early fluid
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2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Gladis Kabil ◽  
Steven A. Frost ◽  
Deborah Hatcher ◽  
Amith Shetty ◽  
Jann Foster ◽  
...  

Abstract Background Early intravenous fluids for patients with sepsis presenting with hypoperfusion or shock in the emergency department remains one of the key recommendations of the Surviving Sepsis Campaign guidelines to reduce mortality. However, compliance with the recommendation remains poor. While several interventions have been implemented to improve early fluid administration as part of sepsis protocols, the extent to which they have improved compliance with fluid resuscitation is unknown. The factors associated with the lack of compliance are also poorly understood. Methods We conducted a systematic review, meta-analysis and narrative review to investigate the effectiveness of interventions in emergency departments in improving compliance with early fluid administration and examine the non-interventional facilitators and barriers that may influence appropriate fluid administration in adults with sepsis. We searched MEDLINE Ovid/PubMed, Ovid EMBASE, CINAHL, and SCOPUS databases for studies of any design to April 2021. We synthesised results from the studies reporting effectiveness of interventions in a meta-analysis and conducted a narrative synthesis of studies reporting non-interventional factors. Results We included 31 studies out of the 825 unique articles identified in the systematic review of which 21 were included in the meta-analysis and 11 in the narrative synthesis. In meta-analysis, interventions were associated with a 47% improvement in the rate of compliance [(Random Effects (RE) Relative Risk (RR) = 1.47, 95% Confidence Interval (CI), 1.25–1.74, p-value < 0.01)]; an average 24 min reduction in the time to fluids [RE mean difference = − 24.11(95% CI − 14.09 to − 34.14 min, p value < 0.01)], and patients receiving an additional 575 mL fluids [RE mean difference = 575.40 (95% CI 202.28–1353.08, p value < 0.01)]. The compliance rate of early fluid administration reported in the studies included in the narrative synthesis is 48% [RR = 0.48 (95% CI 0.24–0.72)]. Conclusion Performance improvement interventions improve compliance and time and volume of fluids administered to patients with sepsis in the emergency department. While patient-related factors such as advanced age, co-morbidities, cryptic shock were associated with poor compliance, important organisational factors such as inexperience of clinicians, overcrowding and inter-hospital transfers were also identified. A comprehensive understanding of the facilitators and barriers to early fluid administration is essential to design quality improvement projects. PROSPERO Registration ID CRD42021225417.


2021 ◽  
Vol 10 (11) ◽  
pp. 4288-4297
Author(s):  
Haiyan Jiang ◽  
Yuting Ren ◽  
Guangdong Qi ◽  
Yue Wang ◽  
Cheng Xu ◽  
...  

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiangmei Kong ◽  
Yueniu Zhu ◽  
Xiaodong Zhu

Abstract Background Positive fluid overload (FO) may cause adverse effect. This study retrospectively analyzed the relationship between early FO and in-hospital mortality in children with mechanical ventilation (MV) in pediatric intensive care unit (PICU). Methods This study retrospectively enrolled 309 children (ages 28 days to 16 years) receiving invasive MV admitted to the PICU of Xinhua Hospital from March 2014 to March 2019. Children receiving MV for less than 48 h were excluded. The FO in the first 3 days of MV was considered to the early FO. Patients were divided into groups according to early FO and survival to evaluate the associations of early FO, percentage FO(%FO) > 10%, and %FO > 20% with in-hospital mortality. Results A total of 309 patients were included. The mean early FO was 8.83 ± 8.81%, and the mortality in hospital was 26.2% (81/309). There were no significant differences in mortality among different FO groups (P = 0.053) or in early FO between survivors and non-survivors (P = 0.992). Regression analysis demonstrated that use of more vasoactive drugs, the presence of multiple organ dysfunction syndrome, longer duration of MV, and a non-operative reason for PICU admission were related to increased mortality (P < 0.05). Although early FO and %FO > 10% were not associated with in-hospital mortality (β = 0.030, P = 0.090, 95% CI = 0.995–1.067; β = 0.479, P = 0.153, 95% CI = 0.837–3.117), %FO > 20% was positively correlated with mortality (β = 1.057, OR = 2.878, P = 0.029, 95% CI = 1.116–7.418). Conclusions The correlation between early FO and mortality was affected by interventions and the severity of the disease, but %FO > 20% was an independent risk factor for in-hospital mortality in critically ill MV-treated children.


2021 ◽  
Vol 10 (21) ◽  
pp. 4873
Author(s):  
Chieh-Liang Wu ◽  
Kai-Chih Pai ◽  
Li-Ting Wong ◽  
Min-Shian Wang ◽  
Wen-Cheng Chao

Fluid balance is an essential issue in critical care; however, the impact of early fluid balance on the long-term mortality in critically ill surgical patients remains unknown. This study aimed to address the impact of day 1–3 and day 4–7 fluid balance on the long-term mortality in critically ill surgical patients. We enrolled patients who were admitted to surgical intensive care units (ICUs) during 2015–2019 at a tertiary hospital in central Taiwan and retrieved date-of-death from the Taiwanese nationwide death registration profile. We used a Log-rank test and a multivariable Cox proportional hazards regression model to determine the independent mortality impact of early fluid balance. A total of 6978 patients were included for analyses (mean age: 60.9 ± 15.9 years; 63.9% of them were men). In-hospital mortality, 90-day mortality, 1-year and overall mortality was 10.3%, 15.8%, 23.8% and 31.7%, respectively. In a multivariable Cox proportional hazard regression model adjusted for relevant covariates, we found that positive cumulative day 4–7 fluid balance was independently associated with long-term mortality (aHR 1.083, 95% CI 1.062–1.105), and a similar trend was found on day 1–3 fluid balance, although to a lesser extent (aHR 1.027, 95% CI 1.011–1.043). In conclusion, the fluid balance in the first week of ICU stay, particularly day 4–7 fluid balance, may affect the long-term outcome in critically ill surgical patients.


2021 ◽  
Author(s):  
Christina M. Moloney ◽  
Sydney A. Labuzan ◽  
Julia E. Crook ◽  
Habeeba Siddiqui ◽  
Monica Castanedes-Casey ◽  
...  

AbstractAlzheimer’s disease (AD) biomarkers have become increasingly more reliable in predicting AD pathology. While phosphorylated tau fluid biomarkers have been studied for over 20 years, there is a lack of deep characterization of these sites in the postmortem brain. Neurofibrillary tangle-bearing neurons, one of the major neuropathologic hallmarks of AD, undergo morphologic changes that mature along a continuum as hyperphosphorylated tau aggregates. To facilitate interpretation of phosphorylated tau sites as an early fluid biomarker, our goal was to characterize which neurofibrillary tangle maturity levels (pretangle, intermediary 1, mature tangle, intermediary 2, and ghost tangle) they recognize. We queried the Florida Autopsied Multi-Ethnic (FLAME) cohort for cases from Braak stages I-VI. We excluded non-AD pathologies and tauopathies. A total of 24 cases, 2 males and 2 females for each Braak stage, were selected. We performed immunohistochemistry on the posterior hippocampus using antibodies directed towards phospho (p) threonine (T) 181, pT205, pT217, and pT231. Slides were digitized to enable quantification of tau burden. To examine differences in regional vulnerability between CA1 and subiculum, we developed a semi-quantitative system to rank the frequency of each neurofibrillary tangle maturity level. We identified all neurofibrillary tangle maturity levels at least once for each phosphorylated tau site. Primarily earlier neurofibrillary tangle maturity levels (pretangle, intermediary 1, mature tangle) were recognized for all phosphorylated tau sites. There was an increase in tau burden in the subiculum compared to CA1; however, this was attenuated compared to thioflavin-S positive tangle counts. On a global scale, tau burden generally increased with each Braak stage. These results provide neurobiologic evidence that these phosphorylated tau fluid biomarker sites are present during earlier neurofibrillary tangle maturity levels. This may help explain why these phosphorylated tau biomarker sites are observed before symptom onset in fluids.


2021 ◽  
Author(s):  
Xiangmei Kong ◽  
Xiaodong Zhu ◽  
Yueniu Zhu

Abstract Background: This study retrospectively analyzed the relationship between early fluid overload(FO) and in-hospital mortality in Children with mechanical ventilation in pediatric intensive care unit.Methods: Patients who were on mechanical ventilation (MV) for≥48 h and aged over 28 days and less than 18 years from March 2014 to March 2019 in department of PICU, Xinhua hospital. Daily FO was calculated as {(daily fluid intake-daily fluid output)/weight at ICU admission * 100%}.We defined the early FO as the FO in the first three days of mechanical ventilation, and divided it into four bands: %FO ≤ 0%, 0%<%FO≤ 10%, 10%<%FO≤ 20%, and %FO > 20%. We compared the mortality in discharge between groups with different FO. We also compared the early FO between survivors and non-survivors. Multivariate stepwise logistic regression analysis was used to analyze the prognostic factors of mortality in hospital.Results: 309 patients were included. There were 202 cases in non-operative and 107 cases in operative. The mean early FO was 8.83 ± 8.81%, and the mortality in hospital was 26.2% (81/309). The percentage of % FO>10% was in present 41.4%(131/309) and %FO>20% was in present 8.7% (27/309). There was no significant difference in discharge-mortality between different FO groups(p=0.053) and in FO between survivors and non-survivors(p=0.992). Regression analysis demonstrated that the more vasoactive drugs, the presence of MODS, the longer duration of MV, and the non-operation reason for PICU admission were related to the increase of mortality(p<0.05); although early FO and %FO>10% were not associated with in-hospital mortality(β=0.030, p=0.090, 95% C.I.=0.995~1.067; β=0.479, p=0.153, 95% C.I.= 0.837~3.117), %FO>20% was related to the increase of mortality (β=1.057, OR=2.878, p=0.029, 95% C.I.=1.116~7.418). There was positive correlation between early FO and LOS in PICU (r=0.148, p=0.009), but the relation is weak.Conclusions: Affected by interventions and the severity of the disease, the correlation between the early FO and %FO>10% with mortality was not clear, but %FO>20% was related to the increase of mortality in critically-ill mechanically ventilated Children. Trial registration: Not applicable


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Heidy Hendra ◽  
Dinesha Sudusinghe ◽  
James Greenan-Barrett ◽  
Melissa Chowdhury ◽  
David Mathew ◽  
...  

Abstract Background and Aims Initial WHO guidance advised cautious fluid administration for patients with COVID-19 due to concern about the development of acute respiratory distress syndrome (ARDS). However, as the pandemic unfolded it became apparent that patients who were admitted to hospital had high rates of AKI and this initiated a change in local clinical guidelines during early April 2020. We aimed to ascertain the impact of judicious intravenous fluid use on mortality, length of hospitalisation and AKI. Method An observational cohort study of 158 adults admitted with confirmed SARS-Cov-2 between 18th March and 9th May 2020 was conducted in a teaching hospital and designated centre for infectious diseases, London, UK. Key clinical and demographic data collected included clinical severity markers on admission, biochemical and haematological parameters as well as radiological findings. Primary outcomes were inpatient mortality, mortality at 6-weeks post discharge, length of hospitalisation and intensive care (ICU) admission. We also measured requirement for kidney replacement therapy (KRT) and AKI recovery rate at discharge. Using tests of difference, we compared key outcomes between patients treated with varying fluid regimens and then identified risk factors for AKI and mortality using multivariate logistic regression with results expressed as odds ratios (OR) with corresponding 95% confidence interval (CI). Results The median age was 74.4 (IQR 59.90 - 84.35) years, 66% were male, 53% white with hypertension and diabetes being the commonest co-morbidities. The median duration of illness prior to admission was 7 days (IQR 2 – 10) with respiratory symptoms and fever most prevalent. The people who presented with AKI on admission were more likely to receive fluids (34% vs 15%, p=0.02). 118 patients (75%) received fluids within 24-hours of admission with no difference in volume administered after local guidance change (p=0.78). Comparing patients receiving fluids with those who did not, we observed no difference in mortality (p=0.97), duration of hospital stays (p=0.26) or requirement for ICU admission (p=0.70). 18% died as an inpatient, and 52 patients were either admitted with or developed AKI. Of these 52 patients, 43 received fluids and 9 did not with no difference in KRT requirement (p=0.34), mortality (p=0.50) or AKI recovery (p=0.63). Peak AKI stage was greater among participants who received fluids though stage of AKI at presentation was also greater (p=0.04). Mortality rate in patients with an AKI is higher compared to overall inpatient mortality (31% vs 18%). Of the 36 patients with AKI who were discharged home, 25 patients (69.4%) had renal recovery by the time of discharge. Increasing age and clinical severity on admission were associated with higher mortality (see Figure 1). Older age was associated with 34 - 53 times higher risk of death compared with those aged ≤ 65 years (age 76 - 85 years: OR 34.26, 95% CI: 3.94 - 297.48, p=0.001; age &gt; 85 years: OR 53.07, 95% CI: 5.23 - 539.03, p=0.001). Patients with NEWS2 &gt;4 on admission has 5-fold increased risk of death than those with a score ≤4 (OR 5.26, 95% CI: 1.32 - 20.92). Black ethnicity was associated with a 16-fold increased risk of developing AKI (OR 15.86, 95% CI: 1.67 - 150.99). Conclusion To our knowledge, this is the first study to examine the impact of fluid management on inpatient mortality as well as on renal-associated outcomes of COVID-19 admission. Fluid administration regimen did not have an impact on mortality, length of hospitalisation or ICU admission, nor did it affect renal outcomes. Given the high rates of AKI and KRT in COVID-19 disease, early fluid administration is likely to be an important cornerstone of future management. Further adequately powered prospective studies are required to identify whether early fluid administration can reduce renal injury.


Author(s):  
Sarah Anne Ingelse ◽  
Marloes M IJland ◽  
Lex M. van Loon ◽  
Reinout A Bem ◽  
Job BM van Woensel ◽  
...  

Background: Intravenous fluids are widely used to treat circulatory deterioration in pediatric acute respiratory distress syndrome (PARDS). However, the accumulation of fluids in the first days of PARDS is associated with adverse outcome. As such, early fluid restriction may prove beneficial, yet the effects of such a fluid strategy on the cardio-pulmonary physiology in PARDS is unclear. In this study, we compared the effect of a restrictive to a liberal fluid strategy on hemodynamic response and the formation of pulmonary edema in an animal model of PARDS. Methods: Sixteen mechanically ventilated lambs (2-6 weeks) received oleic acid infusion to induce PARDS and were randomized to a restrictive or liberal fluid strategy during a 6-hour period of mechanical ventilation. Transpulmonary thermodilution determined extravascular lung water (EVLW) and cardiac output (CO) Post-mortem lung wet-to-dry weight ratios were obtained by gravimetry. Results: Restricting fluids significantly reduced fluid intake, but increased use of vasopressors among animals with PARDS. Arterial blood pressure was similar between groups, yet CO declined significantly in animals receiving restrictive fluids (p=0.005). There was no difference in EVLW over time (p=0.111) and lung wet-to-dry weight ratio (6.1 IQR 6.0-7.3 vs. 7.1 IQR 6.6-9.4 restrictive vs. liberal, p=0.725) between fluid strategies. Conclusions: Both fluid strategies stabilized blood pressure in this model, yet early fluid restriction abated CO. Early fluid restriction did not limit the formation of pulmonary edema, therefore this study suggests that in the early phase of PARDS a restrictive fluid strategy is not beneficial in terms of immediate cardio-pulmonary effects.


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