Progress in fluid resuscitation of septic shock / 中华实用儿科临床杂志

Septic shock remains a major cause of morbidity and mortality in intensive care unit(ICU). Abun-dant fluid resuscitation is one of the most common therapies for septic shock patients;but some fundamental questions about its efficacy and safety remain. In this paper,recent insight derived from clinical trials in terms of fluid type,dose, rate and toxicity are discussed.

Effects of different concentrations of hydroxyethyl starch 130/0.4 applied for different time periods on injury to human renal tubular epithelial cells / 中华麻醉学杂志

Objective To evaluate the effects of different concentrations of hydroxyethyl starch (HES) 130/0.4 applied for different time periods on injury to human renal tubular epithelial cells.Methods Human renal kidney epithelial cells HK-2 at the logarithmic growth phase were seeded in 96-well plates at a density of 1 × 105 cells/ml (0.1 ml/well),in culture flasks (5 ml/flask) or in cluture dishes (5 ml/dish).HK-2 cells were randomly divided into 4 groups (n=49 each) using a random number table:control group (group C) and 0.3％,1.5％ and 3.0％ HES 130/0.4 groups (H1,H2 and H3 groups).In H1,H2 and H3 groups,HK-2 cells were incubated with 0.3％,1.5％ and 3.0％ HES 130/0.4,respectively.The equal volume of PBS was added to the culture medium in group C.At day 1,3,5 and 7 of incubation,the cell viability was measured.At day 3,5 and 7 of incubation,cell apoptosis was detected,and apoptosis rate was calculated.On day 7 of incubation,the cells were stained with toluidine blue for examination of intracellular HES deposition (under light microscope) and pathological changes (with transmission electron microscope).Results Compared with group C,the cell viability was significantly decreased on day 5 and 7 of incubation,and apoptosis rate was increased on day 3,5 and 7 of incubation in group H3,and no significant difference was detected in the parameters mentioned above in H1 and H2 groups.Microscopic examination showed that intracellular HES deposition was observed in H2 and H3 groups,and pathological changes were obvious,and apoptotic cells were also found in H3 group.Conclusion Application of high-concentration HES 130/0.4 for a long period can lead to injury to human renal tubular epithelial cells,however,application of high-or low-concentration HES 130/0.4 for a short period produces no influence on the cells.

Acidosis hiperclorémica: mito y realidad / Hyperchloremic acidosis

La acidosis metabólica es una alteración ácido-base frecuentemente observada en pacientes críticos. Aunque en situaciones extremas este desorden en sí mismo es amenazante para la vida, la presencia de una acidosis metabólica leve no siempre es nociva y puede ser un reflejo de la adaptación fisiológica del organismo a la injuria aguda. Diferentes autores han documentado el desarrollo de acidosis metabólica hiperclorémica asociada al aporte de grandes cantidades de solución salina 0,9 por ciento. Algunos consideran que se trata de una condición benigna y autolimitada, mientras otros sostienen que la acidosis hiperclorémica puede deteriorar la perfusión renal y esplácnica, sin embargo su relevancia clínica real es aún incierta. En un afán de evitar la aparición de acidosis hiperclorémica y sus potenciales efectos adversos, se han desarrollado cristaloides y coloides en formulaciones modificadas para que se asemejen más a la composición del plasma. En este artículo de revisión analizaremo slos mecanismos de producción de la acidosis metabólica hiperclorémica en base al abordaje físico-químico de Stewart; la evidencia existente sobre el impacto de este trastorno sobre las variables de desenlace de los pacientes críticos, y el rol clínico de las nuevas “soluciones balanceadas”.

Metabolic acidosis is an acid-base alteration frequently observed in critically ill patients. Even in extreme situations this disorder in itself is life threatening, the presence of a mild metabolic acidosis is not always harmful and may be the result of physiological adaptation of the organism to acute injury. Several authors have documented the development of hyperchloremic metabolic acidosis associated with the infusion of large amounts of 0.9 percent normal saline. Some consider this to be a benign and transient, while others argue that hyperchloremic acidosis can impair renal and splanchnic perfusion, but her real clinical relevance remains uncertain. In an effort to prevent the development of hyperchloremic acidosis and its potential adverse effects have been development formulations of crystalloid and colloid modified to more closely resemble the composition of the plasma. In this review article will discuss the mechanism of production of hyperchloremic metabolic acidosis by the physicochemical approach Stewart, the existing evidence on the impact of this disorder on the outcome variables in critically ill patients, and clinical role of new “balanced solutions”.