Colloids in critical illness

2016 ◽  
Author(s):  
Andrew Webb
Keyword(s):  
Fluid Responsiveness ◽  
Plasma Volume ◽  
Venous Pressure ◽  
Fluid Challenge ◽  
Central Venous ◽  
Crystalloid Solution ◽  
Large Molecules ◽  
Circulating Volume ◽  
Reliable Increase ◽  
Volume Substitutes

Colloid solutions are homogenous mixtures of large molecules suspended in a crystalloid solution. The efficacy of colloids as volume substitutes or expanders, and length of effect are determined by their physicochemical properties. Smaller volumes of colloid than crystalloid are required for resuscitation. The primary use of colloids is in the correction of circulating volume. Rather than using fixed haemodynamic endpoints, fluid can be given in small aliquots with assessment of the dynamic haemodynamic response to each aliquot. The aim of a fluid challenge is to produce a small, but significant (200 mL) and rapid increase in plasma volume with changes in central venous pressure or stroke volume used to judge fluid responsiveness. Colloid fluids give a reliable increase in plasma volume to judge fluid responsiveness.

Therapeutic goals of fluid resuscitation

2016 ◽  
Author(s):  
Bashar S. Staitieh ◽  
Greg S. Martin
Keyword(s):  
Cardiac Output ◽  
Fluid Responsiveness ◽  
Venous Pressure ◽  
Systolic Pressure ◽  
Fluid Challenge ◽  
Tissue Perfusion ◽  
Pressure Variation ◽  
Fluid Administration ◽  
Waveform Analysis ◽  
Central Venous

Optimizing tissue perfusion by administering intravenous fluids presents a special challenge to the intensive care unit (ICU) clinician. Recent studies have drastically altered how we assess a patient’s fluid responsiveness, particularly with regard to upstream surrogates of tissue perfusion. Central venous pressure and pulmonary capillary wedge pressure have been found to be inaccurate markers of fluid responsiveness and have given way to methods such as cardiac output as assessed by echocardiography and the various forms of arterial waveform analysis. These newer techniques, such as stroke volume variation, systolic pressure variation, and pulse pressure variation, have been found to better delineate which patients will respond to a fluid challenge with an increase in cardiac output, and which will not. In addition, traditional methods of assessing the consequences of excessive fluid administration, such as pulmonary oedema and the non-anion gap acidosis of saline administration, have given way to more sophisticated measurements of extravascular lung water, now available at the bedside. Downstream markers of tissue perfusion, such as base deficit, central venous oxygen saturations, and lactic acid, continue to be useful in particular clinical settings, but are all relatively non-specific markers, and are therefore difficult to use as resuscitation targets for ICU patients in general. Finally, recent data on septic shock and ARDS have demonstrated the importance of conservative fluid strategies, while data in surgical populations have emphasized the need for judicious fluid administration and attention to the balance of blood products used in resuscitation efforts.

scholarly journals The Relation Between Common Carotid Artery Diameter and Central Venous Pressure for Assessment of Intravascular Fluid Status after Major Surgeries; an Observational Study

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Samaa A Kasem Rashwan ◽  
Ashraf Abd Elmawgood Bassiouny ◽  
Ahmed A Badawy ◽  
Ahmed Rabea Mohammed
Keyword(s):  
Carotid Artery ◽  
Central Venous Pressure ◽  
Common Carotid Artery ◽  
Venous Pressure ◽  
Fluid Challenge ◽  
Fluid Administration ◽  
Adult Patients ◽  
P Value ◽  
Central Venous ◽  
Spontaneously Breathing

Objectives: The current study aimed to find the relation between the changes in the common carotid artery (CCA) diameter and the central venous pressure (CVP) in response to a fluid challenge in spontaneously breathing adult patients. Methods: This study included 65 adult patients aged 20 - 60 years who were admitted to the surgical ICU. The CCA diameter and CVP were measured before and after fluid challenge, and the percentage of increase in the CCA diameter and CVP were calculated. The correlation was assessed between changes in the CVP and CCA diameter. Results: The CCA diameter before fluid administration had a significant strong positive correlation to the CVP (r = 0.8, P value < 0.001); the increase in the CCA diameter after fluid administration had a significant moderate positive correlation with the increase in the CVP (r = 0.4, P value < 0.001). The percentage of increase in CCA diameters was positively correlated to the percentage of increase in CVP (r = 0.589, P value = 0.001) following fluid administration. However, the Receiver Operating Characteristic (ROC) analysis was an invalid test (area under curve 0.513, P value = 0.885). Conclusions: After major surgeries, the change in the CCA diameter was positively correlated with the change in the CVP values in response to fluid administration in the spontaneously breathing adult patients, but the cut-off limit cannot be reached.

OPTIMAL CENTRAL VENOUS PRESSURE IN FLUID CHALLENGE IN SEVERE SEPSIS AND SEPTIC SHOCK.

2005 ◽  
Vol 33 ◽  
pp. A166
Author(s):  
Bogdan N Dobrin ◽  
Giulia Soldati ◽  
Marc Van Nuffelen ◽  
Jean-Louis Vincent
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Fluid Challenge ◽  
Central Venous ◽  
Sepsis And Septic Shock

ROLES OF SO2 INDEX FOR PREDICTING OF FLUID RESPONSIVENESS IN HIGH RISK CARDIAC SURGICAL PATIENTS

2015 ◽  
pp. 117-123
Author(s):  
Duc Hoang Doan ◽  
Duc Phu Bui ◽  
Van Minh Huynh
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Index ◽  
Fluid Responsiveness ◽  
Fluid Therapy ◽  
Oxygen Delivery ◽  
Venous Pressure ◽  
Fluid Loading ◽  
Pulmonary Artery Wedge Pressure ◽  
Central Venous ◽  
Wedge Pressure

Purpose: (1) Study the change in SO2 value in fluid therapy in patients after cardiac surgery; (2) Evaluate the role of SO2 monitoring in serving as an indicator of fluid responsiveness in patients after cardiac surgery. Methods: This was a prospective study reported earlier on critically ill patients with clinical hypovolemia after cardiac surgery. Fluid therapy was guided by changes in pulmonary artery wedge pressure or central venous pressure. Fluid responsiveness was defined as ≥15% increase in cardiac index. Hemodynamics, including left ventricular ejection fraction, cardiac index, and oxygen delivery were measured when SO2 blood samples taken. Results: There was 110 patients receiving fluid therapy in postoperative period. The SO2 increased in 104 patients responding to fluid loading (≥15% in cardiac index in n=107) versus those not responding (n=6). The increase in ejection fraction, cardiac index and oxygen delivery was also greater in responders (p=0.005). The area under the receiver operating characteristic curve for fluid responsiveness of changes in SO2 was 0.78 (p=0.05), with an optimal cutoff of 2%. The value of SO2 increased to reflect cardiac index increases with fluid loading was in 66.7% of patients. Conclusions: An increase in SO2 ≥ 2% can thus be used as an indicator of fluid responsiveness in clinically hypovolemic patients after cardiac surgery, particularly in those with systolic cardiac dysfunction. Fluid responsiveness concurs with increased tissue oxygen delivery. Key words: mixed venous oxygen saturation (SO2); oxygen delivery (DO2); oxygen consumption (VO2); central venous pressure (CVP), pulmonary artery wedge pressure (PAWP); cardiac index (CI); hypovolemia; fluid therapy.

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