scholarly journals An Evaluation of the Use of Aggressive Fluid Resuscitation in the Early Treatment of Sepsis Patients

Cureus ◽  
2021 ◽  
Author(s):  
William N Payne ◽  
Alfred Tager ◽  
Mike Broce ◽  
Dany Tager ◽  
Marion Hoy ◽  
...  
Keyword(s):  
Fluid Resuscitation ◽  
Early Treatment ◽  
Aggressive Fluid Resuscitation

scholarly journals Peroxynitrite decomposition catalyst reduces vasopressin requirement in ovine MRSA sepsis

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Osamu Fujiwara ◽  
Satoshi Fukuda ◽  
Ernesto Lopez ◽  
Yaping Zeng ◽  
Yosuke Niimi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Fluid Resuscitation ◽  
Conscious State ◽  
Smoke Inhalation ◽  
Post Injury ◽  
Adjunct Treatment ◽  
Aggressive Fluid Resuscitation ◽  
Severe Hypotension ◽  
Bolus Intravenous Injection

Abstract Background Sepsis is one of the most frequent causes of death in the intensive care unit. Host vascular hypo-responsiveness to vasopressors during septic shock is one of the challenging problems. This study tested the hypothesis that adjunct therapy with peroxynitrite decomposition catalyst (WW-85) would reduce arginine vasopressin (AVP) requirements during sepsis resuscitation, using ovine sepsis model. Methods Thirteen adult female Merino sheep, previously instrumented with multiple vascular catheters, were subjected to “two-hit” (cotton smoke inhalation and intrapulmonary instillation of live methicillin-resistant Staphylococcus aureus; 3.5 × 1011 colony-forming units) injury. Post injury, animals were awakened and randomly allocated to the following groups: (1) AVP: injured, fluid resuscitated, and titrated with AVP, n = 6 or (2) WW-85 + AVP: injured, fluid resuscitated, treated with WW-85, and titrated with AVP, n = 7. One-hour post injury, a bolus intravenous injection of WW-85 (0.1 mg/kg) was followed by a 23-h continuous infusion (0.02 mg/kg/h). Titration of AVP started at a dose of 0.01 unit/min, when mean arterial pressure (MAP) decreased by 10 mmHg from baseline, despite aggressive fluid resuscitation, and the rate was further adjusted to maintain MAP. After the injury, all animals were placed on a mechanical ventilator and monitored in the conscious state for 24 h. Results The injury induced severe hypotension refractory to aggressive fluid resuscitation. High doses of AVP were required to partially attenuate the sepsis-induced hypotension. However, the cumulative AVP requirement was significantly reduced by adjunct treatment with WW-85 at 17–24 h after the injury (p < 0.05). Total AVP dose and the highest AVP rate were significantly lower in the WW-85 + AVP group compared to the AVP group (p = 0.02 and 0.04, respectively). Treatment with WW-85 had no adverse effects. In addition, the in vitro effects of AVP on isolated artery diameter changes were abolished with peroxynitrite co-incubation. Conclusions The modulation of reactive nitrogen species, such as peroxynitrite, may be considered as a novel adjunct treatment option for septic shock associated with vascular hypo-responsiveness to vasopressors.

scholarly journals 2816 Mortality of Different Etiologies of Acute Pancreatitis and Effect of Aggressive vs. Non-Aggressive Fluid Resuscitation

2019 ◽  
Vol 114 (1) ◽  
pp. S1553-S1554
Author(s):  
Varun Kesar ◽  
Adil Mir ◽  
Rajan Kanth ◽  
Mohamad Mouchli ◽  
Mohammad Shakhatreh ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Fluid Resuscitation ◽  
Aggressive Fluid Resuscitation

Aggressive Fluid Resuscitation in Acute Pancreatitis: In Aqua Sanitas?

2017 ◽  
Vol 112 (10) ◽  
pp. 1617-1618 ◽  
Author(s):  
Enrique de-Madaria ◽  
Juan F Martínez ◽  
José R Aparicio ◽  
Félix Lluís
Keyword(s):  
Acute Pancreatitis ◽  
Fluid Resuscitation ◽  
Aggressive Fluid Resuscitation

scholarly journals Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Dejan V. Radenkovic ◽  
Colin D. Johnson ◽  
Natasa Milic ◽  
Pavle Gregoric ◽  
Nenad Ivancevic ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Conservative Treatment ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Severe Acute Pancreatitis ◽  
Fluid Resuscitation ◽  
Interventional Treatment ◽  
Invasive Approach ◽  
Aggressive Fluid Resuscitation ◽  
Abdominal Compartment

Abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment.

Sa1371 Early Aggressive Fluid Resuscitation for Acute Pancreatitis - Is It Time for Large Multicenter Randomized Trial?

2013 ◽  
Vol 144 (5) ◽  
pp. S-277 ◽  
Author(s):  
Abhishek Choudhary ◽  
Alisha M. Hinds ◽  
Rindi M. Uhlich ◽  
Imran Ashraf ◽  
Sameer Siddique ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Randomized Trial ◽  
Fluid Resuscitation ◽  
Multicenter Randomized Trial ◽  
Aggressive Fluid Resuscitation

scholarly journals Assessment and Management of Hypoperfusion in Sepsis and Septic Shock

2021 ◽  
Author(s):  
Zohair Al Aseri
Keyword(s):  
Blood Pressure ◽  
Septic Shock ◽  
Fluid Resuscitation ◽  
Early Treatment ◽  
Daily Practice ◽  
Normal Blood ◽  
Organ Perfusion ◽  
Emergency Physicians ◽  
Normal Blood Pressure ◽  
Sepsis And Septic Shock

Diagnosis of organ hypoperfusion in patient with sepsis is not always straightforward which makes septic shock definition, diagnosis, and early treatment are major challenges that emergency physicians and intensivist must deal with in their daily practice. Normal blood pressure does not always mean good organ perfusion, which means patient might develop septic shock, yet they are not hypotensive. There are several indices that could be used in combination to diagnose and manage hypoperfusion in patients with septic shock. Fluid resuscitation and vasopressor administration along with infection sources control are the cornerstones in septic shock management. This chapter will cover indices that can be used to diagnose hypoperfusion, type and amount of fluid and vasopressor that can be used in resuscitating septic shock patients.

scholarly journals Management of Dengue in Children: An Update

2020 ◽  
Vol 35 (2) ◽  
pp. 162-178
Author(s):  
Mirza Md Ziaul Islam
Keyword(s):  
Fluid Resuscitation ◽  
Dengue Infection ◽  
Clinical Manifestations ◽  
Therapeutic Index ◽  
Severe Dengue ◽  
Management Problem ◽  
Aggressive Fluid Resuscitation ◽  
Critical Phase ◽  
Plasma Leakage ◽  
Severity Of The Disease

Dengue viruses cause symptomatic infections or asymptomatic seroconversion. Symptomatic dengue infection is a systemic and dynamic disease. It has a wide clinical spectrum that includes both severe and non-severe clinical manifestations. Due to its dynamic nature, the severity of the disease will usually only be apparent around defervescence which often coincides with the onset of the critical phase. For a disease that is complex in its manifestations, management is relatively simple, inexpensive and very effective in saving lives, so long as correct and timely interventions are instituted. The main hemodynamic elements of dengue shock is hypovolemia with decreased vascular capacitance resulting from plasma leakage. Thus, the strategy of aggressive fluid resuscitation of septic shock is not applicable to severe dengue with plasma leakage. Volume replacement in children with dengue shock is a challenging management problem. Aggressive fluid resuscitation may indeed be harmful and should be limited to dengue shock with hypotension. There is a “narrow therapeutic index”; therefore, fluids have to be given timely, at the appropriate volume, rate, of the appropriate type (crystalloids, colloid and/or blood) and for the appropriate duration. Therein lies the challenge to physicians who are not familiar with the important practice of fluid titration through frequent and meticulous assessment. Progression of the disease through the critical phase should be tracked in hours of plasma leakage. Recognizing the cues to discontinue intravenous fluid therapy is just as important as knowing when to start it. Given time and hemodynamic stability, other issues such as thrombocytopenia, coagulopathy and raised liver enzymes will recover spontaneously or with supportive care. DS (Child) H J 2019; 35(2) : 162-178

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