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Derek C Angus - One of the best experts on this subject based on the ideXlab platform.
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Intravenous fluid resuscitation is associated with septic endothelial glycocalyx degradation
Critical Care, 2019Co-Authors: Joseph A Hippensteel, Ryo Uchimido, Patrick D Tyler, Ryan C Burke, Xiaorui Han, Fuming Zhang, Sarah A Mcmurtry, James F Colbert, Christopher J Lindsell, Derek C AngusAbstract:Intravenous Fluids, an essential component of sepsis resuscitation, may paradoxically worsen outcomes by exacerbating endothelial injury. Preclinical models suggest that fluid resuscitation degrades the endothelial glycocalyx, a heparan sulfate-enriched structure necessary for vascular homeostasis. We hypothesized that endothelial glycocalyx degradation is associated with the volume of Intravenous Fluids administered during early sepsis resuscitation. We used mass spectrometry to measure plasma heparan sulfate (a highly sensitive and specific index of systemic endothelial glycocalyx degradation) after 6 h of Intravenous Fluids in 56 septic shock patients, at presentation and after 24 h of Intravenous Fluids in 100 sepsis patients, and in two groups of non-infected patients. We compared plasma heparan sulfate concentrations between sepsis and non-sepsis patients, as well as between sepsis survivors and sepsis non-survivors. We used multivariable linear regression to model the association between volume of Intravenous Fluids and changes in plasma heparan sulfate. Consistent with previous studies, median plasma heparan sulfate was elevated in septic shock patients (118 [IQR, 113–341] ng/ml 6 h after presentation) compared to non-infected controls (61 [45–79] ng/ml), as well as in a second cohort of sepsis patients (283 [155–584] ng/ml) at emergency department presentation) compared to controls (177 [144–262] ng/ml). In the larger sepsis cohort, heparan sulfate predicted in-hospital mortality. In both cohorts, multivariable linear regression adjusting for age and severity of illness demonstrated a significant association between volume of Intravenous Fluids administered during resuscitation and plasma heparan sulfate. In the second cohort, independent of disease severity and age, each 1 l of Intravenous Fluids administered was associated with a 200 ng/ml increase in circulating heparan sulfate (p = 0.006) at 24 h after enrollment. Glycocalyx degradation occurs in sepsis and septic shock and is associated with in-hospital mortality. The volume of Intravenous Fluids administered during sepsis resuscitation is independently associated with the degree of glycocalyx degradation. These findings suggest a potential mechanism by which Intravenous fluid resuscitation strategies may induce iatrogenic endothelial injury.
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Intravenous fluid resuscitation is associated with septic endothelial glycocalyx degradation
Critical Care, 2019Co-Authors: Joseph A Hippensteel, Ryo Uchimido, Patrick D Tyler, Ryan C Burke, Xiaorui Han, Fuming Zhang, Sarah A Mcmurtry, James F Colbert, Christopher J Lindsell, Derek C AngusAbstract:Background Intravenous Fluids, an essential component of sepsis resuscitation, may paradoxically worsen outcomes by exacerbating endothelial injury. Preclinical models suggest that fluid resuscitation degrades the endothelial glycocalyx, a heparan sulfate-enriched structure necessary for vascular homeostasis. We hypothesized that endothelial glycocalyx degradation is associated with the volume of Intravenous Fluids administered during early sepsis resuscitation. Methods We used mass spectrometry to measure plasma heparan sulfate (a highly sensitive and specific index of systemic endothelial glycocalyx degradation) after 6 h of Intravenous Fluids in 56 septic shock patients, at presentation and after 24 h of Intravenous Fluids in 100 sepsis patients, and in two groups of non-infected patients. We compared plasma heparan sulfate concentrations between sepsis and non-sepsis patients, as well as between sepsis survivors and sepsis non-survivors. We used multivariable linear regression to model the association between volume of Intravenous Fluids and changes in plasma heparan sulfate. Results Consistent with previous studies, median plasma heparan sulfate was elevated in septic shock patients (118 [IQR, 113–341] ng/ml 6 h after presentation) compared to non-infected controls (61 [45–79] ng/ml), as well as in a second cohort of sepsis patients (283 [155–584] ng/ml) at emergency department presentation) compared to controls (177 [144–262] ng/ml). In the larger sepsis cohort, heparan sulfate predicted in-hospital mortality. In both cohorts, multivariable linear regression adjusting for age and severity of illness demonstrated a significant association between volume of Intravenous Fluids administered during resuscitation and plasma heparan sulfate. In the second cohort, independent of disease severity and age, each 1 l of Intravenous Fluids administered was associated with a 200 ng/ml increase in circulating heparan sulfate ( p = 0.006) at 24 h after enrollment. Conclusions Glycocalyx degradation occurs in sepsis and septic shock and is associated with in-hospital mortality. The volume of Intravenous Fluids administered during sepsis resuscitation is independently associated with the degree of glycocalyx degradation. These findings suggest a potential mechanism by which Intravenous fluid resuscitation strategies may induce iatrogenic endothelial injury.
Bethany J Foster - One of the best experts on this subject based on the ideXlab platform.
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a randomized controlled trial of isotonic versus hypotonic maintenance Intravenous Fluids in hospitalized children
BMC Pediatrics, 2011Co-Authors: Thomas G Saba, James Fairbairn, Fiona Houghton, Diane Laforte, Bethany J FosterAbstract:Background Isotonic saline has been proposed as a safer alternative to traditional hypotonic solutions for Intravenous (IV) maintenance Fluids to prevent hyponatremia. However, the optimal tonicity of maintenance Intravenous Fluids in hospitalized children has not been determined. The objective of this study was to estimate and compare the rates of change in serum sodium ([Na]) for patients administered either hypotonic or isotonic IV Fluids for maintenance needs.
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A randomized controlled trial of isotonic versus hypotonic maintenance Intravenous Fluids in hospitalized children
BMC Pediatrics, 2011Co-Authors: Thomas G Saba, James Fairbairn, Fiona Houghton, Diane Laforte, Bethany J FosterAbstract:Background Isotonic saline has been proposed as a safer alternative to traditional hypotonic solutions for Intravenous (IV) maintenance Fluids to prevent hyponatremia. However, the optimal tonicity of maintenance Intravenous Fluids in hospitalized children has not been determined. The objective of this study was to estimate and compare the rates of change in serum sodium ([Na]) for patients administered either hypotonic or isotonic IV Fluids for maintenance needs. Methods This was a masked controlled trial. Randomization was stratified by admission type: medical patients and post-operative surgical patients, aged 3 months to 18 years, who required IV Fluids for at least 8 hours. Patients were randomized to receive either 0.45% or 0.9% saline in 5.0% dextrose. Treating physicians used the study fluid for maintenance; infusion rate and the use of additional Fluids were left to their discretion. Results Sixteen children were randomized to 0.9% saline and 21 to 0.45% saline. Baseline characteristics, duration (average of 12 hours) and rate of study fluid infusion, and the volume of additional isotonic Fluids given were similar for the two groups. [Na] increased significantly in the 0.9% group (+0.20 mmol/L/h [IQR +0.03, +0.4]; P = 0.02) and increased, but not significantly, in the 0.45% group (+0.08 mmol/L/h [IQR -0.15, +0.16]; P = 0.07). The rate of change and absolute change in serum [Na] did not differ significantly between groups. Conclusions When administered at the appropriate maintenance rate and accompanied by adequate volume expansion with isotonic Fluids, 0.45% saline did not result in a drop in serum sodium during the first 12 hours of fluid therapy in children without severe baseline hyponatremia. Confirmation in a larger study is strongly recommended. Clinical Trial Registration Number NCT00457873 ( http://www.clinicaltrials.gov/ )
Joseph A Hippensteel - One of the best experts on this subject based on the ideXlab platform.
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Intravenous fluid resuscitation is associated with septic endothelial glycocalyx degradation
Critical Care, 2019Co-Authors: Joseph A Hippensteel, Ryo Uchimido, Patrick D Tyler, Ryan C Burke, Xiaorui Han, Fuming Zhang, Sarah A Mcmurtry, James F Colbert, Christopher J Lindsell, Derek C AngusAbstract:Intravenous Fluids, an essential component of sepsis resuscitation, may paradoxically worsen outcomes by exacerbating endothelial injury. Preclinical models suggest that fluid resuscitation degrades the endothelial glycocalyx, a heparan sulfate-enriched structure necessary for vascular homeostasis. We hypothesized that endothelial glycocalyx degradation is associated with the volume of Intravenous Fluids administered during early sepsis resuscitation. We used mass spectrometry to measure plasma heparan sulfate (a highly sensitive and specific index of systemic endothelial glycocalyx degradation) after 6 h of Intravenous Fluids in 56 septic shock patients, at presentation and after 24 h of Intravenous Fluids in 100 sepsis patients, and in two groups of non-infected patients. We compared plasma heparan sulfate concentrations between sepsis and non-sepsis patients, as well as between sepsis survivors and sepsis non-survivors. We used multivariable linear regression to model the association between volume of Intravenous Fluids and changes in plasma heparan sulfate. Consistent with previous studies, median plasma heparan sulfate was elevated in septic shock patients (118 [IQR, 113–341] ng/ml 6 h after presentation) compared to non-infected controls (61 [45–79] ng/ml), as well as in a second cohort of sepsis patients (283 [155–584] ng/ml) at emergency department presentation) compared to controls (177 [144–262] ng/ml). In the larger sepsis cohort, heparan sulfate predicted in-hospital mortality. In both cohorts, multivariable linear regression adjusting for age and severity of illness demonstrated a significant association between volume of Intravenous Fluids administered during resuscitation and plasma heparan sulfate. In the second cohort, independent of disease severity and age, each 1 l of Intravenous Fluids administered was associated with a 200 ng/ml increase in circulating heparan sulfate (p = 0.006) at 24 h after enrollment. Glycocalyx degradation occurs in sepsis and septic shock and is associated with in-hospital mortality. The volume of Intravenous Fluids administered during sepsis resuscitation is independently associated with the degree of glycocalyx degradation. These findings suggest a potential mechanism by which Intravenous fluid resuscitation strategies may induce iatrogenic endothelial injury.
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Intravenous fluid resuscitation is associated with septic endothelial glycocalyx degradation
Critical Care, 2019Co-Authors: Joseph A Hippensteel, Ryo Uchimido, Patrick D Tyler, Ryan C Burke, Xiaorui Han, Fuming Zhang, Sarah A Mcmurtry, James F Colbert, Christopher J Lindsell, Derek C AngusAbstract:Background Intravenous Fluids, an essential component of sepsis resuscitation, may paradoxically worsen outcomes by exacerbating endothelial injury. Preclinical models suggest that fluid resuscitation degrades the endothelial glycocalyx, a heparan sulfate-enriched structure necessary for vascular homeostasis. We hypothesized that endothelial glycocalyx degradation is associated with the volume of Intravenous Fluids administered during early sepsis resuscitation. Methods We used mass spectrometry to measure plasma heparan sulfate (a highly sensitive and specific index of systemic endothelial glycocalyx degradation) after 6 h of Intravenous Fluids in 56 septic shock patients, at presentation and after 24 h of Intravenous Fluids in 100 sepsis patients, and in two groups of non-infected patients. We compared plasma heparan sulfate concentrations between sepsis and non-sepsis patients, as well as between sepsis survivors and sepsis non-survivors. We used multivariable linear regression to model the association between volume of Intravenous Fluids and changes in plasma heparan sulfate. Results Consistent with previous studies, median plasma heparan sulfate was elevated in septic shock patients (118 [IQR, 113–341] ng/ml 6 h after presentation) compared to non-infected controls (61 [45–79] ng/ml), as well as in a second cohort of sepsis patients (283 [155–584] ng/ml) at emergency department presentation) compared to controls (177 [144–262] ng/ml). In the larger sepsis cohort, heparan sulfate predicted in-hospital mortality. In both cohorts, multivariable linear regression adjusting for age and severity of illness demonstrated a significant association between volume of Intravenous Fluids administered during resuscitation and plasma heparan sulfate. In the second cohort, independent of disease severity and age, each 1 l of Intravenous Fluids administered was associated with a 200 ng/ml increase in circulating heparan sulfate ( p = 0.006) at 24 h after enrollment. Conclusions Glycocalyx degradation occurs in sepsis and septic shock and is associated with in-hospital mortality. The volume of Intravenous Fluids administered during sepsis resuscitation is independently associated with the degree of glycocalyx degradation. These findings suggest a potential mechanism by which Intravenous fluid resuscitation strategies may induce iatrogenic endothelial injury.
Anthony Delaney - One of the best experts on this subject based on the ideXlab platform.
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haemoglobin concentration and volume of Intravenous Fluids in septic shock in the arise trial
Critical Care, 2018Co-Authors: Matthew J Maiden, Mark E Finnis, Sandra L Peake, Simon Mcrae, Anthony DelaneyAbstract:Intravenous Fluids may contribute to lower haemoglobin levels in patients with septic shock. We sought to determine the relationship between the changes in haemoglobin concentration and the volume of Intravenous Fluids administered during resuscitation from septic shock. We performed a retrospective cohort study of patients enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial who were not transfused red blood cells (N = 1275). We determined the relationship between haemoglobin concentration, its change over time and volume of Intravenous Fluids administered over 6, 24 and 72 h using univariate and multivariate analysis. Median (IQR) haemoglobin concentration at baseline was 133 (118–146) g/L and decreased to 115 (102–127) g/L within the first 6 h of resuscitation (P < 0.001), 110 (99–122) g/L after 24 h, and 109 (97–121) g/L after 72 h. At the corresponding time points, the cumulative volume of Intravenous fluid administered was 1.3 (0.7–2.2) L, 2.9 (1.8–4.3) L and 4.6 (2.7–7.1) L. Haemoglobin concentration and its change from baseline had an independent but weak association with Intravenous fluid volume at each time point (R2 < 20%, P < 0.001). After adjusting for covariates, each litre of Intravenous fluid administered was associated with a change in haemoglobin concentration of − 1.0 g/L (95% CI −1.5 to −0.6, P < 0.001) at 24 h and − 1.3 g/L (− 1.6 to − 0.9, P < 0.001) at 72 h. Haemoglobin concentration decreases during resuscitation from septic shock, and has a significant but weak association with the volume of Intravenous Fluids administered.
Ryan C Burke - One of the best experts on this subject based on the ideXlab platform.
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Intravenous fluid resuscitation is associated with septic endothelial glycocalyx degradation
Critical Care, 2019Co-Authors: Joseph A Hippensteel, Ryo Uchimido, Patrick D Tyler, Ryan C Burke, Xiaorui Han, Fuming Zhang, Sarah A Mcmurtry, James F Colbert, Christopher J Lindsell, Derek C AngusAbstract:Intravenous Fluids, an essential component of sepsis resuscitation, may paradoxically worsen outcomes by exacerbating endothelial injury. Preclinical models suggest that fluid resuscitation degrades the endothelial glycocalyx, a heparan sulfate-enriched structure necessary for vascular homeostasis. We hypothesized that endothelial glycocalyx degradation is associated with the volume of Intravenous Fluids administered during early sepsis resuscitation. We used mass spectrometry to measure plasma heparan sulfate (a highly sensitive and specific index of systemic endothelial glycocalyx degradation) after 6 h of Intravenous Fluids in 56 septic shock patients, at presentation and after 24 h of Intravenous Fluids in 100 sepsis patients, and in two groups of non-infected patients. We compared plasma heparan sulfate concentrations between sepsis and non-sepsis patients, as well as between sepsis survivors and sepsis non-survivors. We used multivariable linear regression to model the association between volume of Intravenous Fluids and changes in plasma heparan sulfate. Consistent with previous studies, median plasma heparan sulfate was elevated in septic shock patients (118 [IQR, 113–341] ng/ml 6 h after presentation) compared to non-infected controls (61 [45–79] ng/ml), as well as in a second cohort of sepsis patients (283 [155–584] ng/ml) at emergency department presentation) compared to controls (177 [144–262] ng/ml). In the larger sepsis cohort, heparan sulfate predicted in-hospital mortality. In both cohorts, multivariable linear regression adjusting for age and severity of illness demonstrated a significant association between volume of Intravenous Fluids administered during resuscitation and plasma heparan sulfate. In the second cohort, independent of disease severity and age, each 1 l of Intravenous Fluids administered was associated with a 200 ng/ml increase in circulating heparan sulfate (p = 0.006) at 24 h after enrollment. Glycocalyx degradation occurs in sepsis and septic shock and is associated with in-hospital mortality. The volume of Intravenous Fluids administered during sepsis resuscitation is independently associated with the degree of glycocalyx degradation. These findings suggest a potential mechanism by which Intravenous fluid resuscitation strategies may induce iatrogenic endothelial injury.
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Intravenous fluid resuscitation is associated with septic endothelial glycocalyx degradation
Critical Care, 2019Co-Authors: Joseph A Hippensteel, Ryo Uchimido, Patrick D Tyler, Ryan C Burke, Xiaorui Han, Fuming Zhang, Sarah A Mcmurtry, James F Colbert, Christopher J Lindsell, Derek C AngusAbstract:Background Intravenous Fluids, an essential component of sepsis resuscitation, may paradoxically worsen outcomes by exacerbating endothelial injury. Preclinical models suggest that fluid resuscitation degrades the endothelial glycocalyx, a heparan sulfate-enriched structure necessary for vascular homeostasis. We hypothesized that endothelial glycocalyx degradation is associated with the volume of Intravenous Fluids administered during early sepsis resuscitation. Methods We used mass spectrometry to measure plasma heparan sulfate (a highly sensitive and specific index of systemic endothelial glycocalyx degradation) after 6 h of Intravenous Fluids in 56 septic shock patients, at presentation and after 24 h of Intravenous Fluids in 100 sepsis patients, and in two groups of non-infected patients. We compared plasma heparan sulfate concentrations between sepsis and non-sepsis patients, as well as between sepsis survivors and sepsis non-survivors. We used multivariable linear regression to model the association between volume of Intravenous Fluids and changes in plasma heparan sulfate. Results Consistent with previous studies, median plasma heparan sulfate was elevated in septic shock patients (118 [IQR, 113–341] ng/ml 6 h after presentation) compared to non-infected controls (61 [45–79] ng/ml), as well as in a second cohort of sepsis patients (283 [155–584] ng/ml) at emergency department presentation) compared to controls (177 [144–262] ng/ml). In the larger sepsis cohort, heparan sulfate predicted in-hospital mortality. In both cohorts, multivariable linear regression adjusting for age and severity of illness demonstrated a significant association between volume of Intravenous Fluids administered during resuscitation and plasma heparan sulfate. In the second cohort, independent of disease severity and age, each 1 l of Intravenous Fluids administered was associated with a 200 ng/ml increase in circulating heparan sulfate ( p = 0.006) at 24 h after enrollment. Conclusions Glycocalyx degradation occurs in sepsis and septic shock and is associated with in-hospital mortality. The volume of Intravenous Fluids administered during sepsis resuscitation is independently associated with the degree of glycocalyx degradation. These findings suggest a potential mechanism by which Intravenous fluid resuscitation strategies may induce iatrogenic endothelial injury.