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Josef Haik - One of the best experts on this subject based on the ideXlab platform.
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a simplified Fluid resuscitation formula for burns in mass casualty scenarios analysis of the consensus recommendation from the who emergency medical teams technical working group on burns
Burns, 2021Co-Authors: T Leclerc, T Potokar, Amy Hughes, Ian Norton, Calin Alexandru, Josef Haik, Naiem MoiemenAbstract:Abstract Background Burn Fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an Initial Fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines. Methods The TWGB formula was numerically compared with 2–4 mL/kg/%TBSA for adults and the Galveston formula for children. Results In adults, the TWGB formula estimated Fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20–25% and the 50–60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance Fluids. Beyond 60% TBSA, the TWGB formula underestimated Fluid requirements in all age groups. Conclusion The TWGB formula for mass burn casualties may enable appropriate Fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.
Kianoush Kashani - One of the best experts on this subject based on the ideXlab platform.
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effect of Initial infusion rates of Fluid resuscitation on outcomes in patients with septic shock a historical cohort study
Critical Care, 2020Co-Authors: Bo Hu, Joy C Y Chen, Yue Dong, Ryan D Frank, Melissa Passe, Erica Portner, Zhiyong Peng, Kianoush KashaniAbstract: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.
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effect of Initial infusion rates of Fluid resuscitation on outcomes in patients with septic shock a historical cohort study
Critical Care, 2020Co-Authors: Joy C Y Chen, Yue Dong, Ryan D Frank, Melissa Passe, Zhiyong Peng, Erica R Portner, Kianoush KashaniAbstract: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.
Naiem Moiemen - One of the best experts on this subject based on the ideXlab platform.
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a simplified Fluid resuscitation formula for burns in mass casualty scenarios analysis of the consensus recommendation from the who emergency medical teams technical working group on burns
Burns, 2021Co-Authors: T Leclerc, T Potokar, Amy Hughes, Ian Norton, Calin Alexandru, Josef Haik, Naiem MoiemenAbstract:Abstract Background Burn Fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an Initial Fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines. Methods The TWGB formula was numerically compared with 2–4 mL/kg/%TBSA for adults and the Galveston formula for children. Results In adults, the TWGB formula estimated Fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20–25% and the 50–60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance Fluids. Beyond 60% TBSA, the TWGB formula underestimated Fluid requirements in all age groups. Conclusion The TWGB formula for mass burn casualties may enable appropriate Fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.
Amy Hughes - One of the best experts on this subject based on the ideXlab platform.
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a simplified Fluid resuscitation formula for burns in mass casualty scenarios analysis of the consensus recommendation from the who emergency medical teams technical working group on burns
Burns, 2021Co-Authors: T Leclerc, T Potokar, Amy Hughes, Ian Norton, Calin Alexandru, Josef Haik, Naiem MoiemenAbstract:Abstract Background Burn Fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an Initial Fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines. Methods The TWGB formula was numerically compared with 2–4 mL/kg/%TBSA for adults and the Galveston formula for children. Results In adults, the TWGB formula estimated Fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20–25% and the 50–60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance Fluids. Beyond 60% TBSA, the TWGB formula underestimated Fluid requirements in all age groups. Conclusion The TWGB formula for mass burn casualties may enable appropriate Fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.
Mauricio Rocha E Silva - One of the best experts on this subject based on the ideXlab platform.
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small volume of hypertonic saline as the Initial Fluid replacement in experimental hypodynamic sepsis
Critical Care, 2006Co-Authors: Alejandra G Garrido, Ruy J Cruz, Luiz Francisco Poli De Figueiredo, Mauricio Rocha E SilvaAbstract:Introduction We conducted the present study to examine the effects of hypertonic saline solution (7.5%) on cardiovascular function and splanchnic perfusion in experimental sepsis.
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small volume of hypertonic saline as the Initial Fluid replacement in experimental hypodynamic sepsis
Critical Care, 2006Co-Authors: Alejandra G Garrido, Ruy J Cruz, Luiz Francisco Poli De Figueiredo, Mauricio Rocha E SilvaAbstract:We conducted the present study to examine the effects of hypertonic saline solution (7.5%) on cardiovascular function and splanchnic perfusion in experimental sepsis. Anesthetized and mechanically ventilated mongrel dogs received an intravenous infusion of live Escherichia coli over 30 minutes. After 30 minutes, they were randomized to receive lactated Ringer's solution 32 ml/kg (LR; n = 7) over 30 minutes or 7.5% hypertonic saline solution 4 ml/kg (HS; n = 8) over 5 minutes. They were observed without additional interventions for 120 minutes. Cardiac output (CO), mean arterial pressure (MAP), portal and renal blood flow (PBF and RBF, respectively), gastric partial pressure of CO2 (pCO2; gas tonometry), blood gases and lactate levels were assessed. E. coli infusion promoted significant reductions in CO, MAP, PBF and RBF (approximately 45%, 12%, 45% and 25%, respectively) accompanied by an increase in lactate levels and systemic and mesenteric oxygen extraction (sO2ER and mO2ER). Widening of venous-arterial (approximately 15 mmHg), portal-arterial (approximately 18 mmHg) and gastric mucosal-arterial (approximately 55 mmHg) pCO2 gradients were also observed. LR and HS infusion transiently improved systemic and regional blood flow. However, HS infusion was associated with a significant and sustained reduction of systemic (18 ± 2.6 versus 38 ± 5.9%) and mesenteric oxygen extraction (18.5 ± 1.9 versus 36.5 ± 5.4%), without worsening other perfusional markers. A large volume of LR or a small volume of HS promoted similar transient hemodynamic benefits in this sepsis model. However, a single bolus of HS did promote sustained reduction of systemic and mesenteric oxygen extraction, suggesting that hypertonic saline solution could be used as a salutary intervention during Fluid resuscitation in septic patients.