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Melissa J Parker - One of the best experts on this subject based on the ideXlab platform.

  • rapid paediatric Fluid Resuscitation a randomised controlled trial comparing the efficiency of two provider endorsed manual paediatric Fluid Resuscitation techniques in a simulated setting
    BMJ Open, 2014
    Co-Authors: Evan T Cole, Greg Harvey, Gary Foster, Lehana Thabane, Sara Urbanski, Melissa J Parker
    Abstract:

    Objectives Manual techniques of intravascular Fluid administration are commonly used during paediatric Resuscitation, although it is unclear which technique is most efficient in the hands of typical healthcare providers. We compared the rate of Fluid administration achieved with the disconnect–reconnect and push–pull manual syringe techniques for paediatric Fluid Resuscitation in a simulated setting. Methods This study utilised a randomised crossover trial design and enrolled 16 consenting healthcare provider participants from a Canadian paediatric tertiary care centre. The study was conducted in a non-clinical setting using a model simulating a 15 kg child in decompensated shock. Participants administered 900 mL (60 mL/kg) of normal saline to the simulated patient using each of the two techniques under study. The primary outcome was the rate of Fluid administration, as determined by two blinded independent video reviewers. We also collected participant demographic data and evaluated other secondary outcomes including total volume administered, number of catheter dislodgements, number of technical errors, and subjective and objective measures of provider fatigue. Results All 16 participants completed the trial. The mean (SD) rate of Fluid administration (mL/s) was greater for the disconnect–reconnect technique at 1.77 (0.145) than it was for the push–pull technique at 1.62 (0.226), with a mean difference of 0.15 (95% CI 0.055 to 0.251; p=0.005). There was no difference in mean volume administered (p=0.778) or participant self-reported fatigue (p=0.736) between techniques. No catheter dislodgement events occurred. Conclusions The disconnect–reconnect technique allowed for the fastest rate of Fluid administration, suggesting that use of this technique may be preferable in situations requiring rapid Resuscitation. These findings may help to inform future iterations of paediatric Resuscitation guidelines. Trial registration number This trial was registered at ClinicalTrials.gov [NCT01774214] prior to enrolling the first participant.

  • factors affecting pediatric isotonic Fluid Resuscitation efficiency a randomized controlled trial evaluating the impact of syringe size
    BMC Emergency Medicine, 2013
    Co-Authors: Greg Harvey, Gary Foster, Asmaa Manan, Lehana Thabane, Melissa J Parker
    Abstract:

    Background Goal-directed therapy guidelines for pediatric septic shock Resuscitation recommend Fluid delivery at speeds in excess of that possible through use of regular Fluid infusion pumps. In our experience, syringes are commonly used by health care providers (HCPs) to achieve rapid Fluid Resuscitation in a pediatric Fluid Resuscitation scenario. At present, it is unclear which syringe size health care providers should use when performing Fluid Resuscitation to achieve maximal Fluid Resuscitation efficiency. The objective of this study was therefore to determine if an optimal syringe size exists for conducting manual pediatric Fluid Resuscitation.

  • translating Resuscitation guidelines into practice health care provider attitudes preferences and beliefs regarding pediatric Fluid Resuscitation performance
    PLOS ONE, 2013
    Co-Authors: Melissa J Parker, Asmaa Manan
    Abstract:

    Introduction Children who require Fluid Resuscitation for the treatment of shock present to tertiary and non-tertiary medical settings. While timely Fluid therapy improves survival odds, guidelines are poorly translated into clinical practice. The objective of this study was to characterize the attitudes, preferences and beliefs of health care providers working in acute care settings regarding pediatric Fluid Resuscitation performance. Methods A single-centre survey study was conducted at McMaster Children's Hospital from January to May, 2012. The sampling frame (n = 115) included nursing staff, physician staff and subspecialty trainees working in Pediatric Emergency Medicine (PEM) or Pediatric Critical Care Medicine (PCCM). A self-administered questionnaire was developed and assessed for face validity prior to distribution. Eligible participants were invited at 0, 2, and 4 weeks to complete a web-based version of the survey. A follow-up survey administration phase was conducted to improve the response rate. Results Response rate was 72.2% (83/115), with 83% (68/82) self-identifying as nursing staff and 61% (50/82) as PCCM providers. Resuscitation experience, frequency of shock management, and years in specialty, were similar between PCCM and PEM responders. Physicians and nurses had differing opinions regarding the most effective method to achieve rapid Fluid Resuscitation in young children presenting in shock (p<0.001). Disagreement also existed regarding the age and size of patients in whom rapid infuser devices, such as the Level-1 Rapid Infuser, should be used (p<0.001). Providers endorsed a number of potential concerns related to the use of rapid infuser devices in children, and only 14% of physicians and 55% of nursing staff felt that they had received adequate training in the use of such devices (p = 0.005). Conclusions There is a lack of consensus among health care providers regarding how pediatric Fluid Resuscitation guidelines should be operationalized, supporting a need for further work to define best practices.

Yun Zhang - One of the best experts on this subject based on the ideXlab platform.

  • effect of global end diastolic volume index guidance Fluid Resuscitation in elderly patients with septic shock
    Chinese critical care medicine, 2017
    Co-Authors: Rumin Zhang, Shifu Wang, Meiling Zhao, Lei Wang, Yun Zhang
    Abstract:

    Objective To evaluate the effect of global end diastolic volume index (GEDVI) on Fluid Resuscitation in elderly patients with septic shock. Methods A prospective randomized controlled trial (RCT) was conducted. Septic shock patients over 65 years admitted to intensive care unit (ICU) of Shandong Province, Zibo Central Hospital from January 2013 to December 2015 were enrolled. The patients were randomly divided into control group and observation group, 20 cases in each group. In accordance with the guidelines for the treatment of septic shock, early goal-directed therapy (EGDT), rehydration in the control group was treated with the guide of central venous pressure (CVP); observation group was received pulse indicator continuous cardiac output (PiCCO) monitoring, and rehydration was treated according to the GEDVI and extravascular lung water index (EVLWI), i.e. GEDVI was maintained in 650-800 mL/m2, EVLWI was not obviously increased compared with the basic value and without the emphasis of CVP. Initial acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure score (SOFA), procalcitonin (PCT), mean arterial pressure (MAP), lactic acid (Lac) and oxygenation index (PaO2/FiO2); serial Lac, central venous to arterial carbon dioxide pressure (Pcv-aCO2), Fluid balance, the amount of noradrenaline accumulation, PaO2/FiO2 after 6, 24 and 48 hours Resuscitation; mechanical ventilation time, incidence of acute heart failure, ICU hospitalization time and 28-day mortality were recorded. Results There was no significant difference in gender, age, APACHEⅡ score, SOFA score, primary disease, infection site and basal PCT, MAP, Lac, PaO2/FiO2 between the two groups. Compared with the control group, 6 hours Lac, Pcv-aCO2 recovery, positive Fluid balance, noradrenaline accumulation and PaO2/FiO2 of the observation group showed no significant difference; positive Fluid balance 24 hours in the recovery was significantly reduced (mL: 2 919.80±986.44 vs. 3 991.40±933.53), Pcv-aCO2 significantly decreased [mmHg (1 mmHg = 0.133 kPa): 5.55±1.43 vs. 7.10±2.38], PaO2/FiO2 significantly improved (mmHg: 194.80±28.57 vs. 177.65±23.46), and noradrenaline accumulation was increased significantly (mg: 40.99±20.69 vs. 27.31±19.34) with statistically significant difference (all P < 0.05); the blood level of Lac 48 hours in the recovery was significantly decreased (mmol/L: 1.16±0.89 vs. 1.85±1.01), Pcv-aCO2 (mmHg: 5.35±1.18 vs. 6.70±2.34), and PaO2/FiO2 (mmHg: 215.75±33.84 vs. 190.60±32.89) were further improved, the positive Fluid balance was significantly reduced (mL: 3 141.55±1 245.69 vs. 4 533.85±1 416.67, all P < 0.05). Compared with the control group, mechanical ventilation time (days: 3.65±1.31 vs. 4.50±1.19), ICU hospitalization time (days: 5.80±1.67 vs. 7.15±2.30) was significantly shorter in the observation group (both P < 0.05), acute heart failure rate was decreased significantly (5.0% vs. 30.0%, P < 0.05), but the 28-day mortality showed no statistical significance (25.0% vs. 40.0%, P = 0.311). Conclusions Compared to the conventional EGDT methods, Fluid Resuscitation under the guidance of GEDVI in elderly patients with septic shock with less liquid loading, can achieve better oxygenation and reduce heart failure, shorten the duration of mechanical ventilation and ICU stay, and play an important significant guidance for elderly patients' Fluid Resuscitation with septic shock. Key words: Septic shock; Aged; Global end diastolic volume index; Fluid Resuscitation; Pulse indicator continuous cardiac output

Simon Finfer - One of the best experts on this subject based on the ideXlab platform.

  • patterns of intravenous Fluid Resuscitation use in adult intensive care patients between 2007 and 2014 an international cross sectional study
    PLOS ONE, 2017
    Co-Authors: Naomi Hammond, Colman Taylor, Simon Finfer, Flavia Ribeiro Machado, Laurent Billot, Frank Bloos
    Abstract:

    Background In 2007, the Saline versus Albumin Fluid Evaluation—Translation of Research Into Practice Study (SAFE-TRIPS) reported that 0.9% sodium chloride (saline) and hydroxyethyl starch (HES) were the most commonly used Resuscitation Fluids in intensive care unit (ICU) patients. Evidence has emerged since 2007 that these Fluids are associated with adverse patient-centred outcomes. Based on the published evidence since 2007, we sought to determine the current type of Fluid Resuscitation used in clinical practice and the predictors of Fluid choice and determine whether these have changed between 2007 and 2014. Methods In 2014, an international, cross-sectional study was conducted (Fluid-TRIPS) to document current patterns of intravenous Resuscitation Fluid use and determine factors associated with Fluid choice. We examined univariate and multivariate associations between patients and prescriber characteristics, geographical region and Fluid type. Additionally, we report secular trends of Resuscitation Fluid use in a cohort of ICUs that participated in both the 2007 and 2014 studies. Regression analysis were conducted to determine changes in the administration of crystalloid or colloid between 2007 and 2014. Findings In 2014, a total of 426 ICUs in 27 countries participated. Over the 24 hour study day, 1456/6707 (21.7%) patients received Resuscitation Fluid during 2716 Resuscitation episodes. Crystalloids were administered to 1227/1456 (84.3%) patients during 2208/2716 (81.3%) episodes and colloids to 394/1456 (27.1%) patients during 581/2716 (21.4%) episodes. In multivariate analyses, practice significantly varied between geographical regions. Additionally, patients with a traumatic brain injury were less likely to receive colloid when compared to patients with no trauma (adjusted OR 0.24; 95% CI 0.1 to 0.62; p = 0.003). Patients in the ICU for one or more days where more likely to receive colloid compared to patients in the ICU on their admission date (adjusted OR 1.75; 95% CI 1.27 to 2.41; p = <0.001). For secular trends in Fluid Resuscitation, 84 ICUs in 17 countries contributed data. In 2007, 527/1663 (31.7%) patients received Fluid Resuscitation during 1167 episodes compared to 491/1763 (27.9%) patients during 960 episodes in 2014. The use of crystalloids increased from 498/1167 (42.7%) in 2007 to 694/960 (72.3%) in 2014 (odds ratio (OR) 3.75, 95% confidence interval (CI) 2.95 to 4.77; p = <0.001), primarily due to a significant increase in the use of buffered salt solutions. The use of colloids decreased from 724/1167 (62.0%) in 2007 to 297/960 (30.9%) in 2014 (OR 0.29, 95% CI 0.19 to 0.43; p = <0.001), primarily due to a decrease in the use of HES, but an overall increase in the use of albumin. Conclusions Clinical practices of intravenous Fluid Resuscitation have changed between 2007 and 2014. Geographical location remains a strong predictor of the type of Fluid administered for Fluid Resuscitation. Overall, there is a preferential use of crystalloids, specifically buffered salt solutions, over colloids. There is now an imperative to conduct a trial determining the safety and efficacy of these Fluids on patient-centred outcomes. Trial registration Clinicaltrials.gov: Fluid-Translation of research into practice study (Fluid-TRIPS) NCT02002013

  • 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 Medicine, 2013
    Co-Authors: David Gattas, Simon Finfer, Laurent Billot, Arina Dan, John Myburgh
    Abstract:

    Purpose To determine whether Fluid Resuscitation of acutely ill adults with 6 % hydroxyethyl starch (6 % HES 130) with a molecular weight of 130 kD and a molar substitution ratio of approximately 0.4 (6 % HES 130) compared with other Resuscitation Fluids results in a difference in the relative risk of death or treatment with renal replacement therapy (RRT).

Kianoush Kashani - One of the best experts on this subject based on the ideXlab platform.

  • effect of initial infusion rates of Fluid Resuscitation on outcomes in patients with septic shock a historical cohort study
    Critical Care, 2020
    Co-Authors: Bo Hu, Joy C Y Chen, Yue Dong, Ryan D Frank, Melissa Passe, Erica Portner, Zhiyong Peng, Kianoush Kashani
    Abstract:

    BACKGROUND: Fluid Resuscitation has become the cornerstone of early septic shock management, but the optimal Fluid rate is still not well studied. The goal of this investigation is to examine the relationship between Fluid Resuscitation rate and septic shock resolution. METHOD: We retrospectively studied adult (>/= 18 years) patients with septic shock, defined based on sepsis III definition, from January 1, 2006, through May 31, 2018, in the medical intensive care unit (MICU) of Mayo Clinic Rochester. The Fluid Resuscitation time was defined as the time required to infuse the initial Fluid bolus of 30 ml/kg, based on the recommendations of the 2016 surviving sepsis campaign. The cohort was divided into four groups based on the average Fluid rate (group 1 >/= 0.5, group 2 0.25-0.49, group 3 0.17-0.24, and group 4 < 0.17 ml/kg/min). The primary outcome was the time to shock reversal. Multivariable regression analyses were conducted to account for potential confounders. RESULT: A total of 1052 patients met eligibility criteria and were included in the analysis. The time-to-shock reversal was significantly different among the groups (P < .001). Patients in group 1 who received Fluid Resuscitation at a faster rate had a shorter time to shock reversal (HR = 0.78; 95% CI 0.66-0.91; P = .01) when compared with group 4 with a median (IQR) time-to-shock reversal of 1.7 (1.5, 2.0) vs. 2.8 (2.6, 3.3) days, respectively. Using 0.25 ml/kg/min as cutoff, the higher Fluid infusion rate was associated with a shorter time to shock reversal (HR = 1.22; 95% CI 1.06-1.41; P = .004) and with decreased odds of 28-day mortality (HR = 0.71; 95% CI 0.60-0.85; P < .001). CONCLUSION: In septic shock patients, initial Fluid Resuscitation rate of 0.25-0.50 ml/kg/min (i.e., completion of the initial 30 ml/kg IV Fluid Resuscitation within the first 2 h), may be associated with early shock reversal and lower 28-day mortality compared with slower rates of infusion.

  • effect of initial infusion rates of Fluid Resuscitation on outcomes in patients with septic shock a historical cohort study
    Critical Care, 2020
    Co-Authors: Joy C Y Chen, Yue Dong, Ryan D Frank, Melissa Passe, Zhiyong Peng, Erica R Portner, Kianoush Kashani
    Abstract:

    Fluid Resuscitation has become the cornerstone of early septic shock management, but the optimal Fluid rate is still not well studied. The goal of this investigation is to examine the relationship between Fluid Resuscitation rate and septic shock resolution. We retrospectively studied adult (≥ 18 years) patients with septic shock, defined based on sepsis III definition, from January 1, 2006, through May 31, 2018, in the medical intensive care unit (MICU) of Mayo Clinic Rochester. The Fluid Resuscitation time was defined as the time required to infuse the initial Fluid bolus of 30 ml/kg, based on the recommendations of the 2016 surviving sepsis campaign. The cohort was divided into four groups based on the average Fluid rate (group 1 ≥ 0.5, group 2 0.25–0.49, group 3 0.17–0.24, and group 4 < 0.17 ml/kg/min). The primary outcome was the time to shock reversal. Multivariable regression analyses were conducted to account for potential confounders. A total of 1052 patients met eligibility criteria and were included in the analysis. The time-to-shock reversal was significantly different among the groups (P < .001). Patients in group 1 who received Fluid Resuscitation at a faster rate had a shorter time to shock reversal (HR = 0.78; 95% CI 0.66–0.91; P = .01) when compared with group 4 with a median (IQR) time-to-shock reversal of 1.7 (1.5, 2.0) vs. 2.8 (2.6, 3.3) days, respectively. Using 0.25 ml/kg/min as cutoff, the higher Fluid infusion rate was associated with a shorter time to shock reversal (HR = 1.22; 95% CI 1.06–1.41; P = .004) and with decreased odds of 28-day mortality (HR = 0.71; 95% CI 0.60–0.85; P < .001). In septic shock patients, initial Fluid Resuscitation rate of 0.25–0.50 ml/kg/min (i.e., completion of the initial 30 ml/kg IV Fluid Resuscitation within the first 2 h), may be associated with early shock reversal and lower 28-day mortality compared with slower rates of infusion.

Rumin Zhang - One of the best experts on this subject based on the ideXlab platform.

  • effect of global end diastolic volume index guidance Fluid Resuscitation in elderly patients with septic shock
    Chinese critical care medicine, 2017
    Co-Authors: Rumin Zhang, Shifu Wang, Meiling Zhao, Lei Wang, Yun Zhang
    Abstract:

    Objective To evaluate the effect of global end diastolic volume index (GEDVI) on Fluid Resuscitation in elderly patients with septic shock. Methods A prospective randomized controlled trial (RCT) was conducted. Septic shock patients over 65 years admitted to intensive care unit (ICU) of Shandong Province, Zibo Central Hospital from January 2013 to December 2015 were enrolled. The patients were randomly divided into control group and observation group, 20 cases in each group. In accordance with the guidelines for the treatment of septic shock, early goal-directed therapy (EGDT), rehydration in the control group was treated with the guide of central venous pressure (CVP); observation group was received pulse indicator continuous cardiac output (PiCCO) monitoring, and rehydration was treated according to the GEDVI and extravascular lung water index (EVLWI), i.e. GEDVI was maintained in 650-800 mL/m2, EVLWI was not obviously increased compared with the basic value and without the emphasis of CVP. Initial acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure score (SOFA), procalcitonin (PCT), mean arterial pressure (MAP), lactic acid (Lac) and oxygenation index (PaO2/FiO2); serial Lac, central venous to arterial carbon dioxide pressure (Pcv-aCO2), Fluid balance, the amount of noradrenaline accumulation, PaO2/FiO2 after 6, 24 and 48 hours Resuscitation; mechanical ventilation time, incidence of acute heart failure, ICU hospitalization time and 28-day mortality were recorded. Results There was no significant difference in gender, age, APACHEⅡ score, SOFA score, primary disease, infection site and basal PCT, MAP, Lac, PaO2/FiO2 between the two groups. Compared with the control group, 6 hours Lac, Pcv-aCO2 recovery, positive Fluid balance, noradrenaline accumulation and PaO2/FiO2 of the observation group showed no significant difference; positive Fluid balance 24 hours in the recovery was significantly reduced (mL: 2 919.80±986.44 vs. 3 991.40±933.53), Pcv-aCO2 significantly decreased [mmHg (1 mmHg = 0.133 kPa): 5.55±1.43 vs. 7.10±2.38], PaO2/FiO2 significantly improved (mmHg: 194.80±28.57 vs. 177.65±23.46), and noradrenaline accumulation was increased significantly (mg: 40.99±20.69 vs. 27.31±19.34) with statistically significant difference (all P < 0.05); the blood level of Lac 48 hours in the recovery was significantly decreased (mmol/L: 1.16±0.89 vs. 1.85±1.01), Pcv-aCO2 (mmHg: 5.35±1.18 vs. 6.70±2.34), and PaO2/FiO2 (mmHg: 215.75±33.84 vs. 190.60±32.89) were further improved, the positive Fluid balance was significantly reduced (mL: 3 141.55±1 245.69 vs. 4 533.85±1 416.67, all P < 0.05). Compared with the control group, mechanical ventilation time (days: 3.65±1.31 vs. 4.50±1.19), ICU hospitalization time (days: 5.80±1.67 vs. 7.15±2.30) was significantly shorter in the observation group (both P < 0.05), acute heart failure rate was decreased significantly (5.0% vs. 30.0%, P < 0.05), but the 28-day mortality showed no statistical significance (25.0% vs. 40.0%, P = 0.311). Conclusions Compared to the conventional EGDT methods, Fluid Resuscitation under the guidance of GEDVI in elderly patients with septic shock with less liquid loading, can achieve better oxygenation and reduce heart failure, shorten the duration of mechanical ventilation and ICU stay, and play an important significant guidance for elderly patients' Fluid Resuscitation with septic shock. Key words: Septic shock; Aged; Global end diastolic volume index; Fluid Resuscitation; Pulse indicator continuous cardiac output