Fluid therapy in critical illness

Extreme Physiology & Medicine

Michael G Mythen²  Mark R Edwards¹ 

[1]NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK

[2]UCLH/UCL NIHR Comprehensive Biomedical Research Centre, London, UK

关键词: Glycocalyx;    Goal-directed therapy;    Surgery;    Critical illness;    Intravenous fluid;   

Others  :  1132644
DOI  :  10.1186/2046-7648-3-16

 received in 2014-06-06, accepted in 2014-08-13,  发布年份 2014

【 摘 要 】

Major surgery and critical illnesses such as sepsis and trauma all disturb normal physiological fluid handling. Intravenous fluid therapy for resuscitation and fluid maintenance is a central part of medical care during these conditions, yet the evidence base supporting practice in this area lacks answers to a number of important questions. Recent research developments include a refinement of our knowledge of the endothelial barrier structure and function and a focus on the potential harm that may be associated with intravenous fluid therapy. Here, we briefly describe the contemporary view of fluid physiology and how this may be disrupted by pathological processes. The important themes in critical illness fluid research are discussed, with a particular focus on two emerging ideas: firstly, that individualising fluid treatment to the patient, their underlying disease state and the phase of that illness may be key to improving clinical outcomes using fluid interventions and, secondly, that fluids should be considered to be drugs, with specific indications and contraindications, dose ranges and potential toxicities.

【 授权许可】

   
2014 Edwards and Mythen; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Myburgh JA, Mythen MG: Resuscitation fluids. N Engl J Med 2013, 369:1243-1251.
• [2]Chappell D, Jacob M, Hofmann-Kiefer K: A rational approach to perioperative fluid management. Anesthesiology 2008, 109:723-740.
• [3]Hamilton-Davies C, Mythen MG, Salmon JB, Jacobson D, Shukla A, Webb AR: Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry. Intensive Care Med 1997, 23:276-281.
• [4]Mythen MG, Webb AR: Intra-operative gut mucosal hypoperfusion is associated with increased post-operative complications and cost. Intensive Care Med 1994, 20:99-104.
• [5]Deitch EA: The role of intestinal barrier failure and bacterial translocation in the development of systemic infection and multiple organ failure. Arch Surg Chic Ill 1960 1990, 125:403-404.
• [6]Levick JR, Michel CC: Microvascular fluid exchange and the revised Starling principle. Cardiovasc Res 2010, 87:198-210.
• [7]Henry CB, Duling BR: TNF-alpha increases entry of macromolecules into luminal endothelial cell glycocalyx. Am J Physiol Heart Circ Physiol 2000, 279:H2815-H2823.
• [8]Bruegger D, Jacob M, Rehm M, Loetsch M, Welsch U, Conzen P, Becker BF: Atrial natriuretic peptide induces shedding of endothelial glycocalyx in coronary vascular bed of guinea pig hearts. Am J Physiol Heart Circ Physiol 2005, 289:H1993-H1999.
• [9]Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R: A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004, 350:2247-2256.
• [10]Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K: Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008, 358:125-139.
• [11]James MFM, Michell WL, Joubert IA, Nicol AJ, Navsaria PH, Gillespie RS: Resuscitation with hydroxyethyl starch improves renal function and lactate clearance in penetrating trauma in a randomized controlled study: the FIRST trial (Fluids in Resuscitation of Severe Trauma). Br J Anaesth 2011, 107:693-702.
• [12]Hahn RG: Volume kinetics for infusion fluids. Anesthesiology 2010, 113:470-481.
• [13]Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, Glass P, Lipman J, Liu B, McArthur C, McGuinness S, Rajbhandari D, Taylor CB, Webb SAR: Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 2012, 367:1901-1911.
• [14]Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345:1368-1377.
• [15]The ProCESS Investigators: A randomized trial of protocol-based care for early septic shock. N Engl J Med 2014, 370:1683-1693.
• [16]Dart AB, Mutter TC, Ruth CA, Taback SP, et al.: Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function. Cochrane Database Syst Rev 2010, (1):1-104.
• [17]Haase N, Perner A, Hennings LI, Siegemund M, Lauridsen B, Wetterslev M, Wetterslev J: Hydroxyethyl starch 130/0.38-0.45 versus crystalloid or albumin in patients with sepsis: systematic review with meta-analysis and trial sequential analysis. BMJ 2013, 346:f839.
• [18]Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Åneman A, Madsen KR, Møller MH, Elkjær JM, Poulsen LM, Bendtsen A, Winding R, Steensen M, Berezowicz P, Søe-Jensen P, Bestle M, Strand K, Wiis J, White JO, Thornberg KJ, Quist L, Nielsen J, Andersen LH, Holst LB, Thormar K, Kjældgaard A-L, Fabritius ML, Mondrup F, Pott FC, Møller TP, et al.: Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. N Engl J Med 2012, 367:124-134.
• [19]Raghunathan K, Murray P, Beattie WS, Lobo D, Myburgh JA, Sladen R, Kellum JA, Mythen M, Shaw AD: Choice of fluid in acute illness: what should be given? Management strategies from the twelfth consensus conference of the acute dialysis quality initiative (ADQI) London 2013. Br J Anaesth 2014. in press
• [20]Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS: Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988, 94:1176-1186.
• [21]Boyd O, Grounds RM, Bennett ED: A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 1993, 270:2699-2707.
• [22]Grocott MPW, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K: Perioperative increase in global blood flow to explicit defined goals and outcomes following surgery. Cochrane Database Syst Rev Online 2012., 11CD004082
• [23]Pearse RM, Harrison DA, MacDonald N, Gillies MA, Blunt M, Ackland G, Grocott MP, Ahern A, Griggs K, Scott R, Hinds C, Rowan K, OPTIMISE Study Group: Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA 2014, 311(21):2181-2190.
• [24]Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, Rasmussen MS, Lanng C, Wallin L, Iversen LH, Gramkow CS, Okholm M, Blemmer T, Svendsen P-E, Rottensten HH, Thage B, Riis J, Jeppesen IS, Teilum D, Christensen AM, Graungaard B, Pott F: Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. Ann Surg 2003, 238:641-648.
• [25]Corcoran T, Rhodes JEJ, Clarke S, Myles PS, Ho KM: Perioperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg 2012, 114:640-651.
• [26]Shaw AD, Bagshaw SM, Goldstein SL, Scherer LA, Duan M, Schermer CR, Kellum JA: Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte. Ann Surg 2012, 255(5):821-829.
• [27]McCluskey SA, Karkouti K, Wijeysundera D, Minkovich L, Tait G, Beattie WS: Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality: a propensity-matched cohort study. Anesth Analg 2013, 117:412-421.
• [28]Burdett E, Dushianthan A, Bennett-Guerrero E, Cro S, Gan TJ, Grocott MP, James MF, Mythen MG, O'Malley CM, Roche AM, Rowan K: Perioperative buffered versus non-buffered fluid administration for surgery in adults. Cochrane Database Syst Rev Online 2012., 12CD004089
• [29]Cannon W, Fraser J, Cowell E: The preventative treatment of wound shock. Jama J Am Med Assoc 1918, 618:621.
• [30]Bickell WH, Wall MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, Mattox KL: Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994, 331:1105-1109.
• [31]Harris T, Thomas GOR, Brohi K: Early fluid resuscitation in severe trauma. BMJ 2012, 345:e5752.
• [32]Johansson PI, Oliveri RS, Ostrowski SR: Hemostatic resuscitation with plasma and platelets in trauma. J Emerg Trauma Shock 2012, 5:120-125.
• [33]Morrison CA, Carrick MM, Norman MA, Scott BG, Welsh FJ, Tsai P, Liscum KR, Wall MJJ, Mattox KL: Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: preliminary results of a randomized controlled trial. J Trauma-Inj Infect 2011, 70:652-663.
• [34]Dutton RP, Mackenzie CF, Scalea TM: Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J Trauma 2002, 52:1141-1146.
• [35]Moppett IK: Traumatic brain injury: assessment, resuscitation and early management. Br J Anaesth 2007, 99:18-31.
• [36]Bulger EM, May S, Kerby JD, Emerson S, Stiell IG, Schreiber MA, Brasel KJ, Tisherman SA, Coimbra R, Rizoli S, Minei JP, Hata JS, Sopko G, Evans DC, Hoyt DB: Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock. Ann Surg 2011, 253:431-441.
• [37]Kamel H, Navi BB, Nakagawa K, Hemphill JC 3rd, Ko NU: Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: a meta-analysis of randomized clinical trials. Crit Care Med 2011, 39:554-559.
• [38]Bulger EM, May S, Brasel KJ, Schreiber M, Kerby JD, Tisherman SA, Newgard C, Slutsky A, Coimbra R, Emerson S, Minei JP, Bardarson B, Kudenchuk P, Baker A, Christenson J, Idris A, Davis D, Fabian TC, Aufderheide TP, Callaway C, Williams C, Banek J, Vaillancourt C, Van Heest R, Sopko G, Hata JS, Hoyt DB: Out-of-hospital hypertonic resuscitation following severe traumatic brain injury: a randomized controlled trial. Jama J Am Med Assoc 2010, 304:1455-1464.
• [39]Medical Research Council: Developing and Evaluating Complex Interventions: New Guidance. London: Medical Research Council; 2008.
• [40]Shoemaker WC, Chang P, Czer L, Bland R, Shabot MM, State D: Cardiorespiratory monitoring in postoperative patients: I. Prediction of outcome and severity of illness. Crit Care Med 1979, 7:237-242.
• [41]Connors AF, Speroff T, Dawson NV, Thomas C, Harrell FE, Wagner D, Desbiens N, Goldman L, Wu AW, Califf RM, Fulkerson WJ, Vidaillet H, Broste S, Bellamy P, Lynn J, Knaus WA: The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. Jama J Am Med Assoc 1996, 276:889-897.
• [42]National Institute for Health and Care Excellence: CardioQ-ODM Oesophageal Doppler Monitor [MTG3]. London: National Institute for Health and Care Excellence; 2011.
• [43]Noblett SE, Snowden CP, Shenton BK, Horgan AF: Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection. Br J Surg 2006, 93:1069-1076.
• [44]Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D: Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994, 330:1717-1722.
• [45]Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R: A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group. N Engl J Med 1995, 333:1025-1032.
• [46]Boyd JH, Forbes J, Nakada T, Walley KR, Russell JA: Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 2011, 39:259-265.
• [47]Annane D, Siami S, Jaber S, Martin C, Elatrous S, Declère AD, Preiser JC, Outin H, Troché G, Charpentier C, Trouillet JL, Kimmoun A, Forceville X, Darmon M, Lesur O, Reignier J, Abroug F, Berger P, Clec'h C, Cousson J, Thibault L, Chevret S, CRISTAL Investigation: Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: The CRISTAL randomized trial. JAMA 2013, 310(17):1809-1817.
• [48]Vincent J-L, De Backer D: Circulatory shock. N Engl J Med 2013, 369:1726-1734.
• [49]The SAFE Study Investigators: A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004, 350:2247-2256.
• [50]Cooper DJ, Myburgh J, Heritier S, Finfer S, Bellomo R, Billot L, Murray L, Vallance S: Albumin resuscitation for traumatic brain injury: is intracranial hypertension the cause of increased mortality? J Neurotrauma 2013, 30:512-518.
• [51]Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, Fanizza C, Caspani L, Faenza S, Grasselli G, Iapichino G, Antonelli M, Parrini V, Fiore G, Latini R, Gattinoni L: Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med 2014, 370:1412-1421.
• [52]NICE: Intravenous Fluid Therapy in Adults in Hospital (Clinical Guidance 174). London: NICE; 2014.
• [53]Maitland K, Kiguli S, Opoka RO, Engoru C, Olupot-Olupot P, Akech SO, Nyeko R, Mtove G, Reyburn H, Lang T, Brent B, Evans JA, Tibenderana JK, Crawley J, Russell EC, Levin M, Babiker AG, Gibb DM, FEAST Trial Group: Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011, 364:2483-2495.
• [54]Maitland K, George EC, Evans JA, Kiguli S, Olupot-Olupot P, Akech SO, Opoka RO, Engoru C, Nyeko R, Mtove G, Reyburn H, Brent B, Nteziyaremye J, Mpoya A, Prevatt N, Dambisya CM, Semakula D, Ddungu A, Okuuny V, Wokulira R, Timbwa M, Otii B, Levin M, Crawley J, Babiker AG, Gibb DM: Exploring mechanisms of excess mortality with early fluid resuscitation: insights from the FEAST trial. BMC Med 2013, 11:68. BioMed Central Full Text