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Objective: To compare early outcomes and 24-hour survival after LVR with the novel polyethylene glycol-20k-based crystalloid (PEG-20k), WB, or hextend in a preclinical model of lethal HS. Background: Posttraumatic HS is a major cause of preventable death. current resuscitation strategies focus on restoring oxygen-carrying capacity (OCC) and coagulation with blood products. Our lab shows that PEG-20k is an effective non-sanguineous, LVR solution in acute models of HS through mechanisms targeting cell swelling-induced microcirculatory failure. Methods: Male pigs underwent splenectomy followed by controlled hemorrhage until lactate reached 7.5–8.5 mmol/L. They were randomized to receive LVR with PEG-20k, WB, or Hextend. Surviving animals were recovered 4 hours post-LVR. Outcomes included 24-hour survival rates, mean arterial pressure, lactate, hemoglobin, and estimated intravascular volume changes. Results: Twenty-four-hour survival rates were 100%, 16.7%, and 0% in the PEG-20k, WB, and Hextend groups, respectively (P = 0.001). PEG-20k significantly restored mean arterial press, intravascular volume, and capillary perfusion to baseline, compared to other groups. This caused complete lactate clearance despite decreased OCC. Neurological function was normal after next-day recovery in PEG-20k resuscitated pigs. Conclusion: Superior early and 24-hour outcomes were observed with PEG-20k LVR compared to WB and Hextend in a preclinical porcine model of lethal HS, despite decreased OCC from substantial volume-expansion. These findings demonstrate the importance of enhancing microcirculatory perfusion in early resuscitation strategies. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of the administration of 4% albumin on lactated Ringer's, when compared with lactated Ringer's alone, in the early phase of sepsis in cancer patients.Design: Single-center, randomized, double-blind, controlled-parallel trial.Setting: A tertiary care university cancer hospital.Patients: Cancer patients with severe sepsis or septic shock.Interventions: Between October 2014 and December 2016, patients were randomly assigned to receive either bolus of albumin in a lactated Ringer's solution or lactated Ringer's solution alone during the first 6 hours of fluid resuscitation after intensive care medicine (ICU) admission. Primary outcome was defined as death from any cause at 7 days. Secondary outcomes were defined as death from any cause within 28 days, change in Sequence Organ Failure Assessment scores from baseline to day 7, days alive and free of mechanical ventilation, days alive and free of vasopressor, renal replacement therapy during ICU stay, and length of ICU and hospital stay.Measurements and Main Results: A total of 360 patients were enrolled in the trial. At 7 days, 46 of 180 patients (26%) died in the albumin group and 40 of 180 (22%) died in the lactated Ringer's group (p = 0.5). At 28 days, 96 of 180 patients (53%) died in the albumin group and 83 of 180 (46%) died in the lactated Ringer's group (p = 0.2). No significant differences in secondary outcomes were observed.Conclusions: Adding albumin to early standard resuscitation with lactated Ringer's in cancer patients with sepsis did not improve 7-day survival. [ABSTRACT FROM AUTHOR]

Normal saline is the crystalloid of choice for fluid resuscitation with its utility born out of the cholera epidemic of 1832. However, its ubiquitous usage is being challenged because of a growing body of evidence suggesting that a large volume infusion of normal saline does in fact have deleterious effects on multiple body systems. Careful considerations should be given to the physiological effects of using large amounts of normal saline as one would with another pharmacological agents. [ABSTRACT FROM AUTHOR]

The author reflects on treatment approaches of sepsis with balanced crystalloid fluid therapy for treating acute respiratory distress syndrome, also considered as lung-limited sepsis. Also discussed is morbidity and mortality, management of patients by early goal-directed therapy, and lack of improvements in treatment outcomes for patients with sepsis and septic shock. The author also talks about differences in choice of resuscitation fluids.

Severe sepsis is a continuum of physiologic stages characterized by infection, systemic inflammation, and hypoperfusion leading to tissue injury and organ failure. The primary goal of sepsis treatment is to prevent morbidity and mortality. Crystalloids are now recommended over colloids for volume resuscitation, one of the key interventions for patients with sepsis. INSET: TABLE l. Potential empiric IV antimicrobial regimens for.... [ABSTRACT FROM AUTHOR]

Objective: Isotonic saline is the most commonly used crystalloid in the ICU, but recent evidence suggests that balanced fluids like Lactated Ringer's solution may be preferable. We examined the association between choice of crystalloids and in-hospital mortality during the resuscitation of critically ill adults with sepsis. Design: A retrospective cohort study of patients admitted with sepsis, not undergoing any surgical procedures, and treated in an ICU by hospital day 2. We used propensity score matching to control for confounding and compared the following outcomes after resuscitation with balanced versus with no-balanced fluids: in-hospital mortality, acute renal failure with and without dialysis, and hospital and ICU lengths of stay. We also estimated the dose-response relationship between receipt of increasing proportions of balanced fluids and in-hospital mortality. Setting: Three hundred sixty U.S. hospitals that were members of the Premier Healthcare alliance between November 2005 and December 2010. Patients: A total of 53,448 patients with sepsis, treated with vasopressors and crystalloids in an ICU by hospital day 2 including 3,396 (6.4%) that received balanced fluids. Interventions: None. Measurements and Main Results: Patients treated with balanced fluids were younger and less likely to have heart or chronic renal failure, but they were more likely to receive mechanical ventilation, invasive monitoring, colloids, steroids, and larger crystalloid volumes (median 7 vs 5L). Among 6,730 patients in a propensity-matched cohort, receipt of balanced fluids was associated with lower in hospital mortality (19.6% vs 22.8%; relative risk, 0.86; 95% Cl, 0.78, 0.94). Mortality was progressively lower among patients receiving larger proportions of balanced fluids. There were no significant differences in the prevalence of acute renal failure (with and without dialysis) or in-hospital and ICU lengths of stay. Conclusions: Among critically ill adults with sepsis, resuscitation with balanced fluids was associated with a lower risk of in-hospital mortality. If confirmed in randomized trials, this finding could have significant public health implications, as crystalloid resuscitation is nearly universal in sepsis. [ABSTRACT FROM AUTHOR]

The article assesses shock reversal and required fluid volumes in septic shock patients. Results reveal that shock reversal was realized fast with synthetic colloids or crystalloids. Colloids use led to just marginally lower required volumes of resuscitation fluid. Findings also suggest that both low molecular weight hydroxyethyl starch and gelatin may impair renal function.

The article discusses a study on the impact of synthetic colloids and crystalloids on patients with severe sepsis. The study subjects included patients with severe sepsis who were admitted to the surgical intensive care unit. The study procedure included the administration of hydroxyethyl starch, the administration of crystalloids, and the administration of gelatin.

The article evaluates the effect of hypoproteinemia on plasma volume expansion produced by a bolus of crystalloid solution given to awake sheep. Experiments showed a significant reduction in total plasma protein concentration after plasmapheresis and a lower colloid osmotic pressures. It concludes that hypoproteinemia does not reduce plasma volume expansion in response to a saline infusion in awake sheep.

Background and objective: Crystalloid haemodilution has been widely found to enhance coagulation onset, but the duration of this effect has never been documented. Methods: Twelve healthy, consenting volunteers had a rapid infusion of 14 mL kg-1 of normal (0.9%) saline. Blood samples were taken, prior to (control), and immediately after (30 min) the rapid saline infusion was completed (30 min). They were then repeated at regular intervals up to 120min. Haematocrit/platelet counts were taken to determine the degree of dilution and thrombelastograms, with and without platelet antagonists (ReoPro, Abciximab), were measured in all samples. Antithrombin levels were selectively measured. Results: The haematocrit and platelet count showed a rapid dilutional decrease at 30 min (mean of -12.2% and -14.4%, respectively), with values returning towards baseline within 15 min after finishing the infusion. There was a significantly faster onset of coagulation (decrease in r-time) in the post-infusion sample (30 min) compared to control (P < 0.05), again returning towards normal as the dilution effect was reversed. Similar thrombelastograms findings were evident in the plasma factor only group (platelets inhibited by ReoPro). Antithrombin levels changed in keeping with the haemodilution effect (P < 0.0001). There was a linear relationship between antithrombin and thrombelastograms r-time (P = 0.012). Conclusion: The faster onset of coagulation brought on by haemodilution return towards normal as the dilutional effect is reversed. This effect is mediated through plasma clotting factors. Of interest is the significant inverse correlation of the onset of coagulation increasing as the antithrombin levels decreased with dilution. [ABSTRACT FROM AUTHOR]

The authors reflect on the highlights of the article "Impact of a Sequential Intervention on Albumin Utilization in Critical Care" by P. F. Lyu published in the July 2016 issue of the journal "Critical Care Medicine." Topics covered include the findings of a prospective study conducted to encourage reduced use of albumin in the intensive care unit (ICU), the noted pattern of the nature of reducing albumin use in the ICU, and the noted limitations of the study.

The article presents the author's comments on hemodynamic management and resuscitation of septic shock in patients. It mentions that the norepinephrine, rather than dopamine, is associated with improved survival. Use of crystalloids as the best fluid for resuscitation is noted, and attention is given to the study published in the same issue by Waechter et. al., which indicated the importance of timing in best practice for treating septic shock.

An introduction is presented in which the editor discusses the article "Liberal Versus Restricted Fluid Resuscitation Strategies in Trauma Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies" published within the issue.

The author expresses his views on colloids and renal dysfunction in relation to a study conducted by researcher O. Bayer and colleagues, published in a 2011 issue of the journal "Critical Care Medicine." The study focused on the renal impact of synthetic colloids and crystalloids on patients with severe sepsis. Results of the study revealed the association between hyperoncotic albumin and the rates of acute kidney injury and renal replacement therapy in multiple logistic regression analysis.