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At a glance: The ONWARDS insulin icodec trials

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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Letter

The relationship between the decrease in haemoglobin concentration and the volume of fluids administered during resuscitation from septic shock may not be so “weak”

Author: Azriel Perel

Published in: Critical Care | Issue 1/2018

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Excerpt

In a retrospective analysis of the database of the ARISE trial [1], Maiden et al. [2] found an independent though weak association between haemoglobin concentration (Hgb) and the volume of fluids administered during resuscitation from septic shock. The volume infused accounted for less than 20% of the observed decrease in the Hgb, but the explanations for this decrease, other than haemodilution, seem unlikely even to the authors themselves [2]. A closer look at this study suggests a much stronger association between the volume infused and Hgb decrease. …
Literature
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Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371:1496–506.CrossRef
2.
Maiden MJ, Finnis ME, Peake S, McRae S, Delaney A, Bailey M, Bellomo R. Haemoglobin concentration and volume of intravenous fluids in septic shock in the ARISE trial. Crit Care. 2018;22:118.CrossRef
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Raghunathan K, Singh M, Nathanson BH, Bennett-Guerrero E, Lindenauer PK. Early blood transfusions in Sepsis: unchanged survival and increased costs. Am J Crit Care. 2018;27:205–11.CrossRef
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Perel A. Iatrogenic hemodilution: a possible cause for avoidable blood transfusions? Crit Care. 2017;21:291.CrossRef
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Hahn RG, Svensen C. Plasma dilution and the rate of infusion of Ringer's solution. Br J Anaesth. 1997;79:64–7.CrossRef
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Jansma G, de Lange F, Kingma WP, Vellinga NA, Koopmans M, Kuiper MA, et al. ‘Sepsis-related anemia’ is absent at hospital presentation; a retrospective cohort analysis. BMC Anesthesiol. 2015;15:55.CrossRef
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Nguyen BV, Bota DP, Melot C, Vincent JL. Time course of hemoglobin concentrations in nonbleeding intensive care unit patients. Crit Care Med. 2003;31:406–10.CrossRef
Metadata
Title
The relationship between the decrease in haemoglobin concentration and the volume of fluids administered during resuscitation from septic shock may not be so “weak”
Author
Azriel Perel
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2118-6

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