Tags

Type your tag names separated by a space and hit enter

Effects of fluid resuscitation with synthetic colloids or crystalloids alone on shock reversal, fluid balance, and patient outcomes in patients with severe sepsis: a prospective sequential analysis.
Crit Care Med. 2012 Sep; 40(9):2543-51.CC

Abstract

OBJECTIVE

To assess shock reversal and required fluid volumes in patients with septic shock.

DESIGN

Prospective before and after study comparing three different treatment periods.

SETTING

Fifty-bed single-center surgical intensive care unit.

PATIENTS

Consecutive patients with severe sepsis.

INTERVENTIONS

Fluid therapy directed at preset hemodynamic goals with hydroxyethyl starch (predominantly 6% hydroxyethyl starch 130/0.4) in the first period, 4% gelatin in the second period, and only crystalloids in the third period.

MEASUREMENTS AND MAIN RESULTS

Main outcome was time to shock reversal (serum lactate <2.2 mmol/L and discontinuation of vasopressor use). Hemodynamic goals were mean arterial pressure >70 mm Hg; ScvO2 <70%; central venous pressure >8 mm Hg. Safety outcomes were acute kidney injury defined by Risk, Injury, Failure, Loss, and End-stage kidney disease criteria and new need for renal replacement therapy. Hemodynamic measures, serum lactate, and creatinine were comparable at baseline in all study periods (hydroxyethyl starch n = 360, gelatin n = 352, only crystalloids n = 334). Severity scores, hospital length of stay, and intensive care unit or hospital mortality did not differ significantly among groups. All groups showed similar time to shock reversal. More fluid was needed over the first 4 days in the crystalloid group (fluid ratios 1.4:1 [crystalloids to hydroxyethyl starch] and 1.1:1 [crystalloids to gelatin]). After day 5, fluid balance was more negative in the crystalloid group. Hydroxyethyl starch and gelatin were independent risk factors for acute kidney injury (odds ratio, 95% confidence interval 2.55, 1.76-3.69 and 1.85, 1.31-2.62, respectively). Patients receiving synthetic colloids received significantly more allogeneic blood products.

CONCLUSIONS

Shock reversal was achieved equally fast with synthetic colloids or crystalloids. Use of colloids resulted in only marginally lower required volumes of resuscitation fluid. Both low molecular weight hydroxyethyl starch and gelatin may impair renal function.

Authors+Show Affiliations

Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University Jena, Jena, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22903091

Citation

Bayer, Ole, et al. "Effects of Fluid Resuscitation With Synthetic Colloids or Crystalloids Alone On Shock Reversal, Fluid Balance, and Patient Outcomes in Patients With Severe Sepsis: a Prospective Sequential Analysis." Critical Care Medicine, vol. 40, no. 9, 2012, pp. 2543-51.
Bayer O, Reinhart K, Kohl M, et al. Effects of fluid resuscitation with synthetic colloids or crystalloids alone on shock reversal, fluid balance, and patient outcomes in patients with severe sepsis: a prospective sequential analysis. Crit Care Med. 2012;40(9):2543-51.
Bayer, O., Reinhart, K., Kohl, M., Kabisch, B., Marshall, J., Sakr, Y., Bauer, M., Hartog, C., Schwarzkopf, D., & Riedemann, N. (2012). Effects of fluid resuscitation with synthetic colloids or crystalloids alone on shock reversal, fluid balance, and patient outcomes in patients with severe sepsis: a prospective sequential analysis. Critical Care Medicine, 40(9), 2543-51.
Bayer O, et al. Effects of Fluid Resuscitation With Synthetic Colloids or Crystalloids Alone On Shock Reversal, Fluid Balance, and Patient Outcomes in Patients With Severe Sepsis: a Prospective Sequential Analysis. Crit Care Med. 2012;40(9):2543-51. PubMed PMID: 22903091.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of fluid resuscitation with synthetic colloids or crystalloids alone on shock reversal, fluid balance, and patient outcomes in patients with severe sepsis: a prospective sequential analysis. AU - Bayer,Ole, AU - Reinhart,Konrad, AU - Kohl,Matthias, AU - Kabisch,Björn, AU - Marshall,John, AU - Sakr,Yasser, AU - Bauer,Michael, AU - Hartog,Christiane, AU - Schwarzkopf,Daniel, AU - Riedemann,Niels, PY - 2012/8/21/entrez PY - 2012/8/21/pubmed PY - 2012/12/10/medline SP - 2543 EP - 51 JF - Critical care medicine JO - Crit Care Med VL - 40 IS - 9 N2 - OBJECTIVE: To assess shock reversal and required fluid volumes in patients with septic shock. DESIGN: Prospective before and after study comparing three different treatment periods. SETTING: Fifty-bed single-center surgical intensive care unit. PATIENTS: Consecutive patients with severe sepsis. INTERVENTIONS: Fluid therapy directed at preset hemodynamic goals with hydroxyethyl starch (predominantly 6% hydroxyethyl starch 130/0.4) in the first period, 4% gelatin in the second period, and only crystalloids in the third period. MEASUREMENTS AND MAIN RESULTS: Main outcome was time to shock reversal (serum lactate <2.2 mmol/L and discontinuation of vasopressor use). Hemodynamic goals were mean arterial pressure >70 mm Hg; ScvO2 <70%; central venous pressure >8 mm Hg. Safety outcomes were acute kidney injury defined by Risk, Injury, Failure, Loss, and End-stage kidney disease criteria and new need for renal replacement therapy. Hemodynamic measures, serum lactate, and creatinine were comparable at baseline in all study periods (hydroxyethyl starch n = 360, gelatin n = 352, only crystalloids n = 334). Severity scores, hospital length of stay, and intensive care unit or hospital mortality did not differ significantly among groups. All groups showed similar time to shock reversal. More fluid was needed over the first 4 days in the crystalloid group (fluid ratios 1.4:1 [crystalloids to hydroxyethyl starch] and 1.1:1 [crystalloids to gelatin]). After day 5, fluid balance was more negative in the crystalloid group. Hydroxyethyl starch and gelatin were independent risk factors for acute kidney injury (odds ratio, 95% confidence interval 2.55, 1.76-3.69 and 1.85, 1.31-2.62, respectively). Patients receiving synthetic colloids received significantly more allogeneic blood products. CONCLUSIONS: Shock reversal was achieved equally fast with synthetic colloids or crystalloids. Use of colloids resulted in only marginally lower required volumes of resuscitation fluid. Both low molecular weight hydroxyethyl starch and gelatin may impair renal function. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/22903091/Effects_of_fluid_resuscitation_with_synthetic_colloids_or_crystalloids_alone_on_shock_reversal_fluid_balance_and_patient_outcomes_in_patients_with_severe_sepsis:_a_prospective_sequential_analysis_ L2 - https://dx.doi.org/10.1097/CCM.0b013e318258fee7 DB - PRIME DP - Unbound Medicine ER -