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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2014

Open Access 01-12-2014 | Research

Duration of hemodynamic effects of crystalloids in patients with circulatory shock after initial resuscitation

Authors: Thieme Souza Oliveira Nunes, Renata Teixeira Ladeira, Antônio Tonete Bafi, Luciano Cesar Pontes de Azevedo, Flavia Ribeiro Machado, Flávio Geraldo Rezende Freitas

Published in: Annals of Intensive Care | Issue 1/2014

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Abstract

Background

In the later stages of circulatory shock, monitoring should help to avoid fluid overload. In this setting, volume expansion is ideally indicated only for patients in whom the cardiac index (CI) is expected to increase. Crystalloids are usually the choice for fluid replacement. As previous studies evaluating the hemodynamic effect of crystalloids have not distinguished responders from non-responders, the present study was designed to evaluate the duration of the hemodynamic effects of crystalloids according to the fluid responsiveness status.

Methods

This is a prospective observational study conducted after the initial resuscitation phase of circulatory shock (>6 h vasopressor use). Critically ill, sedated adult patients monitored with a pulmonary artery catheter who received a fluid challenge with crystalloids (500 mL infused over 30 min) were included. Hemodynamic variables were measured at baseline (T0) and at 30 min (T1), 60 min (T2), and 90 min (T3) after a fluid bolus, totaling 90 min of observation. The patients were analyzed according to their fluid responsiveness status (responders with CI increase >15% and non-responders ≤15% at T1). The data were analyzed by repeated measures of analysis of variance.

Results

Twenty patients were included, 14 of whom had septic shock. Overall, volume expansion significantly increased the CI: 3.03 ± 0.64 L/min/m2 to 3.58 ± 0.66 L/min/m2 (p < 0.05). From this period, there was a progressive decrease: 3.23 ± 0.65 L/min/m2 (p < 0.05, T2 versus T1) and 3.12 ± 0.64 L/min/m2 (p < 0.05, period T3 versus T1). Similar behavior was observed in responders (13 patients), 2.84 ± 0.61 L/min/m2 to 3.57 ± 0.65 L/min/m2 (p < 0.05) with volume expansion, followed by a decrease, 3.19 ± 0.69 L/min/m2 (p < 0.05, T2 versus T1) and 3.06 ± 0.70 L/min/m2 (p < 0.05, T3 versus T1). Blood pressure and cardiac filling pressures also decreased significantly after T1 with similar findings in both responders and non-responders.

Conclusions

The results suggest that volume expansion with crystalloids in patients with circulatory shock after the initial resuscitation has limited success, even in responders.
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Literature
1.
2.
Funk DJ, Jacobsohn E, Kumar A: Role of the venous return in critical illness and shock: part II-shock and mechanical ventilation. Crit Care Med 2013,41(2):573–579.PubMedCrossRef
3.
Michrd F, Teboul JL: Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 2002,121(6):2000–2008.CrossRef
4.
5.
Cordemans C, De Laet I, Van Regenmortel N, Schoonheydt K, Dits H, Huber W, Malbrain ML: Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance. Ann Intensive Care 2012, 2(Suppl 1):S1.PubMedCentralPubMedCrossRef
6.
Durairaj L, Schmidt GA: Fluid therapy in resuscitated sepsis: less is more. Chest 2008,133(1):252–263.PubMedCrossRef
7.
Ragaller MJ, Theilen H, Koch T: Volume replacement in critically ill patients with acute renal failure. J Am Soc Nephrol 2001,12(Suppl 17):S33-S39.PubMed
8.
Freitas FG, Bafi AT, Nascente AP, Assunção M, Mazza B, Azevedo LC, Machado FR: Predictive value of pulse pressure variation for fluid responsiveness in septic patients using lung-protective ventilation strategies. Br J Anaesth 2013,110(3):402–408.PubMedCrossRef
9.
Michard F: Changes in arterial pressure during mechanical ventilation. Anesthesiology 2005,103(2):419–428. quiz 449–415PubMedCrossRef
10.
11.
Jacob M, Chappell D, Hofmann-Kiefer K, Helfen T, Schuelke A, Jacob B, Burges A, Conzen P, Rehm M: The intravascular volume effect of Ringer’s lactate is below 20%: a prospective study in humans. Crit Care 2012, 16(3):R86.PubMedCentralPubMedCrossRef
12.
Lobo DN, Stanga Z, Aloysius MM, Wicks C, Nunes QM, Ingram KL, Risch L, Allison SP: Effect of volume loading with 1 liter intravenous infusions of 0.9% saline, 4% succinylated gelatine (Gelofusine) and 6% hydroxyethyl starch (Voluven) on blood volume and endocrine responses: a randomized, three-way crossover study in healthy volunteers. Crit Care Med 2010,38(2):464–470.PubMedCrossRef
13.
McIlroy DR, Kharasch ED: Acute intravascular volume expansion with rapidly administered crystalloid or colloid in the setting of moderate hypovolemia. Anesth Analg 2003,96(6):1572–1577. table of contentsPubMedCrossRef
14.
Myburgh JA, Mythen MG: Resuscitation fluids. N Engl J Med 2013,369(25):2462–2463.PubMed
15.
Woodcock TE, Woodcock TM: Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. Br J Anaesth 2012,108(3):384–394.PubMedCrossRef
16.
Gondos T, Marjanek Z, Ulakcsai Z, Szabo Z, Bogar L, Karolyi M, Gartner B, Kiss K, Havas A, Futo J: Short-term effectiveness of different volume replacement therapies in postoperative hypovolaemic patients. Eur J Anaesthesiol 2010,27(9):794–800.PubMedCrossRef
17.
Trof RJ, Sukul SP, Twisk JW, Girbes AR, Groeneveld AB: Greater cardiac response of colloid than saline fluid loading in septic and non-septic critically ill patients with clinical hypovolaemia. Intensive Care Med 2010,36(4):697–701.PubMedCentralPubMedCrossRef
18.
Verheij J, van Lingen A, Beishuizen A, Christiaans HM, de Jong JR, Girbes AR, Wisselink W, Rauwerda JA, Huybregts MA, Groeneveld AB: Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery. Intensive Care Med 2006,32(7):1030–1038.PubMedCrossRef
19.
Kuitunen A, Suojaranta-Ylinen R, Kukkonen S, Niemi T: A comparison of the haemodynamic effects of 4% succinylated gelatin, 6% hydroxyethyl starch (200/0.5) and 4% human albumin after cardiac surgery. Scand J Surg 2007,96(1):72–78.PubMed
20.
Verheij J, van Lingen A, Raijmakers PG, Rijnsburger ER, Veerman DP, Wisselink W, Girbes AR, Groeneveld AB: Effect of fluid loading with saline or colloids on pulmonary permeability, oedema and lung injury score after cardiac and major vascular surgery. Br J Anaesth 2006,96(1):21–30.PubMedCrossRef
21.
Hartog CS, Bauer M, Reinhart K: The efficacy and safety of colloid resuscitation in the critically ill. Anesth Analg 2011,112(1):156–164.PubMedCrossRef
22.
Guidet B, Martinet O, Boulain T, Philippart F, Poussel JF, Maizel J, Forceville X, Feissel M, Hasselmann M, Heininger A, Van Aken H: Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: the CRYSTMAS study. Crit Care 2012, 16(3):R94.
23.
Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, Glass P, Lipman J, Liu B, McArthur C, McGuinness S, Rajbhandari D, Taylor CB, Webb SA: Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 2012,367(20):1901–1911.PubMedCrossRef
24.
Rioux JP, Lessard M, De Bortoli B, Roy P, Albert M, Verdant C, Madore F, Troyanov S: Pentastarch 10% (250 kDa/0.45) is an independent risk factor of acute kidney injury following cardiac surgery. Crit Care Med 2009,37(4):1293–1298.PubMedCrossRef
25.
Gattas DJ, Dan A, Myburgh J, Billot L, Lo S, Finfer S: Fluid resuscitation with 6% hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacement therapy. Intensive Care Med 2013,39(4):558–568.PubMedCrossRef
26.
Zarychanski R, Abou-Setta AM, Turgeon AF, Houston BL, McIntyre L, Marshall JC, Fergusson DA: Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA 2013,309(7):678–688.PubMedCrossRef
27.
Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL: Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 2001,119(3):867–873.PubMedCrossRef
28.
Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL: Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 2000,162(1):134–138.PubMedCrossRef
29.
Wiesenack C, Fiegl C, Keyser A, Prasser C, Keyl C: Assessment of fluid responsiveness in mechanically ventilated cardiac surgical patients. Eur J Anaesthesiol 2005,22(9):658–665.PubMedCrossRef
30.
Fang ZX, Li YF, Zhou XQ, Zhang Z, Zhang JS, Xia HM, Xing GP, Shu WP, Shen L, Yin GQ: Effects of resuscitation with crystalloid fluids on cardiac function in patients with severe sepsis. BMC Infect Dis 2008, 8: 50.
31.
Marx G, Pedder S, Smith L, Swaraj S, Grime S, Stockdale H, Leuwer M: Resuscitation from septic shock with capillary leakage: hydroxyethyl starch (130 kd), but not Ringer’s solution maintains plasma volume and systemic oxygenation. Shock 2004,21(4):336–341.PubMedCrossRef
32.
Marx G, Cobas Meyer M, Schuerholz T, Vangerow B, Gratz KF, Hecker H, Sumpelmann R, Rueckoldt H, Leuwer M: Hydroxyethyl starch and modified fluid gelatin maintain plasma volume in a porcine model of septic shock with capillary leakage. Intensive Care Med 2002,28(5):629–635.PubMedCrossRef
33.
Lopes MR, Oliveira MA, Pereira VO, Lemos IP, Auler JO Jr, Michard F: Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial. Crit Care 2007, 11(5):R100.PubMedCentralPubMedCrossRef
34.
Benes J, Chytra I, Altmann P, Hluchy M, Kasal E, Svitak R, Pradl R, Stepan M: Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care 2010, 14(3):R118.PubMedCentralPubMedCrossRef
35.
Scheeren TW, Wiesenack C, Gerlach H, Marx G: Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study. J Clin Monit Comput 2013,27(3):225–233.PubMedCrossRef
36.
Buettner M, Schummer W, Huettemann E, Schenke S, van Hout N, Sakka SG: Influence of systolic-pressure-variation-guided intraoperative fluid management on organ function and oxygen transport. Br J Anaesth 2008,101(2):194–199.PubMedCrossRef
37.
Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA: Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 2011,39(2):259–265.PubMedCrossRef
38.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D: Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006,34(2):344–353.PubMedCrossRef
39.
Prowle JR, Echeverri JE, Ligabo EV, Ronco C, Bellomo R: Fluid balance and acute kidney injury. Nat Rev Nephrol 2010,6(2):107–115.PubMedCrossRef
40.
Bihari S, Prakash S, Bersten AD: Post resusicitation fluid boluses in severe sepsis or septic shock: prevalence and efficacy (price study). Shock 2013,40(1):28–34.PubMedCrossRef
41.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001,345(19):1368–1377.PubMedCrossRef
42.
Krafft P, Steltzer H, Hiesmayr M, Klimscha W, Hammerle AF: Mixed venous oxygen saturation in critically ill septic shock patients. The role of defined events. Chest 1993,103(3):900–906.PubMedCrossRef
43.
van Beest PA, Hofstra JJ, Schultz MJ, Boerma EC, Spronk PE, Kuiper MA: The incidence of low venous oxygen saturation on admission to the intensive care unit: a multi-center observational study in The Netherlands. Crit Care 2008, 12(2):R33.PubMedCentralPubMedCrossRef
44.
Axler O, Tousignant C, Thompson CR, Dalla’va-Santucci J, Drummond A, Phang PT, Russell JA, Walley KR: Small hemodynamic effect of typical rapid volume infusions in critically ill patients. Crit Care Med 1997,25(6):965–970.PubMedCrossRef
Metadata
Title
Duration of hemodynamic effects of crystalloids in patients with circulatory shock after initial resuscitation
Authors
Thieme Souza Oliveira Nunes
Renata Teixeira Ladeira
Antônio Tonete Bafi
Luciano Cesar Pontes de Azevedo
Flavia Ribeiro Machado
Flávio Geraldo Rezende Freitas
Publication date
01-12-2014
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2014
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-014-0025-9

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