A survey of fluid therapy in 2 intensive care units / 中华内科杂志

To explore the present status of fluid therapy and clinical outcome in critically ill patients in intensive care units (ICU).ICU patients consecutively admitted to our ICU were prospectively enrolled.Patients' demographics,laboratory data,fluid record and clinical outcome were collected.Fluid intake quantity of all patients was at peak on the fifth day which was 2 806 (1 997,3 582)ml.From the fourth day in ICU,fluid balance started to benegative as-84 (-1 127,612)ml and gradually increased.Crystalloid solution was the main components.For treatment purposes,medication injections and nutrients were major fluids.Positive correlations were found between total fluid intake quantity,total crystalloid volume,total colloidal volume and hospital stay,ICU stay,duration of intubation (r values as 0.211,0.686,0.282,0.155,0.506,0.174,0.209,0.072,0.292,respectively P＜0.05).Moreover,positive correlations were also demonstrated between total colloidal volume and total bilirubin,direct bilirubin,alanine transaminase,aspartate transaminase,blood urea nitrogen,serum creatinine (r values as 0.196,0.242,0.190,0.335,0.284,0.223,respectively P＜0.05).

Fluid resuscitation for critically ill patients / 解放军医学杂志

Fluid overload is frequently found in patients with intravenous fluid resuscitation,and recent studies showed the potential risks of fluid overload for organ failure and mortality.To avoid volume overload and its associated complications,strategies to identify fluid responsiveness are necessary.Apart from the amount of fluid utilized for resuscitation,the type of fluid used also impacts patient outcome.In recent years,there has also been an increasing focus on comparing various resuscitation fluids with respect to both benefits and risks.In this article,through analyzing the impact of fluid overload on patient outcome,we describe the differences in static and dynamic estimates of fluid responsiveness,and review the current literature regarding choice of intravenous fluids for resuscitation in critically ill patients to help clinicians to make appropriative decision on intravenous fluids prescription and to optimize patient outcome.

Impact of Plasma-Lyte pH 7.4 on acid-base status and hemodynamics in a model of controlled hemorrhagic shock

OBJECTIVE: Intravenous infusion of crystalloid solutions is a cornerstone of the treatment of hemorrhagic shock. However, crystalloid solutions can have variable metabolic acid-base effects, perpetuating or even aggravating shock-induced metabolic acidosis. The aim of this study was to compare, in a controlled volume-driven porcine model of hemorrhagic shock, the effects of three different crystalloid solutions on the hemodynamics and acid-base balance. METHODS: Controlled hemorrhagic shock (40 percent of the total blood volume was removed) was induced in 18 animals, which were then treated with normal saline (0.9 percent NaCl), Lactated Ringer's Solution or Plasma-Lyte pH 7.4, in a blinded fashion (n = 6 for each group). Using a predefined protocol, the animals received three times the volume of blood removed. RESULTS: The three different crystalloid infusions were equally capable of reversing the hemorrhage-induced low cardiac output and anuria. The Lactated Ringer's Solution and Plasma-Lyte pH 7.4 infusions resulted in an increased standard base excess and a decreased serum chloride level, whereas treatment with normal saline resulted in a decreased standard base excess and an increased serum chloride level. The Plasma-Lyte pH 7.4 infusions did not change the level of the unmeasured anions. CONCLUSION: Although the three tested crystalloid solutions were equally able to attenuate the hemodynamic and tissue perfusion disturbances, only the normal saline induced hyperchloremia and metabolic acidosis.

Fluid therapy: classification and characteristics of intravenous fluids

Fluid and electrolyte therapies including nutritional support are markedly developing in medicine and many kinds of commercial fluids are being introduced to clinical practice. Understanding the characteristics and usefulness of intravenous fluids is necessary to manage patients properly. Disputes about the usefulness of crystalloid or colloid solutions for specific clinical conditions still continue. To make ideal fluid therapy possible, many kinds of fluids will be developed and applied to clinical practice in the near future by mimicking the composition and functions of human body fluids. The selection of crystalloid and colloid solutions for fluid therapy should be performed by considering patients' clinical and pathophysiological conditions and the characteristics and usefulness of each intravenous fluid.

The effect of intraoperative colloid solutions coadministered with 6% hydroxyethyl starch (130/0.4) on platelet function in patients undergoing total intravenous anesthesia / 대한마취과학회지

BACKGROUND: Colloid solutions are used to treat hypovolemia and expanding plasma, but they may inhibit platelet function and reduce the level of coagulation factors during surgery. This study was conducted to compare the effects of hydroxyethyl starch (HES) on adenosine diphosphate (ADP)- and collagen-induced platelet aggregation in patients undergoing total intravenous anesthesia. METHODS: Patients undergoing endoscopic sinus surgery under total intravenous anesthesia with propofol and remifentanil were divided into a group that underwent fluid management with only crystalloid solution (n = 15) and a group that was managed with crystalloid solution that included 6% HES (130/0.4) (n = 15). ADP- and collagen-induced platelet aggregation were measured 5 minutes before induction, after the first intraoperative hour, and one hour postoperatively. RESULTS: Significantly diminished ADP- and collagen-induced aggregation values were observed intraoperatively when compared with the preoperative value in the patients that were managed with colloid solution that included HES. In addition, significantly diminished collagen-induced aggregation values were observed intraoperatively when compared with the preoperative value in the group that was managed with the solution that only contained the crystalloid. However, ADP- and collagen-induced platelet aggregation were recovered postoperatively in both groups. CONCLUSIONS: The results of this study indicated that fluid therapy with colloid solution that contained 6% HES (130/0.4) may diminish ADP-induced platelet aggregation intraoperatively in patients subjected to total intravenous anesthesia.

Comparison of an Ephedrine Injection with Crystalloid Infusion for Prevention of Hypotension During Spinal Anesthesia in Geriatric Patients / 대한마취과학회지

This study was designed to compare the efficacy of an ephedrine intramuscular injection with crystalloidadministration for the prevention of hypotension during spinal anesthesia in geriatric patients undergoing hip fracture surgery. Twenty-seven ASA II patients scheduled for the .arthroplasty of femoral neck fracture under spinal anesthesia were randomly allocated to receive either 15 ml/kg of Ringer's lactated solution (crystalloid group) or an ephedrine intramuscular injection (ephedrine group). Spinal anesthesia was performed in a lateral decubitus position. According to the patient's height, 10-12 mg of hyperbaric 0,5% tetracaine was injected through a 23-25 gauge spinal needle at the L3-4 or L4-5 interspace. Patients in crystalloid group received Ringer's lactated solution 15 mVkg, over 20 minutes before spinal anesthesia. Patients in the ephedrine group were injectede 30 mg of ephedrine I.M immediately after spinal anesthesia. The incidence of hypotension was 8/12 (66%) in the crystalloid group and 6/15 (40%) in the ephedrine group (p<0.01). There was no significant difference between the groups in the level of anesthesia or heart rate, and hypertension did not occur in either group. The result of this study suggests that the intramuscular injection of ephedrine may be more effective than crystalloid infusion for the prophylaxis of hypotension associated with spinal anesthesia in geriatric patients.

Comparison of an Ephedrine Injection with Crystalloid Infusion for Prevention of Hypotension During Spinal Anesthesia in Geriatric Patients / 대한마취과학회지

This study was designed to compare the efficacy of an ephedrine intramuscular injection with crystalloidadministration for the prevention of hypotension during spinal anesthesia in geriatric patients undergoing hip fracture surgery. Twenty-seven ASA II patients scheduled for the .arthroplasty of femoral neck fracture under spinal anesthesia were randomly allocated to receive either 15 ml/kg of Ringer's lactated solution (crystalloid group) or an ephedrine intramuscular injection (ephedrine group). Spinal anesthesia was performed in a lateral decubitus position. According to the patient's height, 10-12 mg of hyperbaric 0,5% tetracaine was injected through a 23-25 gauge spinal needle at the L3-4 or L4-5 interspace. Patients in crystalloid group received Ringer's lactated solution 15 mVkg, over 20 minutes before spinal anesthesia. Patients in the ephedrine group were injectede 30 mg of ephedrine I.M immediately after spinal anesthesia. The incidence of hypotension was 8/12 (66%) in the crystalloid group and 6/15 (40%) in the ephedrine group (p<0.01). There was no significant difference between the groups in the level of anesthesia or heart rate, and hypertension did not occur in either group. The result of this study suggests that the intramuscular injection of ephedrine may be more effective than crystalloid infusion for the prophylaxis of hypotension associated with spinal anesthesia in geriatric patients.