy. FINDINGS A total of 15 articles from 2008 to 2020 conducted in a surgical setting were selected for the review; eleven randomized controlled studies, three observational studies, and one cohort-controlled trial. CONCLUSIONS The findings suggest balanced crystalloid solutions are superior to NS in the operating room in terms of maintaining a stable acid-base balance. PL is preferable to LR because it most closely resembles plasma concentration. Future research is needed to determine the cost-effectiveness of the solutions.
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Affiliation(s)
- Alejandra Salinero
- University of Miami School of Nursing and Health Studies, Coral Gables, FL.
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6
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Lactate versus acetate buffered intravenous crystalloid solutions: a scoping review. Br J Anaesth 2020; 125:693-703. [DOI: 10.1016/j.bja.2020.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/29/2020] [Accepted: 07/19/2020] [Indexed: 02/07/2023] Open
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Redant S, Langman Y, De Bels D, Attou R, Honore PM. Mechanism of arrhythmias during the infusion of Ringer's acetate and Ringer's lactate solutions during cardiac surgery: new insights. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:413. [PMID: 31849333 PMCID: PMC6918549 DOI: 10.1186/s13054-019-2696-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/06/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Sébastien Redant
- ICU Department, Centre Hospitalier Universitaire Brugmann, Brugmann University Hospital, Place Van Gehuchtenplein, 4, 1020, Brussels, Belgium
| | - Yael Langman
- ICU Department, Centre Hospitalier Universitaire Brugmann, Brugmann University Hospital, Place Van Gehuchtenplein, 4, 1020, Brussels, Belgium
| | - David De Bels
- ICU Department, Centre Hospitalier Universitaire Brugmann, Brugmann University Hospital, Place Van Gehuchtenplein, 4, 1020, Brussels, Belgium
| | - Rachid Attou
- ICU Department, Centre Hospitalier Universitaire Brugmann, Brugmann University Hospital, Place Van Gehuchtenplein, 4, 1020, Brussels, Belgium
| | - Patrick M Honore
- ICU Department, Centre Hospitalier Universitaire Brugmann, Brugmann University Hospital, Place Van Gehuchtenplein, 4, 1020, Brussels, Belgium.
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Pfortmueller CA, Messmer AS, Hess B, Reineke D, Jakob L, Wenger S, Waskowski J, Zuercher P, Stoehr F, Erdoes G, Luedi MM, Jakob SM, Englberger L, Schefold JC. Hypertonic saline for fluid resuscitation after cardiac surgery (HERACLES): study protocol for a preliminary randomised controlled clinical trial. Trials 2019; 20:357. [PMID: 31200756 PMCID: PMC6570959 DOI: 10.1186/s13063-019-3420-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/09/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Intraoperative and postoperative management of cardiac surgery patients is complex, involving the application of differential vasopressors and volume therapy. It has been shown that a positive fluid balance has a major impact on postoperative outcome. Today, the advantages and disadvantages of buffered crystalloid solutes are a topic of controversy, with no consensus being reached so far. The use of hypertonic saline (HS) has shown promising results with respect to lower total fluid balance and postoperative weight gain in critically ill patients in preliminary studies. However, collection of more data on HS in critically ill patients seems warranted. This preliminary study aims to investigate whether fluid resuscitation using HS in patients following cardiac surgery results in less total fluid volume being administered. METHODS In a prospective double-blind randomised controlled clinical trial, we aim to recruit 96 patients undergoing elective cardiac surgery for ischaemic and/or valvular heart disease. After postoperative admission to the intensive care unit (ICU), patients will be randomly assigned to receive 5 ml/kg ideal body weight HS (7.3% NaCl) or normal saline (NS, 0.9% NaCl) infused within 60 min. Blood and urine samples will be collected preoperatively and postoperatively up to day 6 to assess changes in renal, cardiac, inflammatory, acid-base, and electrolyte parameters. Additionally, we will perform renal ultrasonography studies to assess renal blood flow before, during, and after infusion, and we will measure total body water using preoperative and postoperative body composition analysis (bioimpedance). Patients will be followed up for 90 days. DISCUSSION The key objective of this study is to assess the cumulative amount of fluid administered in the intervention (HS) group versus control (NS) group during the ICU stay. In this preliminary, prospective, randomised controlled clinical trial we will test the hypothesis that use of HS results in less total fluids infused and less postoperative weight gain when compared to the standard of intensive care in cardiac surgery patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT03280745 . Registered on 12 September 2017.
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Affiliation(s)
- Carmen A. Pfortmueller
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Anna S. Messmer
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Benjamin Hess
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - David Reineke
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laura Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Stefanie Wenger
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Jan Waskowski
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Frederik Stoehr
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Gabor Erdoes
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M. Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M. Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Lars Englberger
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
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Pfortmueller CA, Kabon B, Schefold JC, Fleischmann E. Crystalloid fluid choice in the critically ill : Current knowledge and critical appraisal. Wien Klin Wochenschr 2018; 130:273-282. [PMID: 29500723 DOI: 10.1007/s00508-018-1327-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/11/2018] [Indexed: 12/24/2022]
Abstract
Intravenous infusion of crystalloid solutions is one of the most frequently administered medications worldwide. Available crystalloid infusion solutions have a variety of compositions and have a major impact on body systems; however, administration of crystalloid fluids currently follows a "one fluid for all" approach than a patient-centered fluid prescription. Normal saline is associated with hyperchloremic metabolic acidosis, increased rates of acute kidney injury, increased hemodynamic instability and potentially mortality. Regarding balanced infusates, evidence remains less clear since most studies compared normal saline to buffered infusion solutes.; however, buffered solutes are not homogeneous. The term "buffered solutes" only refers to the concept of acid-buffering in infusion fluids but this does not necessarily imply that the solutes have similar physiological impacts. The currently available data indicate that balanced infusates might have some advantages; however, evidence still is inconclusive. Taking the available evidence together, there is no single fluid that is superior for all patients and settings, because all currently available infusates have distinct differences, advantages and disadvantages; therefore, it seems inevitable to abandon the "one fluid for all" strategy towards a more differentiated and patient-centered approach to fluid therapy in the critically ill.
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Affiliation(s)
- Carmen A Pfortmueller
- Clinic for General Anesthesiology, Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria. .,Department of Intensive Care, Inselspital, Bern University Hospital, Bern, Switzerland.
| | - Barbara Kabon
- Clinic for General Anesthesiology, Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
| | - Joerg C Schefold
- Department of Intensive Care, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Edith Fleischmann
- Clinic for General Anesthesiology, Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
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Balakrishnan S, Kannan M, Rajan S, Purushothaman SS, Kesavan R, Kumar L. Evaluation of the Metabolic Profile of Ringer Lactate versus Ringer Acetate in Nondiabetic Patients Undergoing Major Surgeries. Anesth Essays Res 2018; 12:719-723. [PMID: 30283183 PMCID: PMC6157230 DOI: 10.4103/aer.aer_109_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Stress-induced neuroendocrine and metabolic changes lead to intraoperative hyperglycemia which is related to surgery and the type of intravenous fluids used. Aims: The primary objective was to assess the incidence of hyperglycemia with use of lactate versus acetate-based intravenous fluids in nondiabetics undergoing major surgeries. Incidence of lactatemia and metabolic acidosis were also assessed. Settings and Design: Prospective parallel group observational study conducted in a tertiary care institute. Subjects and Methods: A total of 208 nondiabetic patients undergoing major head and neck free flap or abdominal surgeries were included in the study. Group A received Ringer lactate, and Group B received Ringer acetate as intraoperative maintenance fluid. Intraoperative blood sugar, pH, and lactate levels were monitored. Statistical Tests Used: Chi-square test and independent “t” test were used for analysis. Results: Intraoperative hyperglycemia was more frequent in Group A than B (17.3 vs. 18.4%). Group B patients undergoing gastrointestinal (GI) surgeries showed higher blood glucose at 2, 4, 6, and 8 h when compared to flap surgeries. In Group A, significantly higher blood sugar values were noted at 2 and 8 h in those undergoing GI surgeries. Group B patients undergoing GI surgeries had significantly higher lactate levels at 6 and 8 h. Group B patients had significant acidosis when surgeries lasted >6 h. Conclusion: Nondiabetic patients undergoing major abdominal surgeries who received acetate-based fluids had relatively higher intraoperative blood sugar levels as compared to those receiving lactated solutions, but the incidence of hyperglycemia was comparable. When the duration of surgery exceeded 6 h, acetate-based solutions resulted in significantly higher lactate levels with progressive metabolic acidosis.
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Affiliation(s)
- Sindhu Balakrishnan
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Manjulatha Kannan
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sunil Rajan
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Shyam Sundar Purushothaman
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Rajesh Kesavan
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Lakshmi Kumar
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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11
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Hassan MH, Hassan WMNW, Zaini RHM, Shukeri WFWM, Abidin HZ, Eu CS. Balanced Fluid Versus Saline-Based Fluid in Post-operative Severe Traumatic Brain Injury Patients: Acid-Base and Electrolytes Assessment. Malays J Med Sci 2017; 24:83-93. [PMID: 29386975 DOI: 10.21315/mjms2017.24.5.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/22/2017] [Indexed: 01/17/2023] Open
Abstract
Background Normal saline (NS) is a common fluid of choice in neurosurgery and neuro-intensive care unit (ICU), but it does not contain other electrolytes and has the potential to cause hyperchloremic metabolic acidosis with prolonged infusion. These problems may be reduced with the availability of balanced fluid (BF), which becomes a more physiological isotonic solution with the presence of complete electrolyte content. This study aimed to compare the changes in electrolytes and acid-base between NS and BF (Sterofundin® ISO) therapy for post-operative severe traumatic brain injury (TBI) patients in neuro-ICU. Methods Sixty-six severe TBI patients who required emergency craniotomy or craniectomy and were planned for post-operative ventilation were randomised into NS (n = 33) and BF therapy groups (n = 33). The calculation of maintenance fluid given was based on the Holliday-Segar method. The electrolytes and acid-base parameters were assessed at an 8 h interval for 24 h. The data were analysed using repeated measures ANOVA. Results The NS group showed a significant lower base excess (-3.20 versus -1.35, P = 0.049), lower bicarbonate level (22.03 versus 23.48 mmol/L, P = 0.031), and more hyperchloremia (115.12 versus 111.74 mmol/L, P < 0.001) and hypokalemia (3.36 versus 3.70 mmol/L, P < 0.001) than the BF group at 24 h of therapy. The BF group showed a significantly higher level of calcium (1.97 versus 1.79 mmol/L, P = 0.003) and magnesium (0.94 versus 0.80 mmol/L, P < 0.001) than the NS group at 24 h of fluid therapy. No significant differences were found in pH, pCO2, lactate, and sodium level. Conclusion BF therapy showed better effects in maintaining higher electrolyte parameters and reducing the trend toward hyperchloremic metabolic acidosis than the NS therapy during prolonged fluid therapy for postoperative TBI patients.
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Affiliation(s)
- Mohamad Hasyizan Hassan
- Department of Neurosciences, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.,Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Wan Mohd Nazaruddin Wan Hassan
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Rhendra Hardy Mohd Zaini
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Wan Fadzlina Wan Muhd Shukeri
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Huda Zainal Abidin
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Chong Soon Eu
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.,Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200 Bertam, Pulau Pinang, Malaysia
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12
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Pagel JI, Hulde N, Kammerer T, Schwarz M, Chappell D, Burges A, Hofmann-Kiefer K, Rehm M. The impact of phosphate-balanced crystalloid infusion on acid-base homeostasis (PALANCE study): study protocol for a randomized controlled trial. Trials 2017; 18:313. [PMID: 28693594 PMCID: PMC5504754 DOI: 10.1186/s13063-017-2051-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 06/13/2017] [Indexed: 11/16/2022] Open
Abstract
Background This study aims to investigate the effects of a modified, balanced crystalloid including phosphate in a perioperative setting in order to maintain a stable electrolyte and acid-base homeostasis in the patient. Methods/design This is a single-centre, open-label, randomized controlled trial involving two parallel groups of female patients comparing a perioperative infusion regime with sodium glycerophosphate and Jonosteril® (treatment group) or Jonosteril® (comparator) alone. The primary endpoint is to maintain a stable concentration of weak acids [A-] according to the Stewart approach of acid-base balance. Secondary endpoints are measurement of serum phosphate levels, other acid-base parameters such as the strong ion difference (SID), the onset and severity of postoperative nausea and vomiting (PONV), electrolyte levels and their excretion in the urine, monitoring of renal function and glycocalyx components, haemodynamics, amounts of catecholamines and other vasopressors used and the safety of the infusion regime. Discussion Perioperative fluid replacement with the use of currently available crystalloid preparations still fail to maintain a stable acid-base balance and experts agree that common balanced solutions are still not ideal. This study aims to investigate the effectivity and safety of a new crystalloid solution by adding sodium glycerophosphate to a standardized crystalloid preparation in order to maintain a balanced perioperative acid-base homeostasis. Trial registration EudraCT number 201002422520. Registered on 30 November 2010. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2051-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith-Irina Pagel
- Department of Anaesthesiology, Hospital of the University of Munich LMU, Marchioninistr. 15, 81377, Munich, Germany.
| | - Nikolai Hulde
- Department of Anaesthesiology, Hospital of the University of Munich LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - Tobias Kammerer
- Department of Anaesthesiology, Hospital of the University of Munich LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - Michaela Schwarz
- Department of Anaesthesiology, Surgical Clinic of Munich-Bogenhausen, Munich, Germany
| | - Daniel Chappell
- Department of Anaesthesiology, Hospital of the University of Munich LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Burges
- Department of Gynaecology, Hospital of the University of Munich, LMU, Munich, Germany
| | - Klaus Hofmann-Kiefer
- Department of Anaesthesiology, Hospital of the University of Munich LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - Markus Rehm
- Department of Anaesthesiology, Hospital of the University of Munich LMU, Marchioninistr. 15, 81377, Munich, Germany
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13
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Juvany M, Guirao X, Oliva JC, Badía Pérez JM. Role of Combined Post-Operative Venous Lactate and 48 Hours C-Reactive Protein Values on the Etiology and Predictive Capacity of Organ-Space Surgical Site Infection after Elective Colorectal Operation. Surg Infect (Larchmt) 2017; 18:311-318. [DOI: 10.1089/sur.2016.172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Xavier Guirao
- Unit of Endocrine, Head, and Neck Surgery and Unit of Surgical Infections Support, Department of General Surgery, Parc Taulí, Hospital Universitari, Sabadell, Spain
| | - Joan Carles Oliva
- Statistical Unit, Parc Taulí Fundation-University Institute UAB, Corporació Parc Taulí, Sabadell, Spain
| | - Jose M. Badía Pérez
- Department of General Surgery, Hospital General de Granollers, Granollers, Spain
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Mayr T, Bauer A, Reichart B, Guethoff S, Schoenmann U, Längin M, Panelli A, Kind A, Brenner P, Abicht JM. Hemodynamic and perioperative management in two different preclinical pig-to-baboon cardiac xenotransplantation models. Xenotransplantation 2017; 24. [DOI: 10.1111/xen.12295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/29/2016] [Accepted: 01/26/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Tanja Mayr
- Department of Anaesthesiology; Ludwig Maximilian University; Munich Germany
| | - Andreas Bauer
- Department of Anaesthesiology; Ludwig Maximilian University; Munich Germany
| | - Bruno Reichart
- Walter Brendel Centre of Experimental Medicine; Ludwig Maximilian University; Munich Germany
| | - Sonja Guethoff
- Walter Brendel Centre of Experimental Medicine; Ludwig Maximilian University; Munich Germany
| | | | - Matthias Längin
- Department of Anaesthesiology; Ludwig Maximilian University; Munich Germany
| | - Alessandro Panelli
- Walter Brendel Centre of Experimental Medicine; Ludwig Maximilian University; Munich Germany
| | - Alexander Kind
- Chair of Livestock Biotechnology; School of Life Sciences Weihenstephan; Technical University of Munich; Munich Germany
| | - Paolo Brenner
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
| | - Jan-Michael Abicht
- Department of Anaesthesiology; Ludwig Maximilian University; Munich Germany
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Pfortmueller C, Funk GC, Potura E, Reiterer C, Luf F, Kabon B, Druml W, Fleischmann E, Lindner G. Acetate-buffered crystalloid infusate versus infusion of 0.9% saline and hemodynamic stability in patients undergoing renal transplantation : Prospective, randomized, controlled trial. Wien Klin Wochenschr 2017; 129:598-604. [PMID: 28255797 PMCID: PMC5599439 DOI: 10.1007/s00508-017-1180-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/06/2017] [Indexed: 12/31/2022]
Abstract
Background Infusion therapy is one of the most frequently prescribed medications in hospitalized patients. Currently used crystalloid solutes have a variable composition and may therefore influence acid-base status, intracellular and extracellular water content and plasma electrolyte compositions and have a major impact on organ function and outcome. The aim of our study was to investigate whether use of acetate-based balanced crystalloids leads to better hemodynamic stability compared to 0.9% saline. Methods We performed a sub-analysis of a prospective, randomized, controlled trial comparing effects of 0.9% saline or an acetate-buffered, balanced crystalloid during the perioperative period in patients with end-stage renal disease undergoing cadaveric renal transplantation. Need for catecholamine therapy and blood pressure were the primary measures. Results A total of 150 patients were included in the study of which 76 were randomized to 0.9% saline while 74 received an acetate-buffered balanced crystalloid. Noradrenaline for cardiocirculatory support during surgery was significantly more often administered in the normal saline group, given earlier and with a higher cumulative dose compared to patients receiving an acetate-buffered balanced crystalloid (30% versus 15%, p = 0.027; 68 ± 45 µg/kg versus 75 ± 60 µg/kg, p = 0.0055 and 0.000492 µg/kg body weight/min, ±0.002311 versus 0.000107 µg/kg/min, ±0.00039, p = 0.04, respectively). Mean minimum arterial blood pressure was significantly lower in patients randomized to 0.9% saline than in patients receiving the balanced infusion solution (57.2 [SD 8.7] versus 60.3 [SD 10.2] mm Hg, p = 0.024). Conclusion The use of an acetate-buffered, balanced infusion solution results in reduced need for use of catecholamines and cumulative catecholamine dose for hemodynamic support and in less occurrence of arterial hypotension in the perioperative period. Further research in the field is strongly encouraged.
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Affiliation(s)
- Carmen Pfortmueller
- Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital Vienna and Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Eva Potura
- Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Christian Reiterer
- Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Florian Luf
- Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Barbara Kabon
- Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Wilfred Druml
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Edith Fleischmann
- Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Gregor Lindner
- Department of Emergency Medicine, Hirslanden - Klinik Im Park, Zurich, Switzerland
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Sharma A, Yadav M, Kumar BR, Lakshman PS, Iyenger R, Ramchandran G. A comparative study of Sterofundin and Ringer lactate based infusion protocol in scoliosis correction surgery. Anesth Essays Res 2016; 10:532-537. [PMID: 27746547 PMCID: PMC5062242 DOI: 10.4103/0259-1162.181425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: A major change in anesthesia practice as regards to intraoperative infusion therapy is the present requirement. Switching over to balanced fluids can substantially decrease the incidence of lactic acidosis and hyperchloremic acidosis. The deleterious effects of unbalanced fluids are more recognizable during major surgeries. We prospectively studied the influence of Sterofundin (SF) and Ringer lactate (RL) on acid–base changes, hemodynamics, and readiness for extubation during scoliosis surgery. Subjects and Methods: Thirty consecutive children posted for scoliosis surgery were randomized to receive either RL (n = 15) or SF (n = 15) as intraoperative fluid at 10 mg/kg/h. Fluid boluses were added according to the study fluid algorithm. Arterial blood was sampled and analyzed at hourly intervals during surgery. Red blood cell transfusion was guided by hematocrit below 27. Patients were followed for 24 h postoperatively in the Intensive Care Unit. Results: There was no statistically significant difference in the volume of infused fluid (2400 ± 512 ml in Group RL and 2200 ± 640 ml in Group SF. There were no significant changes in pH of patients infused with SF. Statistically, significant higher lactate levels were seen in RL-infused group. The strong ion difference was decreased in both groups, but it normalized earlier with SF. Conclusions: SF-infused patients had nonremarkable changes in acid–base physiology in scoliosis surgery.
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Affiliation(s)
- Ashima Sharma
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Monu Yadav
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - B Rajesh Kumar
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - P Sai Lakshman
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Raju Iyenger
- Department of Orthopedics, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Gopinath Ramchandran
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Soussi S, Ferry A, Chaussard M, Legrand M. Chloride toxicity in critically ill patients: What's the evidence? Anaesth Crit Care Pain Med 2016; 36:125-130. [PMID: 27476827 DOI: 10.1016/j.accpm.2016.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 11/03/2015] [Accepted: 03/21/2016] [Indexed: 01/16/2023]
Abstract
Crystalloids have become the fluid of choice in critically ill patients and in the operating room both for fluid resuscitation and fluid maintenance. Among crystalloids, NaCl 0.9% has been the most widely used fluid. However, emerging evidence suggests that administration of 0.9% saline could be harmful mainly through high chloride content and that the use of fluid with low chloride content may be preferable in major surgery and intensive care patients. Administration of NaCl 0.9% is the leading cause of metabolic hyperchloraemic acidosis in critically ill patients and side effects might target coagulation, renal function, and ultimately increase mortality. More balanced solutions therefore may be used especially when large amount of fluids are administered in high-risk patients. In this review, we discuss physiological background favouring the use of balanced solutions as well as the most recent clinical data regarding the use of crystalloid solutions in critically ill patients and patients undergoing major surgery.
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Affiliation(s)
- Sabri Soussi
- Department of Anaesthesiology and Critical Care, Smur, Burn Unit, AP-HP, groupe hospitalier Saint-Louis-Lariboisière, 75010 Paris, France.
| | - Axelle Ferry
- Department of Anaesthesiology and Critical Care, Smur, Burn Unit, AP-HP, groupe hospitalier Saint-Louis-Lariboisière, 75010 Paris, France.
| | - Maité Chaussard
- Department of Anaesthesiology and Critical Care, Smur, Burn Unit, AP-HP, groupe hospitalier Saint-Louis-Lariboisière, 75010 Paris, France.
| | - Matthieu Legrand
- Department of Anaesthesiology and Critical Care, Smur, Burn Unit, AP-HP, groupe hospitalier Saint-Louis-Lariboisière, 75010 Paris, France; Institut national de la santé et de la recherche médicale (Inserm), UMR Inserm 942, Lariboisière hospital, 75010 Paris, France; Université Paris Diderot, 75475 Paris, France.
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18
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Pfortmueller CA, Fleischmann E. Acetate-buffered crystalloid fluids: Current knowledge, a systematic review. J Crit Care 2016; 35:96-104. [PMID: 27481742 DOI: 10.1016/j.jcrc.2016.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/24/2016] [Accepted: 05/04/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The concept of fluid resuscitation with balanced solutions containing acetate is relatively new. The knowledge about acetate mostly originates from nephrological research, as acetate was primarily used as a dialysis buffer where much higher doses of acetate are infused. The aim of this review is to give an overview of the advantages and disadvantages of an acetate-buffered crystalloid fluid when compared with other crystalloid infusates. METHODS We report trials with the primary object of comparing an acetate-buffered infusion solute to another crystalloid infusate. A systematic literature search of MEDLINE and the Cochrane Controlled Clinical trials register was conducted to identify suitable studies. RESULTS The search strategy used produced 1205 potential titles. After eliminating doubles, 312 titles and abstracts were screened, and 31 references were retrieved for full-text analysis. A total of 27 scientific studies were included in the study. CONCLUSION Acetate-buffered crystalloid solutes do have a favorable influence on microcirculation. To what extent the acetate-buffered crystalloids influence kidney function is controversially discussed and not yet clear. Metabolic alkalosis did not occur in a single study in humans after an acetate-buffered infusate; potassium levels stayed stable in all studies. Cardiac output and contractility seem to be positively influenced; nonetheless, data on maintenance of a target blood pressure remain inconclusive. Whether acetate-buffered crystalloid fluids lead to lower rates of acute kidney injury and increased survival when compared with normal saline is yet unclear and may depend on the amount of fluid administered.
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Affiliation(s)
- Carmen A Pfortmueller
- Clinic for General Anesthesiology, Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria.
| | - Edith Fleischmann
- Clinic for General Anesthesiology, Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria.
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Reanimación con fluidos: perspectiva actual. Med Clin (Barc) 2016; 146:128-32. [DOI: 10.1016/j.medcli.2015.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 10/19/2015] [Accepted: 10/21/2015] [Indexed: 12/30/2022]
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Abstract
PURPOSE OF REVIEW We discuss the importance of the composition of intravenous crystalloid solutions. On the basis of current physiologic principles, evidence from basic science and clinical experiments, recent observational studies, and clinical trials, we conclude that the 'ideal crystalloid' depends on clinical context. We make recommendations on solutions that may be used during critical illness, major surgery, and certain clinical situations. RECENT FINDINGS The routine use of solutions with a supraphysiologic chloride content and a low strong ion difference (SID), such as isotonic saline solution, may be associated with adverse outcomes, especially among critically ill patients. On the contrary, solutions with a physiologic chloride content and a 'balanced' electrolyte composition (SID closer to plasma) may improve the likelihood of survival. The distribution of different types of crystalloids across traditional 'body compartments' is a function of osmolality of the fluid infused relative to plasma, integrity of the glycocalyx, and the hemodynamic/'volume' state of the patient. During critical illness, the routine administration of colloids may offer no clinical benefits compared with the use of crystalloids. SUMMARY Crystalloids, like other types of intravenous fluids, are drugs with important effects on clinical outcomes that may be mediated by osmolality, chloride content, and SID.
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Garnacho-Montero J. [Crystalloids in critical patient resuscitation]. Med Intensiva 2015; 39:390. [PMID: 26031370 DOI: 10.1016/j.medin.2015.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 04/14/2015] [Indexed: 11/18/2022]
Affiliation(s)
- J Garnacho-Montero
- Unidad Clínica de Cuidados Críticos, Hospital Universitario Virgen del Rocío, Sevilla, España.
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González-Castro A. [Crystalloids and colloids in the resuscitation of critical patients: two considerations]. Med Intensiva 2015; 39:389-90. [PMID: 25937266 DOI: 10.1016/j.medin.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Affiliation(s)
- A González-Castro
- Departamento de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
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23
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Blanchard A, Lorthioir A, Zhygalina V, Curis E. Approche de Stewart : ou comment faire du neuf avec du vieux ? MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0889-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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