Intravenous fluid management in critically ill patients: for everybody or for a dedicated team?

2016 ◽  
Vol 60 (6) ◽  
pp. 831-831 ◽  
Author(s):  
J. Wernerman ◽  
G. H. Sigurdsson
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Fluid Management ◽  
Intravenous Fluid ◽  
Dedicated Team

Clinical Significance of Bioimpedance Spectroscopy in Critically Ill Patients

2017 ◽  
Vol 34 (6) ◽  
pp. 495-502 ◽  
Author(s):  
Shang-Feng Yang ◽  
Ching-Min Tseng ◽  
I-Fan Liu ◽  
Shin-Hung Tsai ◽  
Wein-Shung Kuo ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fluid Management ◽  
Laboratory Data ◽  
Acute Stage ◽  
Volume Control ◽  
Hospital Death ◽  
Icu Admission ◽  
The Third

Background: Early fluid resuscitation is a key aspect in the successful management of critically ill patients, but the optimal goal for volume control after the acute stage of critical illness remains unclear. This study aimed to evaluate the prognostic value of bioimpedance spectrometry for fluid management in critically ill patients. Methods: In this prospective observational study, patients who consented to participate were screened within the first 24 hours of admission to a medical intensive care unit (ICU) from February 4, 2015, to January 31, 2016. Information on demographics, comorbidities, primary reasons for admission, baseline laboratory data, and ventilator or inotropic use were documented. Data of fluid intake, fluid output, and body weight were recorded for the first 3 days of ICU admission. Bioimpedance spectrometry was performed on the first and third days after ICU admission. All participants were followed until death or hospital discharge. Results: Of the 140 enrolled patients (median age: 70 years, interquartile range: 60-77 years), 23 (16.4%) patients died during hospitalization. Independent predictors of hospital mortality were Acute Physiology and Chronic Health Evaluation II scores (per 1 point increase, odds ratio [OR]: 1.101) and overhydration (OH) volume on the first day (per 1 L increase, OR: 1.216). Compared to normal OH status (OH volume between −1 and 1 L), hyper OH status (OH volume < −1 L) on the third day after ICU admission was an independent predictor of hospital death (OR: 7.609). Normal OH status on the third day was associated with greater numbers of ICU-free and ventilator-free days. Conclusion: Bioimpedance spectrometry can be used to predict outcomes in critically ill patients. Increased OH volume on day 1 and hyper OH volume on day 3 of ICU admission are associated with a greater risk of hospital mortality. Volume status on day 3 is associated with durations of ventilator use and ICU stay.

scholarly journals How to prescribe and troubleshoot continuous renal replacement therapy: A case-based review

Kidney360 ◽  
2020 ◽  
pp. 10.34067/KID.0004912020
Author(s):  
Javier A. Neyra ◽  
Lenar Yessayan ◽  
Melissa L. Thompson Bastin ◽  
Keith Wille ◽  
Ashita J Tolwani
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Status ◽  
Fluid Management ◽  
Volume Control ◽  
Regional Citrate Anticoagulation ◽  
Case Based

Continuous renal replacement therapy (CRRT) is the preferred dialysis modality for solute management, acid-base stability, and volume control in critically ill patients with acute kidney injury (AKI) in the intensive care unit (ICU). CRRT offers multiple advantages over conventional hemodialysis in the critically ill population such as greater hemodynamic stability, better fluid management, greater solute control, lower bleeding risk and a more continuous (physiologic) approach of kidney support. Despite its frequent use, several aspects of CRRT delivery are still not fully standardized or do not have solid evidence-based foundations. In this manuscript, we provide a case-based review and recommendations of common scenarios and interventions encountered during the provision of CRRT to critically ill patients. Specific focus is made on initial prescription, CRRT dosing, and adjustments related to severe hyponatremia management, concomitant extracorporeal membrane oxygenation support, dialysis catheter placement, use of regional citrate anticoagulation and antibiotic dosing. This case-driven simulation is made as the clinical status of the patient evolves and is based on step-wise decisions made during the care of this patient according to specific patient's needs and the logistics available at the corresponding institution.

scholarly journals Fluid Resuscitation in Critically Ill Patients—Timing and Dose Matters

2017 ◽  
Vol 45 (4) ◽  
pp. 518-523
Author(s):  
K. Lall ◽  
G. Roberts ◽  
U. Buehner
Keyword(s):  
Critically Ill ◽  
Fluid Resuscitation ◽  
Critically Ill Patients ◽  
Public Hospital ◽  
Best Practice ◽  
Fluid Management ◽  
Fluid Administration ◽  
Best Practice Guidelines ◽  
Resuscitation Strategy ◽  
Complex Subject

Fluid management is a complex subject in healthcare, particularly when pertaining to critically ill patients. Following a literature search on international recommendations regarding fluid administration for shocked patients, an audit was undertaken at Rotorua Public Hospital, New Zealand, to assess how the local fluid resuscitation strategy could be improved. The first part of the audit looked at the fluid resuscitation approach used to treat shocked patients admitted to the ICU of Rotorua Hospital in 2014 and changes required to achieve best practice recommendations. The second part tested the success and impact of the subsequently implemented, more measured approach to fluid resuscitation in 2016. Data was extracted from patient files, fluid charts and electronic records to assess fluid administration and de-escalation measures. The collated information was analysed and compared to recommendations found in the literature. The complete audit cycle revealed not only a significant improvement in adherence to best practice guidelines, but also an association with better patient outcomes.

The dose - response association between fluid overload and hospital mortality in critically ill patients: a multicenter, prospective, observational cohort study

2020 ◽  
Author(s):  
Meiping Wang ◽  
Bo Zhu ◽  
Li Jiang ◽  
Ying Wen ◽  
Bin Du ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Dose Response ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Fluid Overload ◽  
Fluid Management ◽  
Management Strategies ◽  
Icu Admission ◽  
Increased Risk

Abstract Background Fluid management is important for ensuring hemodynamic stability in critically ill patients but easily leads to fluid overload. However, the optimal fluid balance plot or range for critically ill patients is unknown. This study aimed to explore the dose-response relationship between fluid overload (FO) and hospital mortality in critically ill patients.Methods Data were derived from the China Critical Care Sepsis Trial (CCCST). Patients with sequential fluid data for the first 3 days of admission to the ICU were included. FO was expressed as the ratio of the cumulative fluid balance (L) and initial body weight (kg) at ICU admission as a percentage. Maximum fluid overload (MFO) was defined as the peak FO value during the first 3 days of ICU admission. We used logistic regression models with restricted cubic splines to assess the relationship between MFO and the risk of hospital mortality.ResultsIn total, 3850 patients were included, 929 (24.1%) of whom died in hospital. For each 1% L/kg increase in the FO, the risk of hospital mortality increased by 4% (HR 1.04, 95% CI 1.03 - 1.05, P < 0.001). FO greater than 10% was associated with a 44% increased HR of hospital mortality compared with FO less than 5% (HR 1.44, 95% CI 1.27 - 1.67). Notably, we also found a non-linear dose-response association between MFO and hospital mortality.Conclusions Both higher and lower fluid balance were associated with an increased risk of hospital mortality. Further studies should explore this relationship and seek for the optimal fluid management strategies for critically ill patients.

scholarly journals Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance

2012 ◽  
Vol 2 (Suppl 1) ◽  
pp. S1 ◽  
Author(s):  
Colin Cordemans ◽  
Inneke De laet ◽  
Niels Van Regenmortel ◽  
Karen Schoonheydt ◽  
Hilde Dits ◽  
...  
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Extravascular Lung Water ◽  
Fluid Management ◽  
Capillary Leak ◽  
Lung Water ◽  
Abdominal Hypertension
Sign in / Sign up

Export Citation Format

Share Document