Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy

Fluid management is a cornerstone in the treatment of burns and, thus, many different formulas were tested for their ability to match the fluid requirements for an adequate resuscitation. Thereof, the Parkland-Baxter formula, first introduced in 1968, is still widely used since then. Though using nearly the same formula to start off, the definition of normovolemia and how to determine the volume status of burn patients has changed dramatically over years. In first instance, the invention of the transpulmonary thermodilution (TTD) enabled an early goal directed fluid therapy with acceptable invasiveness. Furthermore, the introduction of point of care ultrasound (POCUS) has triggered more individualized schemes of fluid therapy. This article explores the historical developments in the field of burn resuscitation, presenting different options to determine the fluid requirements without missing the red flags for hyper- or hypovolemia. Furthermore, the increasing rate of co-morbidities in burn patients calls for a more sophisticated fluid management adjusting the fluid therapy to the actual necessities very closely. Therefore, formulas might be used as a starting point, but further fluid therapy should be adjusted to the actual need of every single patient. Taking the developments in the field of individualized therapies in intensive care in general into account, fluid management in burn resuscitation will also be individualized in the near future.

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CONSERVATIVE, LIBERAL, OR BOTH? AN ANALYSIS OF FLUID MANAGEMENT IN ACUTE LUNG INJURY SECONDARY TO SEPTIC SHOCK

CHEST Journal ◽

10.1378/chest.134.4_meetingabstracts.p89003 ◽

2008 ◽

Vol 134 (4) ◽

pp. 89P

Author(s):

Claire V. Murphy ◽

Scott T. Micek ◽

Marin H. Kollef

Keyword(s):

Septic Shock ◽

Acute Lung Injury ◽

Lung Injury ◽

Fluid Management

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PLETH VARIABILITY INDEX-GUIDED FLUID THERAPY LOWERS POST-OPERATIVE LACTATE LEVELS IN DOGS UNDERGOING ELECTIVE ABDOMINAL SURGERY: A RANDOMIZED CONTROLLED TRIAL

Taiwan Veterinary Journal ◽

10.1142/s168264851750010x ◽

2018 ◽

Vol 44 (01) ◽

pp. 7-14

Author(s):

Chun-Hsiang Hu ◽

Tien-Huan Hsu ◽

Kuan-Sheng Chen ◽

Wei-Ming Lee ◽

Hsien-Chi Wang

Keyword(s):

Abdominal Surgery ◽

Fluid Therapy ◽

Controlled Trial ◽

Fluid Management ◽

Tissue Perfusion ◽

Control Group ◽

Pleth Variability Index ◽

Elective Abdominal Surgery ◽

Variability Index ◽

Lactate Levels

To evaluate the hemodynamic optimization effect of pleth variability index (PVI)-guided fluid therapy during abdominal surgery on tissue perfusion, 19 client-owned dogs that underwent elective abdominal surgery were randomized into control ([Formula: see text]) and PVI ([Formula: see text]) groups. In the control group, perioperative fluid management was based on the 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats. In the PVI group, the fluid rate was maintained based on basic daily requirements. If PVI was higher than 15% for [Formula: see text][Formula: see text]min, 3–5[Formula: see text]mL/kg of crystalloid fluid bolus was infused. The tissue perfusion indicator, lactate levels, was measured at the time of intubation, extubation, and 6, 12 and 24[Formula: see text]h postoperatively. There were no significant differences in total and average fluid infused between control and PVI groups. The control group had significantly higher lactate levels than that of the PVI group at 12[Formula: see text]h postoperatively ([Formula: see text][Formula: see text]mmol/L versus [Formula: see text][Formula: see text]mmol/L, [Formula: see text]) and overall postoperatively ([Formula: see text][Formula: see text]mmol/L versus [Formula: see text][Formula: see text]mmol/L, [Formula: see text]). The control group revealed more profound hemodilution, as indicated by significantly decreased postoperative blood urea nitrogen (BUN), creatinine, and total protein. PVI-guided fluid therapy lowers lactate levels after elective abdominal surgery in dogs. Therefore, based on the result of this study PVI may provide customized fluid therapy to improve tissue perfusion and avoid unnecessary fluid overload.

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Conservative versus liberal fluid therapy for initial severe sepsis and septic shock

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd010593 ◽

2013 ◽

Cited By ~ 1

Author(s):

Danyang Li ◽

Xueyang Li ◽

Wei Cui ◽

Huahao Shen ◽

Hong Zhu ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Fluid Therapy ◽

Sepsis And Septic Shock

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Comparison between Glucose Containing Solution D2.5% and Ringer Lactate as a Maintenance Fluid Management in Infants Undergoing Inguinal Hernia Repair

QJM ◽

10.1093/qjmed/hcab086.074 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammed Hosny Hasan Mohamed ◽

Dalia Abd El Hameed Mohamad Nasr ◽

Amin Mohamed El Ansary

Keyword(s):

Body Weight ◽

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Fluid Therapy ◽

Fluid Management ◽

The Other ◽

Ringer Lactate ◽

Maintenance Fluid ◽

Maintenance Fluid Therapy

Abstract Background Infants and neonates are at particular risk of hypoglycemia when suffering from sepsis, asphyxia and hypothermia. A prospective study showed that up to 20% of preterm infants who were ready for discharge were still at risk of hypoglycemia when a feed was delayed. In contrast, surgery and critical illness may cause hyperglycemia. Objectives The aim of this study is to Assessment of glucose containing solutions 2.5 % as a maintenance fluid management intra operative in infants undergoing hernia repair as regard hyperglycemia and hypoglycemia. Patients and Methods The study was conducted on 100 randomly chosen patients aged from 28 days to 1 year, American Society of Anesthesiologists (ASA) class I scheduled for elective open inguinal hernia repair in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 50 patients each: Ringer lactate Group: patients received ringer lactate as maintenance fluid therapy according to body weight, glucose containing solution: patients received glucose containing solution 2.5% as maintenance fluid therapy according to body weight. Results The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia . Conclusion The usage of glucose containing solution 2.5% remained controversial, in this study we compared glucose 2.5 % in normal saline 0,9 % to ringer lactate and the results didn’t put a final decision to the usage of glucose containing solutions as The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia.

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