scholarly journals Relationship Between Fluid Therapy Strategies and Mortality Among Sepsis Patients in ICU with high CVP: A Retrospective Analysis of the eICU Database

2021 ◽  
Author(s):  
Penglei Yang ◽  
Rui Tan ◽  
Ruiqiang Zheng ◽  
Jun Shao ◽  
Jing Yuan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Chronic Heart Failure ◽  
Fluid Balance ◽  
Fluid Therapy ◽  
Sepsis Group ◽  
Positive Fluid Balance ◽  
Negative Fluid Balance ◽  
Positive Balance ◽  
History Of

Abstract Objective: It is still debated whether sepsis patients with high CVP (central venous pressure) benefit from it. We performed a retrospective study of sepsis patients with CVP ≥ 12 mmHg to analyze mortality resulting from the different amounts of fluid administered in the fluid therapy at the first 6, 24, and 48 h of the course.Methods: This study included sepsis patients from the eICU database who met the sepsis-3 diagnostic criteria and showed CVP ≥ 12 mmHg on admission. We analyzed the differences between the survivors and the non-survivors at baseline and the difference in fluid balance at 6, 24, and 48 h. Restricted cubic spline (RCS) and logistic regression model were used to identify the association between fluid balance and mortality.Results: Out of the 1150 sepsis patients that showed a high CVP obtained from the eICU database, 847 were survivors and 303 were non-survivors. Compared to survivors, non-survivors had a larger positive fluid balance at 6, 24, and 48 h. The fluid balance and mortality in sepsis patients with high CVP showed an inverted U-type relationship. At 6 h, lower mortality was found in patients who required less than -5 ml/kg fluid therapy. At 24 h, mortality was the lowest at -40~-20 ml/kg. At 48 h, low mortality was observed in patients with < -40 ml/kg fluid balance. In septic shock patients with high CVP, positive balance decrease mortality. In sepsis patients with high CVP without a history of chronic heart failure, and with a history of heart failure negative fluid balance can decrease mortality.Conclusion: In the sepsis group without shock, achieving negative fluid balance possible may significantly improve the prognosis of patients with high CVP, and patients with no history of chronic heart failure and patients with history of chronic heart failure should limit fluid infusion. In patients with septic shock whose CVP ≥ 12 mmHg, positive fluid balance may decrease mortality.

scholarly journals The effects of static and dynamic measurements using transpulmonary thermodilution devices on fluid therapy in septic shock: A systematic review

2020 ◽  
Vol 48 (1) ◽  
pp. 11-24
Author(s):  
Timothy G Scully ◽  
Yifan Huang ◽  
Stephen Huang ◽  
Anthony S McLean ◽  
Sam R Orde
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Fluid Balance ◽  
Fluid Therapy ◽  
Transpulmonary Thermodilution ◽  
Venous Pressure ◽  
Positive Fluid Balance ◽  
Central Venous ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy

Transpulmonary thermodilution devices have been widely shown to be accurate in septic shock patients in assessing fluid responsiveness. We conducted a systematic review to assess the relationship between fluid therapy protocols guided by transpulmonary thermodilution devices on fluid balance and the amount of intravenous fluid used in septic shock. We searched MEDLINE, Embase and The Cochrane Library. Studies were eligible for inclusion if they were prospective, parallel trials that were conducted in an intensive care setting in patients with septic shock. The comparator group was either central venous pressure, early goal-directed therapy or pulmonary artery occlusion pressure. Studies assessing only the accuracy of fluid responsiveness prediction by transpulmonary thermodilution devices were excluded. Two reviewers independently performed the search, extracted data and assessed the bias of each study. In total 27 full-text articles were identified for eligibility; of these, nine studies were identified for inclusion in the systematic review. Three of these trials used dynamic parameters derived from transpulmonary thermodilution devices and six used primarily static parameters to guide fluid therapy. There was evidence for a significant reduction in positive fluid balance in four out of the nine studies. From the available studies, the results suggest the benefit of transpulmonary thermodilution monitoring in the septic shock population with regard to reducing positive fluid balance is seen when the devices are utilised for at least 72 hours. Both dynamic and static parameters derived from transpulmonary thermodilution devices appear to lead to a reduction in positive fluid balance in septic shock patients compared to measurements of central venous pressure and early goal-directed therapy.

scholarly journals Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure

2021 ◽  
Author(s):  
S. Sze ◽  
P. Pellicori ◽  
J. Zhang ◽  
J. Weston ◽  
I. B. Squire ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Clinical Frailty Scale ◽  
Mineralocorticoid Receptor Antagonist ◽  
Reduced Ejection Fraction ◽  
Frail Patients ◽  
History Of ◽  
Poor Outcomes ◽  
To Receive

Abstract Background Frailty is common in patients with chronic heart failure (CHF) and is associated with poor outcomes. The natural history of frail patients with CHF is unknown. Methods Frailty was assessed using the clinical frailty scale (CFS) in 467 consecutive patients with CHF (67% male, median age 76 years, median NT-proBNP 1156 ng/L) attending a routine follow-up visit. Those with CFS > 4 were classified as frail. We investigated the relation between frailty and treatments, hospitalisation and death in patients with CHF. Results 206 patients (44%) were frail. Of 291 patients with HF with reduced ejection fraction (HeFREF), those who were frail (N = 117; 40%) were less likely to receive optimal treatment, with many not receiving a renin–angiotensin–aldosterone system inhibitor (frail: 25% vs. non-frail: 4%), a beta-blocker (16% vs. 8%) or a mineralocorticoid receptor antagonist (50% vs 41%). By 1 year, there were 56 deaths and 322 hospitalisations, of which 25 (45%) and 198 (61%), respectively, were due to non-cardiovascular (non-CV) causes. Most deaths (N = 46, 82%) and hospitalisations (N = 215, 67%) occurred in frail patients. Amongst frail patients, 43% of deaths and 64% of hospitalisations were for non-CV causes; 58% of cardiovascular (CV) deaths were due to advancing HF. Among non-frail patients, 50% of deaths and 57% of hospitalisations were for non-CV causes; all CV deaths were due to advancing HF. Conclusion Frailty in patients with HeFREF is associated with sub-optimal medical treatment. Frail patients are more likely to die or be admitted to hospital, but whether frail or not, many events are non-CV. Graphical abstract

scholarly journals Association of Positive Fluid Balance and Mortality in Sepsis and Septic Shock in An Australian Cohort

2017 ◽  
Vol 45 (6) ◽  
pp. 737-743 ◽  
Author(s):  
M. G. Pittard ◽  
S. J. Huang ◽  
A. S. McLean ◽  
S. R. Orde
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Confidence Intervals ◽  
Fluid Balance ◽  
Severity Of Illness ◽  
Primary Outcome Measure ◽  
Published Data ◽  
Positive Fluid Balance ◽  
Retrospective Audit ◽  
Sepsis And Septic Shock

In patients with septic shock, a correlation between positive fluid balance and worsened outcomes has been reported in multiple observational studies worldwide. No published data exists in an Australasian cohort. We set out to explore this association in our institution. We conducted a retrospective audit of patient records from August 2012 to May 2015 in a single-centre, 24-bed surgical and medical intensive care unit (ICU) in Sydney, Australia. All patients with septic shock were included. Exclusion criteria included length of stay less than 24 hours or vasopressors needed for less than six hours. Data was gathered on fluid balance for the first seven days of ICU admission, biochemical data and other clinical indices. The primary outcome measure was survival to hospital discharge. One hundred and eighty-six patients with septic shock were included, with an overall hospital mortality of 23.7%. Seventy-five percent of patients required mechanical ventilation, and 27.4% required haemodialysis. The mean daily fluid balance on the first day of admission was positive 1,424 ml and 1,394 ml for ICU and hospital survivors, respectively. On average, the daily fluid balance for non-survivors was higher than the survivors: ICU non-survivors were 602 (95% confidence intervals 230, 974) ml (P=0.0015) and hospital non-survivors were 530 [95% confidence intervals 197, 863] ml (P=0.0017) higher than the survivors. In line with other recently published data, after adjustment for confounders (severity of illness based on the Acute Physiology and Chronic Health Evaluation score) we found a correlation between positive fluid balance and worsened hospital mortality in critically ill patients with sepsis and septic shock. Further research investigating rational use of fluids in this patient group is needed.

Emerging Therapies for Acute and Chronic Heart Failure

2016 ◽  
Vol 29 (1) ◽  
pp. 46-57 ◽  
Author(s):  
Sarah Hanigan ◽  
Robert J. DiDomenico
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiovascular Death ◽  
Phase 3 ◽  
Reduced Ejection Fraction ◽  
Emerging Therapies ◽  
Treat Heart Failure ◽  
Novel Drugs ◽  
The Us ◽  
History Of

Although the period from 1953 to 2001 resulted in the approval of more than 30 medications currently used to treat heart failure (HF), few novel drugs have been approved in the last decade. However, the investigational pipeline for HF medications once again appears promising. In patients with chronic heart failure with reduced ejection fraction (HFrEF), ivabradine and valsartan/sucubitril (LCZ696) were recently approved by the US Food and Drug Administration. Both agents have been shown to reduce the risk of cardiovascular death and HF hospitalization. In the treatment of acute HF, serelaxin and ularitide are the farthest along in development. Both agents have demonstrated favorable effects on surrogate end points and preliminary data suggest a possible mortality benefit with serelaxin. Consequently, phase 3 trials are ongoing to evaluate the effect of serelaxin and ularitide on clinical outcomes. Given the poor history of recent investigational acute HF drugs that have advanced to phase 3/4 studies, enthusiasm for both serelaxin and ularitide must be tempered until these trials are completed.

Problems arising when a system of automated weight monitoring is introduced into the home as part of the care for patients with chronic heart failure

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 29-31 ◽  
Author(s):  
Glenis Johnston ◽  
Gwyneth Weatherburn ◽  
Stephen Ward ◽  
Julie Hendry
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Monitoring System ◽  
Thematic Analysis ◽  
Electronic Monitoring ◽  
Call Centre ◽  
Telemedicine System ◽  
Telemedicine Service ◽  
History Of ◽  
Weight Monitoring

Patients with a history of chronic heart failure participated in a study to evaluate a home telemedicine system which monitored their weight daily. Within three weeks of beginning the study, interviews were conducted with patients (n = 5), their partners (n = 4) and their heart failure nurses (n = 3). A thematic analysis was carried out in order to probe their experiences of the illness and their perception of how telemedicine might affect those experiences. When asked, the participants and their partners did not consider that the electronic monitoring system would be much use to them. Nurses also had a number of misconceptions about the telemedicine service. The results demonstrated that patients needed better education, both in the management of their condition and in the use of the telemedicine equipment and the service provided by the call centre, before the telemedicine system could fulfil its potential.

Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock

2015 ◽  
Vol 30 (1) ◽  
pp. 97-101 ◽  
Author(s):  
Fernando Saes Vilaça de Oliveira ◽  
Flavio Geraldo Resende Freitas ◽  
Elaine Maria Ferreira ◽  
Isac de Castro ◽  
Antonio Toneti Bafi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Severe Sepsis ◽  
Prognostic Factor ◽  
Fluid Balance ◽  
Kidney Injury ◽  
Positive Fluid Balance ◽  
Sepsis And Septic Shock

Positive fluid balance as a major predictor of clinical outcome of patients with sepsis/septic shock after ICU discharge

2016 ◽  
Vol 34 (11) ◽  
pp. 2122-2126 ◽  
Author(s):  
Evgeni Brotfain ◽  
Leonid Koyfman ◽  
Ronen Toledano ◽  
Abraham Borer ◽  
Lior Fucs ◽  
...  
Keyword(s):  
Septic Shock ◽  
Clinical Outcome ◽  
Fluid Balance ◽  
Positive Fluid Balance ◽  
Icu Discharge ◽  
Major Predictor

scholarly journals ACUTE HEART FAILURE PATIENTS

2016 ◽  
Vol 23 (10) ◽  
pp. 1281-1287
Author(s):  
Naeem Asghar ◽  
Shakeel Ahmad ◽  
Muhammad Nazim ◽  
Hafiz Muhammad Faiq Ilyas ◽  
Muhammad Nouman Ahmad
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Acute Heart Failure ◽  
De Novo ◽  
Uncontrolled Hypertension ◽  
Diabetic Patients ◽  
Study Group ◽  
Acute Decompensation ◽  
History Of ◽  
Precipitating Factor

Objectives: The objective of the study is to identify the precipitating factorsamong the patients presenting with AHF (Acute Heart Failure). Study Design: Cross sectionalstudy. Setting: Punjab Institute of Cardiology, Lahore. Duration of Study: 6 months. From01-01-2007 to 30-06-2007. Methodology: The calculated sample size was 170 cases with 5%margin of error, 95% confidence level taking expected percentage of uncontrolled hypertensioni.e. 12% (least percentage among all precipitating factors). Results: In the study group, mostlypatients of AHF were young with mean age of 55 + 6.99 years, male (61.8%), Diabetic (53.5%)and have history of chronic Heart Failure (63.5%). In male the most common precipitating factorof AHF was ACS (39.04%) while in female uncontrolled hypertension (38.46%). Conclusion:In diabetic patients the most common precipitating factor of AHF was ACS (30.7%). In patientswith acute decompensation of chronic heart failure the most common precipitating factor wasnon-compliance of medication (30.55%) while in patients with de novo Acute Heart Failure itwas ACS (41.93%). ACS was the common precipitating factor of Acute Heart Failure (28.2%)among the study group irrespective of gender, diabetes and history of Heart Failure.

scholarly journals Beta-blockers, and real clinical practice in Russia: the gap between the understanding of the doses of beta-blockers and subsequent prognosis in patients with cardiovascular disease

2017 ◽  
Vol 14 (3) ◽  
pp. 36-41
Author(s):  
I V Fomin ◽  
D S Polyakov
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Chronic Heart Failure ◽  
Beta Blockers ◽  
Previous History ◽  
Clinical Manifestations ◽  
Population Level ◽  
Cardiovascular Pathology ◽  
History Of

Presents an analysis of the reception beta-blockers in three epidemiological studies sections of the EPOKhA. Respondents in each slice (2002, 2007, 2017) were stratified into 5 subgroups: only suffering from hypertension - AH (subgroup AH), patients with stable angina pectoris, but in history and clinically has no evidence of acute myocardial infarction (AMI) and chronic heart failure (subgroup of coronary heart disease); after myocardial infarction, but do not have clinical manifestations of chronic heart failure (subgroup myocardial infarction); patients with acute myocardial infarction formed for any reason, but with no previous history of AMI (subgroup chronic heart failure), and patients with clinical manifestations of chronic heart failure after suffering AMI in anamnesis (subgroup myocardial infarction + chronic heart failure). During 15 years in the Russian Federation the frequency of administration of beta-blockers increased from 20% in the section of cardiovascular pathology to 30%. The most sensitive to the use of beta-blockers were patients with a history of AMI and chronic heart failure. Prolonged beta-blockers have been used at the population level only in 2007, but the frequency with any cardiovascular pathology does not exceed the 50% threshold, and the achievement of goals (control heart rate) does not exceed 10% of the level at any pathology. This dependence is associated with low-dose beta-blockers. In any case, the dose of beta-blockers did not exceed 50% of recommended that can be a separate cause of cardiovascular mortality at the population level in Russia.

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