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OXIMETRIA PVI
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ULTIMOS TRABAJOS QUE HE LEIDO Y BREVE RESUMEN
28-12-2012
Conclusion:Significantly less volume was required to achieve HDS for HES vs. NaCl in the initial phase of fluid
resuscitation in severe sepsis patients without any difference for adverse events in both groups.
Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: The CRYSTMAS study Bertrand Guidet, et al, Guidetet al. Critical Care2012,16:R94 http://ccforum.com/content/16/3/R94
resuscitation in severe sepsis patients without any difference for adverse events in both groups.
Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: The CRYSTMAS study Bertrand Guidet, et al, Guidetet al. Critical Care2012,16:R94 http://ccforum.com/content/16/3/R94
In patients in the ICU, there was no significant difference in 90-day mortality be-tween patients resuscitated with 6% HES (130/0.4) or saline. However, more patients
who received resuscitation with HES were treated with renal-replacement therapy.
who received resuscitation with HES were treated with renal-replacement therapy.
Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care, John A. Myburgh, et al, N Engl J Med 2012. DOI: 10.1056/NEJMoa120975
CONCLUSIONS
Patients with severe sepsis assigned to fluid resuscitation with HES 130/0.42 had an increased risk of death at day 90 and were more likely to require renal-replacement therapy, as compared with those receiving Ringer’s acetate.
Patients with severe sepsis assigned to fluid resuscitation with HES 130/0.42 had an increased risk of death at day 90 and were more likely to require renal-replacement therapy, as compared with those receiving Ringer’s acetate.
Hydroxyethyl Starch 130/0.42 versus Ringer’s Acetate in Severe Sepsis Anders Perner, et al, N Engl J Med 2012;367:124-34. DOI: 10.1056/NEJMoa1204242
Conclusiones. En trauma penetrante, el HES proporcionó un aclaramiento de lactato significativamente mejor, y menor lesión renal que con solución salina. En cuanto al trauma cerrado, aún no se han establecido conclusiones firmes.
La resucitación con hidroxietilalmidón optimiza la función renal y el aclaramiento de lactato en trauma penetrante en un estudio controlado aleatorio: el estudio FIRST (Fluids in Resuscitation of Severe Trauma)
M. F. M. James, et al, British Journal of AnaesthesiaPage 1 of 10
doi:10.1093/bja/aer229
M. F. M. James, et al, British Journal of AnaesthesiaPage 1 of 10
doi:10.1093/bja/aer229
22-6-2012
Conclusions: Blood coagulation in parturients may be compromised at high dilution ratios of HES 130/0.4 (6%) to blood. Nevertheless, the infusion of 1,000 ml of HES 130/0.4 (6%) in normal parturients did not significantly affect blood coagulation.
Assessment of coagulation with 6% hydroxyethyl starch 130/0.4 in cesarean section, Chung-Sik Oh, Tae-Yun Sung, Seong-Hyop Kim, Duk-Kyung Kim, Jeong-Ae Lim, and Nam-Sik Woo, Korean J Anesthesiol 2012; 62: 337-342
Conclusion: Induced changes in PETCO2 during a PLR maneuver could be used to track changes in CO for prediction of fluid responsiveness in mechanically ventilated patients with acute circulatory failure, under fixed minute ventilation and assuming a constant tissue CO2 production.
Non-invasive assessment of fluid responsiveness by changes in partial end-tidal CO2 pressure during a passive leg-raising maneuver. Manuel Ignacio Monge García, Anselmo Gil Cano, Manuel Gracia Romero, Rocío Monterroso Pintado, Virginia Pérez Madueño and Juan Carlos Díaz Monrové, Annals of Intensive Care 2012, 2:9
Summary: Perioperative dilutional coagulopathy is a major coagulation disorder during adult and pediatric surgery. Although the main underlying mechanisms are comparable, data of the development and management of dilutional coagulopathy in children are scarce. Observational data showed that intraoperative coagulation disorders mainly based on complex disturbances of clot firmness including acquired fibrinogen as well as factor XIII deficiencies, while clotting time and platelet counts remained fairly stable. A fast and reliable monitoring of the entire coagulation process (e.g. thrombelastometry) might be of extreme value for detection and guidance of effective coagulation management. Although the transfusion of fresh frozen plasma was recommended in several guidelines, the use of coagulation factors might offer an alternative and potentially superior approach in managing perioperative coagulation disorders. Further studies are urgently needed to determine the efficacy of modern coagulation management.
Management of Dilutional Coagulopathy during Pediatric Major SurgeryThorsten Haasa Jacqueline Maucha Markus Weissa Markus Schmugge, Transfus Med Hemother 2012;39:114–119
Conclusions: Fluid challenge did not improve arterial pressure in about one third of hypotensive critically ill patients. Cardiovascular and renal variables did not enable us to predict the individual response to volume administration.
Prediction of arterial pressure increase after fluid challengeGiuseppe Natalini, Antonio Rosano, Carmine Rocco Militano, Antonella Di Maio, Pierluigi Ferretti, Michele Bertelli, Federica de Giuli and Achille Bernardini, BMC Anesthesiology 2012, 12:3
Albumin has been widely used in patients with cirrhosis in an attempt to improve circulatory and renal functions. The benefits of albumin infusions in preventing the deterioration in renal function associated with large-volume paracentesis, spontaneous bacterial peritonitis, and established hepatorenal syndrome in conjunction with a vasoconstrictor are well established. While some of these indications are supported by the results of randomized studies, others are based only on clinical experience and have not been proved in prospective studies. The paucity of well-designed trials, the high cost of albumin, the lack of a clear-cut survival benefit, and fear of transmitting unknown infections make the use of albumin controversial. The recent development of the molecular adsorbent recirculating system, an albumin dialysis, is an example of the capacity of albumin to act by mechanisms other than its oncotic effect. Efforts should be made to define the indications for albumin use, the dose required, and predictors of response, so that patients gain the maximum benefit from its administration.
Albumin for End-Stage Liver Disease, June Sung Lee, korean j intern med 2012;27:13-19
21-10-2011
CONCLUSIONS: Preoperative dehydration after overnight fasting as measured by urine osmolality did not alter the magnitude of hypotension during general anesthesia. This finding suggests that intravascular volume loading with crystalloid solution to prevent hypotension during general anesthesia is an unfounded practice for low risk patients after overnight fasting.
Toshihiro Osugi, Tsuneo Tatara, Sachiko Yada, and Chikara Tashiro.
Hydration Status After Overnight Fasting as Measured by Urine Osmolality Does Not Alter the Magnitude of Hypotension During General Anesthesia in Low
Risk Patients, Anesth Analg 2011;112:1307–1313.
Toshihiro Osugi, Tsuneo Tatara, Sachiko Yada, and Chikara Tashiro.
Hydration Status After Overnight Fasting as Measured by Urine Osmolality Does Not Alter the Magnitude of Hypotension During General Anesthesia in Low
Risk Patients, Anesth Analg 2011;112:1307–1313.
In conclusion, this study shows that PVI has some value in predicting fluid responsiveness in low-risk patients undergoing colorectal surgery, particularly at the beginning of the procedure. Further research in larger populations is needed to establish cutoff values for PVI in dynamic conditions, and research is also indicated to learn whether a PVI-driven fluid protocol can have the same clinical
benefit as an esophageal Doppler SV protocol. If further studies confirm the initial promise of PVI, the benefits of optimizing circulating volume may be extendable to a wider patient population because of its low cost and noninvasiveness.
Julian A. Hood, FRCA, and R. Jonathan T. Wilson, FRCA
Pleth Variability Index to Predict Fluid Responsiveness in Colorectal Surgery, Anesth Analg 2011;113:1058–63.
benefit as an esophageal Doppler SV protocol. If further studies confirm the initial promise of PVI, the benefits of optimizing circulating volume may be extendable to a wider patient population because of its low cost and noninvasiveness.
Julian A. Hood, FRCA, and R. Jonathan T. Wilson, FRCA
Pleth Variability Index to Predict Fluid Responsiveness in Colorectal Surgery, Anesth Analg 2011;113:1058–63.
Closed-loop (automated) controllers are encountered in all aspects of modern life in applications ranging from air-conditioning to spaceflight. Although these systems are virtually ubiquitous, they are infrequently used in anesthesiology because of the complexity of physiologic systems and the difficulty in obtaining reliable and valid feedback data from the patient. Despite these challenges, closed-loop systems are being increasingly studied and improved for medical use. Two recent developments have made fluid administration a candidate for closed-loop control. First, the further description and development of dynamic
predictors of fluid responsiveness provides a strong parameter for use as a control variable to guide fluid administration. Second, rapid advances in noninvasive monitoring of cardiac output and other hemodynamic variables make goal-directed therapy applicable for a wide range of patients in a variety of clinical care settings. In this article, we review the history of closed-loop controllers in clinical care, discuss the current understanding and limitations of the dynamic predictors of fluid responsiveness, and examine how these variables might be
incorporated into a closed-loop fluid administration system.
Joseph Rinehart, Ngai Liu, Brenton Alexander, and Maxime Cannesson.
Closed-Loop Systems in Anesthesia: Is There a Potential for Closed-Loop Fluid Management and Hemodynamic Optimization? Anesth Analg 2011;X:•••–•••
predictors of fluid responsiveness provides a strong parameter for use as a control variable to guide fluid administration. Second, rapid advances in noninvasive monitoring of cardiac output and other hemodynamic variables make goal-directed therapy applicable for a wide range of patients in a variety of clinical care settings. In this article, we review the history of closed-loop controllers in clinical care, discuss the current understanding and limitations of the dynamic predictors of fluid responsiveness, and examine how these variables might be
incorporated into a closed-loop fluid administration system.
Joseph Rinehart, Ngai Liu, Brenton Alexander, and Maxime Cannesson.
Closed-Loop Systems in Anesthesia: Is There a Potential for Closed-Loop Fluid Management and Hemodynamic Optimization? Anesth Analg 2011;X:•••–•••
CONCLUSION; Although monitoring Hb concentrations in real time has wide applications in anesthesiology and intensive care, the values obtained need to be very accurate before such a system can be used in daily clinical practice. Our study shows poor correlation between Hb measured noninvasively by multiwavelength pulse oximetry and a laboratory hematology analyzer. The difference was greater when the pulse oximetry perfusion index was low, as may occur in shock, hypothermia, or vasoconstriction patients. The accuracy of the multiwavelength pulse oximetry, therefore, needs to be improved before we can recommend its use in the anesthesiology or intensive care setting.
Ba-Vinh Nguyen, Jean-Louis Vincent, Emmanuel Nowak, Michelle Coat, Nicolas Paleiron, Pierre Gouny, Mehdi Ould-Ahmed, Maite´ Guillouet,
Charles Christian Arvieux, and Gildas Gueret,The Accuracy of Noninvasive Hemoglobin Measurement by Multiwavelength Pulse Oximetry After Cardiac Surgery, Anesth Analg 2011;X:œœœ–œœœ.
Ba-Vinh Nguyen, Jean-Louis Vincent, Emmanuel Nowak, Michelle Coat, Nicolas Paleiron, Pierre Gouny, Mehdi Ould-Ahmed, Maite´ Guillouet,
Charles Christian Arvieux, and Gildas Gueret,The Accuracy of Noninvasive Hemoglobin Measurement by Multiwavelength Pulse Oximetry After Cardiac Surgery, Anesth Analg 2011;X:œœœ–œœœ.
To summarize the results of the comparisons we have
up to now, we know that:
• Crystalloid preload is ineffective or very poorly effective.
• Colloid (HES) preload is partly but consistently effective (comparison type I).
• Crystalloid coload seems to be partly effective, in contrast to crystalloid preload (comparison type II), but this benefit is inconsistent and may depend on the
volume and rate of administration at the onset of sympathetic spinal block.
• Colloid (HES) coload is as effective as colloid (HES) preload (4 consistent studies, comparison type III).
• Colloid (HES) coload is as effective or more effective than crystalloid coload (comparison type IV the new study by McDonald et al.11).
Frederic J. Mercier, Fluid Loading for Cesarean Delivery Under Spinal
Anesthesia: Have We Studied All the Options? Anesth Analg 2011;113:677-680.
up to now, we know that:
• Crystalloid preload is ineffective or very poorly effective.
• Colloid (HES) preload is partly but consistently effective (comparison type I).
• Crystalloid coload seems to be partly effective, in contrast to crystalloid preload (comparison type II), but this benefit is inconsistent and may depend on the
volume and rate of administration at the onset of sympathetic spinal block.
• Colloid (HES) coload is as effective as colloid (HES) preload (4 consistent studies, comparison type III).
• Colloid (HES) coload is as effective or more effective than crystalloid coload (comparison type IV the new study by McDonald et al.11).
Frederic J. Mercier, Fluid Loading for Cesarean Delivery Under Spinal
Anesthesia: Have We Studied All the Options? Anesth Analg 2011;113:677-680.
28-7-2011
Conclusions: Administration of albumin compared to saline did not impair renal or other organ function and may have decreased the risk of
death.
death.
The SAFE Study Investigators, Impact of albumin compared to saline on organ function and mortality of patients with severe sepsis, Intensive Care Med (2011) 37:86–96
It can be concluded that contrary to in vitro studies HES 130y0.4 in clinical practice has comparable effects on blood loss after cardiac surgery.
Shahzad G. Rajaa, Shamim Akhtarb, Yaseer Shahbazc, Ayesha Masoodd, In cardiac surgery patients does Voluven, impair coagulation less than other colloids?, Interactive CardioVascular and Thoracic Surgery 12 (2011) 1022–1027
Conclusions: In this specific population of patients, it is clinically valid to use the bioreactance-based NICOM system to predict fluid responsiveness (FR) from changes in cardiac output (CO) during passive leg raising (PLR).
Brahim Benomar, Alexandre Ouattara, Philippe Estagnasie, Alain Brusset, Pierre Squara, Fluid responsiveness predicted by noninvasive Bioreactance-based passive leg raise test, Intensive Care Med (2010) 36:1875–1881
Brahim Benomar, Alexandre Ouattara, Philippe Estagnasie, Alain Brusset, Pierre Squara, Fluid responsiveness predicted by noninvasive Bioreactance-based passive leg raise test, Intensive Care Med (2010) 36:1875–1881
Conclusions: In this study, fluid optimization guided by Stroke volume variation (SVV) during major abdominal surgery is associated with better intraoperative hemodynamic stability, decrease in serum lactate at the end of surgery and lower incidence of postoperative organ complications.
Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study, Jan Benes, Ivan Chytra, Pavel Altmann, Marek Hluchy, Eduard Kasal, Roman Svitak, Richard Pradl and Martin Stepan, Critical Care 2010, 14:R118
Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study, Jan Benes, Ivan Chytra, Pavel Altmann, Marek Hluchy, Eduard Kasal, Roman Svitak, Richard Pradl and Martin Stepan, Critical Care 2010, 14:R118
Goal-directed resuscitation for severe sepsis and septic shock has been reported
to reduce mortality when applied in the emergency department. Conclusion Among patients with septic shock who were treated to normalize central venous and mean arterial pressure, additional management to normalize lactate clearance compared with management to normalize ScvO2 did not result in significantly different in-hospital mortality.
Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy, Alan E. Jones, Nathan I. Shapiro, Stephen Trzeciak, Ryan C. Arnold, Heather A. Claremont, Jeffrey A. Kline, JAMA. 2010;303(8):739-746
to reduce mortality when applied in the emergency department. Conclusion Among patients with septic shock who were treated to normalize central venous and mean arterial pressure, additional management to normalize lactate clearance compared with management to normalize ScvO2 did not result in significantly different in-hospital mortality.
Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy, Alan E. Jones, Nathan I. Shapiro, Stephen Trzeciak, Ryan C. Arnold, Heather A. Claremont, Jeffrey A. Kline, JAMA. 2010;303(8):739-746
Conclusion Stakeholders involved in the developmental process are of great importance in disseminating recommendations before active implementation. Therefore, to successfully implement guidelines and reduce costs of active implementation, any guideline development should consider implementation right from the beginning. Implementation strategies should target identified barriers and
will therefore always be guideline specific.
Merit M. Tabbers & Nicole Boluyt & Martin Offringa, Implementation of an evidence-based guideline on fluid resuscitation: lessons learnt for future guidelines, Eur J Pediatr (2010) 169:749–758
will therefore always be guideline specific.
Merit M. Tabbers & Nicole Boluyt & Martin Offringa, Implementation of an evidence-based guideline on fluid resuscitation: lessons learnt for future guidelines, Eur J Pediatr (2010) 169:749–758
15-2-2011
An 8-month-old girl developed extreme agitation after accidentally ingesting a tablet of her father’s medication (Monocrixo LP (The´rabel Lucien Pharma, Levallois Perret, France), 200 mg tramadol). Unable to sleep... after an episode of epistaxis. Vital signs were significant for sinus tachycardia and a neurologic examination revealed intermediately reactive pupils, agitation alternating with drowsiness with a Glasgow Coma Scale of 10, and increased lower-limb reflexes. Within 24 hours, she developed hyperthermia and high blood pressure.
Marechal C, Honorat R, Claudet I. Serotonin syndrome induced by tramadol intoxication in an 8-month-old infant. Pediatr Neurol 2011;44:72-74.
31-12-2010
Intra-operative intravenous fluid restriction reduces perioperative red blood cell transfusion in elective cardiac surgery, especially in transfusion-prone patients: a prospective, randomized controlled trial
George Vretzakis1, Athina Kleitsaki1, Konstantinos Stamoulis1, Metaxia Bareka1, Stavroula Georgopoulou1, Menelaos Karanikolas2*, Athanasios Giannoukas3, Journal of Cardiothoracic Surgery 2010, 5:7
CCV con CPB, se evaluó durante la estadía Hospitalaria la necesidad de transfusión de paquetes de Glóbulos Rojos, esta se requirió en 137 de los 192 pacientes y recibieron en total 289 unidades, el número de unidades transfundidas fue significativamente menor de 113 unidades en el grupo A (restrictivo, con 500ml de Voluven® y aumentos con bolos de 50ml según necesidad), y 176 unidades en el grupo B, p < 0.0001, (Liberal, con Ringer Lactato a razón de 40ml/hs), siendo el intraoperatorio el periodo de menor número de transfusiones.
Intravascular Volume Therapy With Colloids in Cardiac Surgery
Matthias Lange, MD,* Christian Ertmer, MD,* Hugo Van Aken, MD, PhD,* and Martin Westphal, MD, PhD*†Journal of Cardiothoracic and Vascular Anesthesia, Vol xx, No x (Month), 2010: pp xxx. doi:10.1053/j.jvca.2010.06.005
Matthias Lange, MD,* Christian Ertmer, MD,* Hugo Van Aken, MD, PhD,* and Martin Westphal, MD, PhD*†Journal of Cardiothoracic and Vascular Anesthesia, Vol xx, No x (Month), 2010: pp xxx. doi:10.1053/j.jvca.2010.06.005
This review article gives an overview of the clinically available colloid solutions and describes the role of different colloids for volume expansion in adult patients undergoing cardiopulmonary bypass (CPB) surgery.
26-10-2010
Comparison of 6% hydroxyethyl starch 130/0.4 and saline solution for resuscitation of the microcirculation during the early goal-directed therapy of septic patients.
Arnaldo Dubin, Mario O. Pozo, Christian A. Casabella, Gastón Murias, Fernando Pálizas Jr., Miriam C. Moseinco, Vanina S. Kanoore, Fernando Pálizas, Elisa Estenssoro, Can Ince, doi:10.1016/j.jcrc.2010.04.007, Journal of Critical Care (2010).
In conclusion, the results of this controlled randomized pilot study suggest that in patients with sepsis-induced hypoperfusion, the EGDT may allow a better recruitment of the microcirculation when 6% HES/0.4 is used for the expansion of intravascular volume compared with saline solution. These findings justify a larger clinical trial to confirm the beneficial effects of 6% HES/0.4 on microvascular perfusion and to determine if these improved parameters are associated with an improved outcome.
EARLY GOAL-DIRECTED THERAPY IN TREATMENT OF PEDIATRIC SEPTIC SHOCK
Claudio Flauzino de Oliveira, SHOCK, Vol. 34, Supplement 1, pp. 44Y47, 2010.
In conclusion, early goal-directed therapy in pediatric septic shock is a successful method to optimize and parameterize treatment, but there is still a long way to turn septic shock resuscitation simpler and more widely spread. Advances in that path will consistently decrease mortality rates in any setting or country.
Goal-Directed Fluid Management Based on the Pulse Oximeter–Derived Pleth Variability Index Reduces Lactate Levels and Improves Fluid Management
Patrice Forget, Fernande Lois, and Marc de Kock. DOI: 10.1213/ANE.0b013e3181eb624f, Anesth Analg 2010.
Patrice Forget, Fernande Lois, and Marc de Kock. DOI: 10.1213/ANE.0b013e3181eb624f, Anesth Analg 2010.
In conclusion, the use of PVI-guided fluid management was associated with lower lactate levels during major abdominal surgery. Patients in the PVI-guided group were
given less crystalloid. Reduced lactate levels in PVI-guided patients suggests that PVI-guided fluid management may lead to fluid administration that is tailored to each individual patient’s needs.
given less crystalloid. Reduced lactate levels in PVI-guided patients suggests that PVI-guided fluid management may lead to fluid administration that is tailored to each individual patient’s needs.
Effect of volume loading with 1 liter intravenous infusions of 0.9% saline, 4% succinylated gelatine (Gelofusine) and 6% hydroxyethyl starch (Voluven) on blood volume and endocrine responses: A randomized, three-way crossover study in healthy volunteers.
Dileep N. Lobo, Zeno Stanga, Mark M. Aloysius, Catherine Wicks, Quentin M. Nunes, Katharine L. Ingram, Lorenz Risch, Simon P. Allison. Crit Care Med 2010; 38:464–470
Dileep N. Lobo, Zeno Stanga, Mark M. Aloysius, Catherine Wicks, Quentin M. Nunes, Katharine L. Ingram, Lorenz Risch, Simon P. Allison. Crit Care Med 2010; 38:464–470
In conclusion, despite the 100-kD difference in MWw, Gelofusine and Voluven
possess comparable blood volume-expanding capacities in healthy volunteers.
However, further investigations are required to determine whether this similarity
is maintained in patients in whom the transcapillary rate of albumin may be increased. In addition, excretion of an acute fluid load containing sodium and chloride may be dependent on a sustained suppression of the RAAS rather than on
natriuretic peptides.
possess comparable blood volume-expanding capacities in healthy volunteers.
However, further investigations are required to determine whether this similarity
is maintained in patients in whom the transcapillary rate of albumin may be increased. In addition, excretion of an acute fluid load containing sodium and chloride may be dependent on a sustained suppression of the RAAS rather than on
natriuretic peptides.
How can we optimize medical orderings in intensive care unit (ICU)?
J.-J. Lehot, C.Heuclin, J.Neidecker, R.Cartier, P.Ffrench, M.E. Reverdy, D.Revel, M. Billard, C.Lupo, B.Gonnard, G.Keller, G.Aulagner, O.Bastien. doi:10.1016/j.annfar.2010.06.017, Annales Francaises d’Anesthesie et de Reanimation 2010.
J.-J. Lehot, C.Heuclin, J.Neidecker, R.Cartier, P.Ffrench, M.E. Reverdy, D.Revel, M. Billard, C.Lupo, B.Gonnard, G.Keller, G.Aulagner, O.Bastien. doi:10.1016/j.annfar.2010.06.017, Annales Francaises d’Anesthesie et de Reanimation 2010.
Conclusion: Multidisciplary optimization of medical or dering can be efficient in ICU. However, aprofitsharing with or dering physician swould be necessary to prolong thes eeffects.
Balancing volume resuscitation and ascites management in cirrhosis
Federico Pollia and Luciano Gattinoni, Current Opinion in Anaesthesiology 2010, 23:151–158.
Federico Pollia and Luciano Gattinoni, Current Opinion in Anaesthesiology 2010, 23:151–158.
Goal-directed therapy with volumetric indicators may be particularly useful. Colloid
solutions, owing to their increased intravascular halflives, may be the best choice for these patients.
solutions, owing to their increased intravascular halflives, may be the best choice for these patients.
28-09-2010
The Importance of Fluid Management in Acute Lung Injury Secondary to Septic Shock
Claire V. Murphy, Garrett E. Schramm, Joshua A. Doherty, Richard M. Reichley, Ognjen Gajic, Bekele Afessa, Scott T. Micek and Marin H. Kollef
Claire V. Murphy, Garrett E. Schramm, Joshua A. Doherty, Richard M. Reichley, Ognjen Gajic, Bekele Afessa, Scott T. Micek and Marin H. Kollef
CHEST 2009; 136:102–109
In summary, the fluid management of patients with septic shock complicated by ALI appears to be an important determinant of hospital mortality. Both early goal-directed fluid resuscitation and CLFM seem to be independent aspects of fluid management
that affect patient outcomes.
that affect patient outcomes.
Effects on coagulation of balanced (130/0.42) and non-balanced (130/0.4) hydroxyethyl starch or gelatin compared with balanced Ringer’s solution: an in vitro study using two different viscoelastic coagulation tests ROTEM and SONOCLOT
M. Casutt 1, A. Kristoffy , G. Schuepfer, D. R. Spahn and C. Konrad
British Journal of Anaesthesia 105 (3): 273–81, 2010.
M. Casutt 1, A. Kristoffy , G. Schuepfer, D. R. Spahn and C. Konrad
British Journal of Anaesthesia 105 (3): 273–81, 2010.
Conclusions. Both ROTEM and SONOCLOT are sensitive tests for the detection of impaired blood coagulation due to haemodilution. There are fewer effects on blood coagulation using crystalloids compared with colloids. T#ff0000impair coagulation less than other colloids?, Interactive CardioVascular and Thoracic Surgery 12 (2011) 1022/fontarial,helvetica,sans-serifarial,helvetica,sans-serifarial,helvetica,sans-serifhe effects of GEL and HES are similar. There is no difference between balanced HES 130/0.42 and non-balanced HES 130/0.4.
Severe anaemia and subcapital femur fracture in a patient with Left Ventricular Assist Device Heart Mate II: the cardiologist’s management of this rare patient,
Bill D. Gogas1, John T. Parissis, Gerasimos S. Filippatos, Efstathios K. Iliodromitis,
Konstantinos C. Soultanis, Georgia G. Kostopanagiotou, Stergios P. Theodoropoulos, Dimitrios T. Kremastinos, and Magdi H. Yacoub
Konstantinos C. Soultanis, Georgia G. Kostopanagiotou, Stergios P. Theodoropoulos, Dimitrios T. Kremastinos, and Magdi H. Yacoub
European Journal of Heart Failure (2009) 11, 806–808
The use of Left Ventricular Assist Devices (LVADs) has increased over the last decade because of the lack of healthy donor hearts. In this report we describe for the first time a patient with an LVAD Heart Mate II (HM II) implanted 6 months before admission, who initially suffered from severe anaemia and later on underwent a successful bipolar hip replacement owing to subcapital fracture of the right femur. The patient was managed successfully by a team approach, which included a cardiologist, anaesthesiologist, orthopaedic surgeon, and LVAD technician.
The use of Left Ventricular Assist Devices (LVADs) has increased over the last decade because of the lack of healthy donor hearts. In this report we describe for the first time a patient with an LVAD Heart Mate II (HM II) implanted 6 months before admission, who initially suffered from severe anaemia and later on underwent a successful bipolar hip replacement owing to subcapital fracture of the right femur. The patient was managed successfully by a team approach, which included a cardiologist, anaesthesiologist, orthopaedic surgeon, and LVAD technician.
30-06-2010
Pharmacological optimization of tissue perfusion
N. Mongardon, A. Dyson and M. Singer
Br J Anaesth 2009; 103: 82–8
After fluid resuscitation, vasoactive drug treatment represents the major cornerstone for correcting any major impairment of the circulation. However, debate still rages as to the choice of agent, dose, timing, targets, and monitoring modalities that should optimally be used to benefit the patient yet, at the same time, minimize harm. This review highlights these areas and some new pharmacological agents that broaden our therapeutic options.
Effects of Different Resuscitation Fluids on Acute Lung Injury in a Rat Model of Uncontrolled Hemorrhagic Shock and Infection
Ju Gao, MD, PhD, Wei-Xian Zhao, MD, Fu-Shan Xue, MD, Luo-Jing Zhou, MD, Yan-Hong Yu, MD, and Hai-Bo Zhou, J Trauma. 2009;67: 1213–1219.
Ju Gao, MD, PhD, Wei-Xian Zhao, MD, Fu-Shan Xue, MD, Luo-Jing Zhou, MD, Yan-Hong Yu, MD, and Hai-Bo Zhou, J Trauma. 2009;67: 1213–1219.
In conclusion, our data from a rat model of uncontrolled HS (hemorrhagic shock) and infection demonstrated that the choice of resuscitation fluid might be very important. Of the three resuscitation fluids used in our study, HES (Voluven) was the most appropriate for preventing ALI after severe HS and infection. It decreased expression of TGF-1 and Smad2 and produced a beneficial effect on early mortality.
The use of early intervention to prevent postoperative complications
Shaman Jhanji and Rupert M. Pearse, Current Opinion in Critical Care 2009, 15:349–354
Conclusion
The high-risk surgical population is larger than generally realized. These patients account for over 80% of postoperative deaths but less than 15% of in-patient procedures. Current systems for the identification and
treatment of high-risk surgical patients are inadequate.
Postoperative complications generally result from the interplay between the tissue injury-induced inflammainflammatory response and preexisting disease states. In noncardiac surgical patients, the majority of postoperative complications are either infectious or thrombotic in nature. A great deal of further research is required to clarify various key aspects of care of the high-risk surgical patient. Areas of particular importance include the role of plasma biomarkers in risk assessment, the efficacy of GDHT and the optimal approach to perioperative respiratory care.
Shaman Jhanji and Rupert M. Pearse, Current Opinion in Critical Care 2009, 15:349–354
Conclusion
The high-risk surgical population is larger than generally realized. These patients account for over 80% of postoperative deaths but less than 15% of in-patient procedures. Current systems for the identification and
treatment of high-risk surgical patients are inadequate.
Postoperative complications generally result from the interplay between the tissue injury-induced inflammainflammatory response and preexisting disease states. In noncardiac surgical patients, the majority of postoperative complications are either infectious or thrombotic in nature. A great deal of further research is required to clarify various key aspects of care of the high-risk surgical patient. Areas of particular importance include the role of plasma biomarkers in risk assessment, the efficacy of GDHT and the optimal approach to perioperative respiratory care.
Microwave Oven: How to Use It as a Crystalloid Fluid Warmer
Kaweesak Chittawatanarat MD*, Siriwasan Akanitthaphichat MD*
Kaweesak Chittawatanarat MD*, Siriwasan Akanitthaphichat MD*
J Med Assoc Thai 2009; 92 (11): 1428-33
Conclusion
The authors conclude that the microwave oven is a safe and practical method for warming crystalloid fluids, especially in rural hospitals where a standard warmer is not available. Safe use requires a narrow difference between crystalloid fluid and room temperature, an accurate room temperature thermometer, an accurate stopwatch, and a pretest for microwave ovens.
The authors conclude that the microwave oven is a safe and practical method for warming crystalloid fluids, especially in rural hospitals where a standard warmer is not available. Safe use requires a narrow difference between crystalloid fluid and room temperature, an accurate room temperature thermometer, an accurate stopwatch, and a pretest for microwave ovens.
FLUID RESUSCITATION: PAST, PRESENT, AND THE FUTURE
Heena P. Santry and Hasan B. Alam
SHOCK, Vol. 33, No. 3, pp. 229Y241, 2010
ABSTRACT—Hemorrhage remains a major cause of preventable death following both civilian and military trauma. The goals of resuscitation in the face of hemorrhagic shock are restoring end-organ perfusion and maintaining tissue oxygenation while attempting definitive control of bleeding. However, if not performed properly, resuscitation can actually exacerbate cellular injury caused by hemorrhagic shock, and the type of fluid used for resuscitation plays an important role in this injury pattern. This article reviews the historical development and scientific underpinnings of modern resuscitation techniques. We summarized data from a number of studies to illustrate the differential effects of commonly used resuscitation fluids, including isotonic crystalloids, natural and artificial colloids, hypertonic and hyperoncotic solutions, and artificial oxygen carriers, on cellular injury and how these relate to clinical practice. The data reveal that a uniformly safe, effective, and practical resuscitation fluid when blood products are unavailable and direct hemorrhage control is delayed has been elusive. Yet, it is logical to prevent this cellular injury through wiser resuscitation strategies than attempting immunomodulation after the damage has already occurred. Thus, we describe how some novel resuscitation strategies aimed at preventing or ameliorating cellular injury may become clinically available in the future.
Heena P. Santry and Hasan B. Alam
SHOCK, Vol. 33, No. 3, pp. 229Y241, 2010
ABSTRACT—Hemorrhage remains a major cause of preventable death following both civilian and military trauma. The goals of resuscitation in the face of hemorrhagic shock are restoring end-organ perfusion and maintaining tissue oxygenation while attempting definitive control of bleeding. However, if not performed properly, resuscitation can actually exacerbate cellular injury caused by hemorrhagic shock, and the type of fluid used for resuscitation plays an important role in this injury pattern. This article reviews the historical development and scientific underpinnings of modern resuscitation techniques. We summarized data from a number of studies to illustrate the differential effects of commonly used resuscitation fluids, including isotonic crystalloids, natural and artificial colloids, hypertonic and hyperoncotic solutions, and artificial oxygen carriers, on cellular injury and how these relate to clinical practice. The data reveal that a uniformly safe, effective, and practical resuscitation fluid when blood products are unavailable and direct hemorrhage control is delayed has been elusive. Yet, it is logical to prevent this cellular injury through wiser resuscitation strategies than attempting immunomodulation after the damage has already occurred. Thus, we describe how some novel resuscitation strategies aimed at preventing or ameliorating cellular injury may become clinically available in the future.
30-05-2010
Use of albumin: an update, J. Boldt, Br J Anaesth 2010; 104: 276–84.
Comentario:
Human albumin (HA) is widely used for volume replacement or correction of hypoalbuminaemia. The value of HA in the clinical setting continues to be controversial, and it is unclear whether in today’s climate of cost consciousness, there is still a place for such a highly priced substance. It is therefore appropriate to update our knowledge of the value of HA. With the exception of women in early pregnancy, there appears to be few indications for the use of HA to correct hypovolaemia. Some studies of traumatic brain injury and intensive care patients suggest negative effects on outcome and organ function of (hyperoncotic) HA. Modern synthetic colloids appear to be a cheaper alternative for maintaining colloid oncotic pressure. The value of using HA to correct hypoalbuminaemia has not been clearly justified. Theoretical and pharmacological benefits of HA, such as oxygen radical scavenging or binding of toxic substances, have not as yet been shown to have beneficial clinical consequences. Experimental data from cell lines or animals do not appear to mimic the clinical setting. Convincing data justifying the use of HA either for treating hypovolaemia or for correcting hypoalbuminaemia are still lacking. A restricted use of HA is recommended.
Human albumin (HA) is widely used for volume replacement or correction of hypoalbuminaemia. The value of HA in the clinical setting continues to be controversial, and it is unclear whether in today’s climate of cost consciousness, there is still a place for such a highly priced substance. It is therefore appropriate to update our knowledge of the value of HA. With the exception of women in early pregnancy, there appears to be few indications for the use of HA to correct hypovolaemia. Some studies of traumatic brain injury and intensive care patients suggest negative effects on outcome and organ function of (hyperoncotic) HA. Modern synthetic colloids appear to be a cheaper alternative for maintaining colloid oncotic pressure. The value of using HA to correct hypoalbuminaemia has not been clearly justified. Theoretical and pharmacological benefits of HA, such as oxygen radical scavenging or binding of toxic substances, have not as yet been shown to have beneficial clinical consequences. Experimental data from cell lines or animals do not appear to mimic the clinical setting. Convincing data justifying the use of HA either for treating hypovolaemia or for correcting hypoalbuminaemia are still lacking. A restricted use of HA is recommended.
Abdominal compartment syndrome in trauma resuscitation
Sandro Rizolia,b, Anita Mamtania,b, Sandro Scarpelinia,b,c and Andrew W. Kirkpatrick, Current Opinion in Anaesthesiology 2010, 23:251–257.
Comentario:
Massive crystalloid resuscitation is the most common risk factor associated with ACS, with a net positive balance of 5 l over 24 h, resulting in 85% of the patients developing intraabdominal hypertension (IAH) in a recent study.
28-05-2010
Is the use of colloids for fluid replacement harmless in children?
Sonja Saudan, Current Opinion in Anaesthesiology 2010, 23:363–367.
Summary: Tetrastarches offer the best currently available compromise between cost-effectiveness and safety profile in children with preexisting normal renal function and coagulation.
26-05-2010Hemostatic and Electrolyte Effects of Hydroxyethyl Starches in Patients Undergoing Posterior Lumbar Interbody Fusion Using Pedicle Screws and Cages
Soo Joo Choi, MD,* Hyun Joo Ahn, MD,* Sung Soo Chung, MD,† Myung Hee Kim, MD,*Duck Hwan Choi, MD,* Sangmin M. Lee, MD,* Jin Gu Kang, MD,* and Jin Kyoung Kim, MD*, Spine 2010;35:829–834
Conclusion. If coagulopathy is a concern during PLIF, then, a HES with low MW/DS in a saline-based médium (Voluven) may be a better alternative than a HES with high MW/DS in a balanced salt medium (Hextend).
01-05-2010
Hospital-acquired hyponatremia in postoperative pediatric patients: Prospective observational study
Pablo G. Eulmesekian, MD; Augusto Perez, MD; Pablo G. Minces, MD; Desmond Bohn, MB, FRCPC, Pediatr Crit Care Med 2010; 11:000–000
Conclusions: The prevalence of hyponatremia in this population was high and progressive over time. Negative sodium balance in the first 12 postoperative hours and then a positive fluid balance could be associated with the development of postoperative hyponatremia.
Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malignancy
Yu WenKui, MD, Li Ning, MD, Gong JianFeng, MD, PhD, Li WeiQin, MD, Tang ShaoQiu, MD, Tong Zhihui, MD, Gao Tao, Zhang JuanJuan, Xi FengChan, Shi Hui, Zhu WeiMing, MD, and Li Jie-Shou, MD, PhD, Nanjing, China, Surgery 2009
Conclusion. A fluid-restricted regimen after elective gastrointestinal operations for malignancy may lead to fluid insufficiency and low tissue perfusion in up to 28% of patients. Close monitoring of serum lactate levels with adjustment of intravenous fluid administration intraoperatively and in the early postoperative period may improve the early detection and correction of inadequate tissue perfusion, thereby decreasing the rate of complications.
Conclusion. A fluid-restricted regimen after elective gastrointestinal operations for malignancy may lead to fluid insufficiency and low tissue perfusion in up to 28% of patients. Close monitoring of serum lactate levels with adjustment of intravenous fluid administration intraoperatively and in the early postoperative period may improve the early detection and correction of inadequate tissue perfusion, thereby decreasing the rate of complications.
Prevention du syndrome de Mendelson en obstetrique : lintubation tracheale doit-elle demeurer un principe intangible ? Prevention of aspiration of gastric contents in obstetrics: Should tracheal intubation remain an inviolable principle?
D. Benhamoua, F.J. Mercierb, Annales Francaises dAnesthesie et de Reanimation 28 (2009) 115–118
Dans letude presente, les auteurs nous proposent un algorithme dans lequel un delai de six heures par rapport au dernier repas serait lelement determinant pour decider du recours a lintubation tracheale.
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Dans letude presente, les auteurs nous proposent un algorithme dans lequel un delai de six heures par rapport au dernier repas serait lelement determinant pour decider du recours a lintubation tracheale.