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Journal of critical care · Dec 2024
Hemodynamic effects of slower versus faster intravenous fluid bolus rates in critically ill patients: An observational study.
- TomotaniDaniere Yurie VieiraDYVIntensive Care Department, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Programa de Pós-graduação em Medicina Translacional, Escola Paulista de Medicina, Universi, FreitasFlávio Geraldo RezendeFGRIntensive Care Department, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Programa de Pós-graduação em Medicina Translacional, Escola Paulista de Medicina, Univers, Alexandre Biasi Cavalcante, NetoAry SerpaASBrazilian Research in Intensive Care Network, BRICNET, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Rodrigo Cruvinel Figueiredo, Rodrigo Santos Biondi, João Manoel Silva-Jr, BesenBruno Adler Maccagnan PinheiroBAMPBrazilian Research in Intensive Care Network, BRICNET, Brazil; Hospital Luz Vila Mariana, São Paulo, SP, Brazil., da Rocha ParanhosJorge LuizJLSanta Casa de Misericórdia de São João Del Rei, São João Del Rei, MG, Brazil., Fernando José da Silva Ramos, Fernanda Chohfi Atallah, Thiago Miranda Lopes de Almeida, Maria Aparecida de Souza, Fernando Godinho Zampieri, Flávia Ribeiro Machado, and BRICNet.
- Intensive Care Department, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Programa de Pós-graduação em Medicina Translacional, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
- J Crit Care. 2024 Dec 18; 86: 154985154985.
PurposeWe compared the immediate and sustained effects of 500 mL of crystalloid administered at slow (333 mL/h) versus fast rates (999 mL/h) on mean arterial pressure (MAP) in critically ill patients.Materials And MethodsHemodynamic variables were collected immediately before and every 30 min up to 60 min after the end of the infusion. The primary outcome was the adjusted difference in MAP.ResultsWe included 146 patients (slow rate: 71, fast rate: 75). One hour after the end of the infusion, there was no difference in the overall mean marginal effect on MAP between the groups [1.9 mmHg (95 % CI: -1.5 to 5.3 mmHg), p = 0.27] or on the perfusion parameters. Similarly, no difference was found in the immediate effect after 90 min [overall marginal effect: 1.1 mmHg (95 % CI: -2.3 to 4.6 mmHg); p = 0.52]. In patients with cardiac output (CO) monitoring, there was an increase in CO in the fast rate group (overall mean marginal effect: 1.78 L/min (95 % CI: 0.08 to 3.48 L/min); p = 0.04).ConclusionIn critically ill patients, crystalloid infusion at both fast and slow rates did not lead to immediate or sustained differences in MAP. However, fast infusion may result in a greater increase in CO.Copyright © 2024 Elsevier Inc. All rights reserved.
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