Crit Care Resusc
-
The cardiac output (CO) response to sepsis is typically measured in the intensive care unit after modification by fluid and/or vasoactive drug resuscitation and found to be hyperdynamic. In contrast, the native (preresuscitation) CO in human sepsis is poorly defined. ⋯ Data about the native CO in human sepsis are scant because therapeutic intervention usually precedes measurement. From the limited data available, it appears that most patients are in a normodynamic haemodynamic state at presentation, and cardiac performance also seems to be impaired at the earliest stage of sepsis. As initial resuscitation is partly predicated on assumptions about the underlying cardiovascular physiology, our findings suggest the need to address this knowledge deficit in the management of patients with severe sepsis.
-
Observational Study
Epidemiology of secondary fluid bolus therapy for infection-associated hypotension.
Fluid bolus therapy (FBT) is a common therapy for hypotensive sepsis, but no studies have compared primary FBT (in the first 6 hours after presentation to the emergency department [ED]) with secondary FBT (6-24 hours after presentation to the ED). We aimed to describe the patterns of use, physiological sequelae and outcomes of patients with hypotensive sepsis who were treated with primary FBT or combined primary and secondary FBT (secondary FBT). ⋯ Secondary FBT is given to about half of patients presenting with hypotensive sepsis, takes place in wards more often than in the ICU and delivers a significant proportion of overall fluids, but is associated with limited changes in measured physiological variables.
-
Randomized Controlled Trial Multicenter Study
Effect of saline 0.9% or Plasma-Lyte 148 therapy on feeding intolerance in patients receiving nasogastric enteral nutrition.
To compare the effect of Plasma-Lyte (PL)-148 and saline 0.9% (saline) on gastrointestinal (GI) feeding intolerance in mechanically ventilated patients receiving nasogastric (NG) feeding in an intensive care unit. ⋯ Among mechanically ventilated patients receiving NG feeding, the use of PL-148, compared with saline, did not reduce the proportion of patients developing GI feeding intolerance, but was associated with a decreased incidence of high GRV.
-
Randomized Controlled Trial Multicenter Study
A multicentre randomised controlled pilot study of fluid resuscitation with saline or Plasma-Lyte 148 in critically ill patients.
Normal saline (NS) is the most commonly used crystalloid solution worldwide but contains an excess of chloride and may cause metabolic acidosis and hyperchloraemia. Such abnormalities may be attenuated by the use of a balanced solution such as Plasma-Lyte 148 (PL-148). ⋯ In our exploratory, double-blind, randomised controlled trial, when compared with NS, PL-148 did not significantly increase BE values in critically ill patients requiring fluid resuscitation, but decreased peak chloride concentrations.