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- Li, N, et al.
(författare)
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Effects of different colloid infusions on ROTEM and Multiplate during elective brain tumour neurosurgery.
- 2015
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Ingår i: Perioperative Medicine. - : Springer Science and Business Media LLC. - 2047-0525. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- The European Medicines Agency does not recommend the use of hydroxyethyl starch-based volume replacement solutions in critically ill patients due to an increased risk of renal failure. However, this recommendation is questionable for its perioperative use. Several recent randomised controlled studies do not indicate a risk for renal failure-not even after high-risk surgery. Human albumin is used in our neurointensive care unit as a part of the "Lund concept" of brain injury resuscitation, and albumin has been introduced in elective neurosurgery instead of starch. The aim of our prospective unblinded observational cohort study was to compare the degree of dilutive coagulopathy after albumin and starch intra-operative fluid therapy.
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| 3. |
- Lindén, Anja, et al.
(författare)
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Blood volume in patients likely to be preload responsive : a post hoc analysis of a randomized controlled trial
- 2023
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Ingår i: Intensive Care Medicine Experimental. - 2197-425X. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Preload responsive postoperative patients with signs of inadequate organ perfusion are commonly assumed to be hypovolemic and therefore treated with fluids to increase preload. However, preload is influenced not only by blood volume, but also by venous vascular tone and the contribution of these factors to preload responsiveness in this setting is unknown. Based on this, the objective of this study was to investigate blood volume status in preload-responsive postoperative patients. Methods: Data from a clinical trial including postoperative patients after major abdominal surgery were analyzed. Patients with signs of inadequate organ perfusion and with data from a passive leg raising test (PLR) were included. An increase in pulse pressure by ≥ 9% was used to identify patients likely to be preload responsive. Blood volume was calculated from plasma volume measured using radiolabelled albumin and hematocrit. Patients with a blood volume of at least 10% above or below estimated normal volume were considered hyper- and hypovolemic, respectively. Results: A total of 63 patients were included in the study. Median (IQR) blood volume in the total was 57 (50–65) ml/kg, and change in pulse pressure after PLR was 14 (7–24)%. A total of 43 patients were preload responsive. Of these patients, 44% were hypovolemic, 28% euvolemic and 28% hypervolemic. Conclusions: A large fraction of postoperative patients with signs of hypoperfusion that are likely to be preload responsive, are hypervolemic. In these patients, treatments other than fluid administration may be a more rational approach to increase cardiac output.
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| 4. |
- Nelson, Axel, et al.
(författare)
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Effects of fresh frozen plasma, Ringer's acetate and albumin on plasma volume and on circulating glycocalyx components following haemorrhagic shock in rats.
- 2016
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Ingår i: Intensive Care Medicine Experimental. - : Springer Science and Business Media LLC. - 2197-425X. ; 4:6
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Tidskriftsartikel (refereegranskat)abstract
- Early use of fresh frozen plasma (FFP) in haemorrhagic shock is associated with improved outcome. This effect may partly be due to protection of the endothelial glycocalyx and/or secondary to a superior efficacy of FFP as a plasma volume expander compared to crystalloids. The objective of the present study was to investigate if protection of the glycocalyx by FFP can be demonstrated when potential differences in plasma volume (PV) following resuscitation are accounted for.
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| 5. |
- Statkevicius, Svajunas, et al.
(författare)
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Albumin infusion rate and plasma volume expansion : A randomized clinical trial in postoperative patients after major surgery
- 2019
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Optimal infusion rate of colloids in patients with suspected hypovolemia is unknown, and the primary objective of the present study was to test if plasma volume expansion by 5% albumin is greater if fluid is administered slowly rather than rapidly. Methods: Patients with signs of hypoperfusion after major abdominal surgery were randomized to intravenous infusion of 5% albumin at a dose of 10 ml/kg (ideal body weight) either rapidly (30 min) or slowly (180 min). Plasma volume was measured using radiolabeled albumin at baseline, at 30 min, and at 180 min after the start of infusion. Primary outcome was change in plasma volume from the start of infusion to 180 min after the start of infusion. Secondary outcomes included the change in the area under the plasma volume curve and transcapillary escape rate (TER) for albumin from 180 to 240 min after the start of albumin infusion. Results: A total of 33 and 31 patients were included in the analysis in the slow and rapid groups, respectively. The change in plasma volume from the start of infusion to 180 min did not differ between the slow and rapid infusion groups (7.4 ± 2.6 vs. 6.5 ± 4.1 ml/kg; absolute difference, 0.9 ml/kg [95%CI, - 0.8 to 2.6], P = 0.301). Change in the area under the plasma volume curve was smaller in the slow than in the rapid infusion group and was 866 ± 341 and 1226 ± 419 min ml/kg, respectively, P < 0.001. TER for albumin did not differ and was 5.3 ± 3.1%/h and 5.4 ± 3%/h in the slow and in the rapid infusion groups, respectively, P = 0.931. Conclusions: This study does not support our hypothesis that a slow infusion of colloid results in a greater plasma volume expansion than a rapid infusion. Instead, our result of a smaller change in the area under the plasma volume curve indicates that a slow infusion results in a less efficient plasma volume expansion, but further studies are required to confirm this finding. A rapid infusion has no effect on vascular leak as measured after completion of the infusion. Trial registration: EudraCT2013-004446-42 registered December 23, 2014.
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| 6. |
- Statkevicius, Svajunas
(författare)
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Aspects of fluid therapy in the critically ill. Experimental and clinical studies on fluid therapy in the inflammatory conditions.
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients suffering from inflammatory conditions often present with severe hypovolemia due to vasodilatation and increased vascular permeability. Early administration of fluids is, therefore, a cornerstone and lifesaving therapy.However, a vigorous and aggressive fluid therapy increases tissue edema, worsen tissue perfusion and organ function. Based on this, the presented studies investigated different aspects of administration and choice of resuscitation fluids with the overall objective to obtain a long-lasting plasma volume expansion with minimalextravasation.Plasma volume expanding efficacy of albumin is suggested to be dependent on microvascular permeability whereas the efficacy of Ringers acetate is independent of permeability. In the first study, plasma volume expansion by 5% albumin was compared to that by Ringers acetate in a condition of normal (after mild haemorrhage) and increased microvascular permeability (in rat sepsis model). The results revealed that, while the efficacy of both albumin and Ringers acetate as plasma volume expanders decreased in sepsis, the ratio between the two as plasma volumeexpanders remained unchanged.In the second study, the objective was to investigate dose-response of a crystalloid in hypovolemia induced by two different etiologies- sepsis and severe haemorrhage. Rats were randomized to resuscitation with Ringers acetate at a dose of 10, 30, 50, 75 and 100 ml/kg in sepsis or after a severe (30 ml/kg) haemorrhage. The results showed that plasma volume expansion was lower than previously realized across those a wide range of doses and that normovolemia was not attained even at the highest doses in any of the conditions. In sepsis, crystalloid resuscitation induced a dose-depended decrease in plasma oncotic pressure which could not be explained only by dilution.The third study was a single-center, assessor-blinded, parallel-group, randomised prospective clinical study. Previous experimental studies showed that plasma volume expansion was greater after slow infusion compared to rapid infusion of a colloid of the same volume. Based on this experimental data the study aimed to test thehypothesis that plasma volume expansion is greater after slow infusion of colloid than after a rapid infusion of a given volume of colloid. A total of 70 patients with signs of hypovolemia after major abdominal surgery were included and a total of 34 and 31 patients completed the protocol in the slow and rapid infusion groups, respectively.The results have shown that a slow infusion of 5% albumin did not give a better plasma volume expansion than a rapid infusion in postoperative patients with suspected hypovolemia.
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| 7. |
- Statkevicius, Svajunas, et al.
(författare)
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Effect of Ringer´s acetate in different doses on plasma volume in rat models of hypovolemia
- 2017
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Ingår i: Intensive Care Medicine Experimental. - : Springer Science and Business Media LLC. - 2197-425X. ; 5, s. 1-16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Even though crystalloids are the first choice for fluid resuscitation in hemodynamically unstable patients, their potency as plasma volume expanders in hypovolemia of different etiologies is largely unknown. The objective of the study was to investigate dose-response curves of a crystalloid in hypovolemia induced by either sepsis or hemorrhagic shock.RESULTS: Rats were randomized to resuscitation with Ringers acetate at a dose 10, 30, 50, 75, or 100 ml/kg at 4 h after induction of sepsis by cecal ligation and puncture (CLP) or 2.5 h after a 30 ml/kg hemorrhage. Plasma volume (125I-albumin) was the primary outcome. Plasma volume decreased by about 11.8 (IQR 9.9-14.5) ml/kg relative baseline after CLP and increased dose-dependently by at most 5.8 (IQR 3.3-7.0) ml/kg in the 100 ml/kg group at 15 min after resuscitation. In the hemorrhage group, the plasma volume increased by at most 13.8 (IQR 7.1-15.0) ml/kg in 100 ml/kg group. Blood volumes at baseline, calculated using hematocrit and plasma volumes, were 72.4 (IQR 68.2-79.5) ml/kg in sepsis group and 71.1 (IQR 69.1-74.7) ml/kg in hemorrhage group. At 15 min after resuscitation with a dose of 100 ml/kg blood volumes increased to 54.8 (IQR 52.5-57.7) ml/kg and ; 49.6 (IQR 45.3-56.4) ml/kg, in the sepsis and hemorrhage groups, respectively. Plasma volume expansion as the percentage of dose at 15 min was 5.9 (IQR 2.5-8.8)% and 14.5 (IQR 12.1-20.0)% in the sepsis and hemorrhage groups, respectively. At 60 min, average plasma volume as the percentage of dose had decreased to 2.9 (IQR ([-2.9] - 8.3)% (P = 0.006) in the sepsis group whereas no change was detected in the hemorrhage group. A dose-dependent decrease in the plasma oncotic pressure, which was more marked in sepsis, was detected at 60 min after resuscitation.CONCLUSIONS: We conclude that the efficacy of Ringers acetate as a plasma volume expander is context dependent and that plasma volume expansion is lower than previously realized across a wide range of doses. Ringers acetate decreases plasma oncotic pressure in sepsis, in part, by mechanisms other than dilution.
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