China
Africa
Explore chapters and articles related to this topic
Colloid versus Crystalloids
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
The dose and duration of treatment with either crystalloids or colloids depends on the degree of hypovolemia and response to therapy. Blood pressure, heart rate, and urine output are traditional signs that are monitored. The blood pressure goal is generally a mean arterial blood pressure (MAP) of 65 mm Hg. Urine output should be >0.5 mL/kg/h. Lactate levels and base deficit are additional valuable parameters that can be followed to determine the adequacy of resuscitation. More recently, additional means to detect hypovolemia in intubated and mechanically ventilated patients, such as systolic blood pressure or stroke volume variation, hold the promise of providing guidance on appropriate fluid replacement and reducing the risk of fluid overload. However, use of tidal volumes greater than 8 mL/kg obfuscate the reliability of these monitors. Focused bedside ultrasonography and echocardiography can give clues about volume status (flattened inferior vena cava [IVC] versus a dilated IVC) and heart function.
Body fluids and electrolytes
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Intravenous solutions are classified as crystalloids and colloids. Crystalloids are electrolyte solutions and can be described as hypotonic, isotonic or hypertonic, depending on their contents, such as their osmolality. Colloids are colloidal solutions of high molecular weight molecules, such as albumin or dextran, that remain in the circulation as the molecules are too large to cross the plasma membrane. The Surviving Sepsis Campaign (2016) recommends crystalloids as the fluid of choice for initial resuscitation and subsequent intravascular volume replacement in patients with sepsis or septic shock (Rhodes et al. 2017). A recent Cochrane review (Lewis et al. 2018), looking at colloids versus crystalloids for fluid resuscitation in critically ill people, found that using colloids, compared with fluid replacement, probably makes little or no difference to the number of critically ill adults who die. However, evidence is needed from on-going studies to increase confidence in these findings (Lewis et al. 2018).
Transfusion practice in resuscitation and critical illness
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
As red cell blood products may be considered unacceptable fluids for, at least, early volume expansion in hypovolaemia, the choice of resuscitation fluid is restricted to two other classes of fluid: colloids and crystalloids. Colloids consist of large molecules that do not pass easily from one compartment to another, and so have a tendency to remain within the intravascular compartment. Crystalloids are isotonic sodium-rich fluids that are devoid of large molecules and tend to distribute between the intravascular and interstitial spaces. Although the choice of colloids over crystalloids for resuscitation of haemorrhage would at first hand appear obvious, this is not mirrored by clinical practice.4–6 The reasons for this will be addressed in more detail later in this chapter.
A deadly capillary leak attack. Clarkson’s disease: a narrative review
Published in Acta Clinica Belgica, 2022
E De Tandt, D Van Sassenbroeck, L Heireman, J Dierick, A Luyckx, S Verelst
Because of the similarities at presentation with a hypovolemic/distributive shock, the first treatment consists of targeted fluid resuscitation. Inadequate resuscitation can lead to stroke, other end-organ ischemia and even death, while overzealous fluid resuscitation can lead to anasarca, pulmonary edema and compartment syndrome [4,11,12,15]. Therefore, the volume status of the patient must be carefully monitored. In addition, haemodynamic monitoring remains crucial during the whole episode because of the lurking transitioning from the leaking phase to the recovery phase. Crystalloids are the fluids of choice. When insufficient, albumin or other colloids can be considered. However, the efficacy of albumin is expected to be attenuated due to the ongoing albumin loss which could have a counterproductive effect. Although hydroxyethyl starch solutions have been associated with an increased mortality and acute kidney injury in critically ill patients, the potential benefit of starches probably outweighs the risk in ISCLS patients with refractory shock [7,25].
Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients
Published in Current Medical Research and Opinion, 2020
Hemodynamic stabilization is a crucial element of supportive treatments for severe sepsis and septic shock recommended in the Surviving Sepsis Campaign (SSC) treatment bundle42,46. Early, aggressive use of crystalloid fluid is potentially detrimental. Accumulation of fluid, which is frequent not only in the salvage phase of resuscitation and in patients undergoing major surgery but also in ICU patients with AKI, is linked to higher mortality and impaired renal recovery47–49. Higher fluid balance on day 3 increases the risk of death from sepsis50. In the Sepsis Occurrence in Acutely ill Patients (SOAP) observational study, fluid balance was linked to survival in patients with AKI51. According to a recent cohort study, positive fluid balance in sepsis patients during the second 24-h period after ICU admission was associated with increased mortality, whereas mortality was decreased if a lower fluid balance was achieved; these effects were not evident in the first 24 h52. Given this observational evidence on the association of positive fluid balance with adverse outcomes, prospective RCTs should be able to confirm a causal relationship between a conservative approach to fluid management and increased survival.
The effect of preoperative nefopam treatment on postoperative catheter-related bladder discomfort in patients undergoing transurethral bladder tumor resection: a randomized double-blind study
Published in Scandinavian Journal of Urology, 2018
MiHye Park, Chan Hee Jee, Kyung-Hwa Kwak, Jun-Mo Park, Ji Hyo Kim
Before induction of spinal anesthesia, patients belonging to Group P received 100 mL of normal saline as placebo, and those in Group N received 20 mg of nefopam diluted in 100 mL of normal saline over 10 min. It was performed in the pre-anesthesia room by monitoring the non-invasive blood pressure, heart rate, and oxygen saturation. Electrocardiography, blood pressure, and oxygen saturation were monitored upon arrival in the operating room and subsequently every 5 min. A transverse line connecting the tops of the right and left iliac crests was defined as the L4–5 level. All patients received spinal anesthesia in the lateral decubitus position with 2 mL hyperbaric bupivacaine 0.5% through the L3–4 or L4–5 interspace using a midline approach with a 25 gauge Quincke needle. Before completion of intrathecal injection, intravenous crystalloid 5 mL/kg was administered. When the patient experienced either a greater than 30% decrease in systolic blood pressure from baseline values or a mean arterial blood pressure less than 60 mm Hg, intravenous ephedrine 4 mg or phenylephrine 50 mcg was administered. When the heart rate decreased to <45 beats/min, intravenous atropine 0.5 mg was administered. Intraoperative sedation was not provided.