¿Que hay de nuevo sobre el volumen de líquidos en terapia intensiva?
What's new in volume therapy in the intensive care unit?
van Haren F, Zacharowski K.
Best Pract Res Clin Anaesthesiol. 2014 Sep;28(3):275-283. doi: 10.1016/j.bpa.2014.06.004. Epub 2014 Jul 17.
Abstract
The administration of intravenous fluid to critically ill patients is one of the most common but also one of the most fiercely debated interventions in intensive care medicine. During the past decade, a number of important studies have been published which provide clinicians with improved knowledge regarding the timing, the type and the amount of fluid they should give to their critically ill patients. However, despite the fact that many thousands of patients have been enrolled in these trials of alternative fluid strategies, consensus remains elusive and practice is widely variable. Early adequate resuscitation of patients in shock followed by a restrictive strategy may be associated with better outcomes. Colloids such as modern hydroxyethyl starch are more effective than crystalloids in early resuscitation of patients in shock, and are safe when administered during surgery. However, these colloids may not be beneficial later in the course of intensive care treatment and should best be avoided in intensive care patients who have a high risk of developing acute kidney injury. Albumin has no clear benefit over saline and is associated with increased mortality in neurotrauma patients. Balanced fluids reduce the risk of hyperchloraemic acidosis and possibly kidney injury. The use of hypertonic fluids in patients with sepsis and acute lung injury warrants further investigation and should be considered experimental at this stage. Fluid therapy impacts relevant patient-related outcomes. Clinicians should adopt an individualized strategy based on the clinical scenario and best available evidence. One size does not fit all.
http://www.clinicalanaesthesiology.com/article/S1521-6896(14)00052-4/pdf
¿Deberían las soluciones con hidroxietil almidón estar totalmente prohibidas?
Should hydroxyethyl starch solutions be totally banned?
Vincent JL, Kellum JA, Shaw A, Mythen MG.
Crit Care. 2013 Oct 1;17(5):193. doi: 10.1186/cc13027.
Abstract
The choice of which intravenous solution to prescribe remains a matter of considerable debate in intensive care units around the world. Trends have been moving away from using hydroxyethyl starch solutions following concerns about safety. But are the available data sufficient to clearly assess the risk-benefit balance for all patients, and is there enough evidence of harm to justify removing these drugs completely from our hospitals?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871763/pdf/cc13027.pdf
Riesgo de insuficiencia renal aguda en pacientes tratados con soluciones que tienen hidroxietil almidón
The risk of AKI in patients treated with intravenous solutions containing hydroxyethyl starch.
Shaw AD, Kellum JA.
Clin J Am Soc Nephrol. 2013 Mar;8(3):497-503. doi: 10.2215/CJN.10921012. Epub 2013 Jan 18.
Abstract
Intravenous fluids are arguably one of the most commonly administered inpatient therapies and for the most part have been viewed as part of the nephrologist's toolkit in the management of acute kidney disease. Recently, findings have suggested that intravenous fluids may be harmful if given in excess (quantitative toxicity) and that some may be more harmful than others (qualitative toxicity), particularly for patients who already have AKI. Recent clinical trials have investigated hydroxyethyl starch solutions and found worrying results for the renal community. In this brief review, we consider the published literature on the role of hydroxyethyl starch solutions in AKI, with particular emphasis on two large recent randomized clinical trials conducted in Europe and Australia.
http://cjasn.asnjournals.org/content/8/3/497.full.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
What's new in volume therapy in the intensive care unit?
van Haren F, Zacharowski K.
Best Pract Res Clin Anaesthesiol. 2014 Sep;28(3):275-283. doi: 10.1016/j.bpa.2014.06.004. Epub 2014 Jul 17.
Abstract
The administration of intravenous fluid to critically ill patients is one of the most common but also one of the most fiercely debated interventions in intensive care medicine. During the past decade, a number of important studies have been published which provide clinicians with improved knowledge regarding the timing, the type and the amount of fluid they should give to their critically ill patients. However, despite the fact that many thousands of patients have been enrolled in these trials of alternative fluid strategies, consensus remains elusive and practice is widely variable. Early adequate resuscitation of patients in shock followed by a restrictive strategy may be associated with better outcomes. Colloids such as modern hydroxyethyl starch are more effective than crystalloids in early resuscitation of patients in shock, and are safe when administered during surgery. However, these colloids may not be beneficial later in the course of intensive care treatment and should best be avoided in intensive care patients who have a high risk of developing acute kidney injury. Albumin has no clear benefit over saline and is associated with increased mortality in neurotrauma patients. Balanced fluids reduce the risk of hyperchloraemic acidosis and possibly kidney injury. The use of hypertonic fluids in patients with sepsis and acute lung injury warrants further investigation and should be considered experimental at this stage. Fluid therapy impacts relevant patient-related outcomes. Clinicians should adopt an individualized strategy based on the clinical scenario and best available evidence. One size does not fit all.
http://www.clinicalanaesthesiology.com/article/S1521-6896(14)00052-4/pdf
¿Deberían las soluciones con hidroxietil almidón estar totalmente prohibidas?
Should hydroxyethyl starch solutions be totally banned?
Vincent JL, Kellum JA, Shaw A, Mythen MG.
Crit Care. 2013 Oct 1;17(5):193. doi: 10.1186/cc13027.
Abstract
The choice of which intravenous solution to prescribe remains a matter of considerable debate in intensive care units around the world. Trends have been moving away from using hydroxyethyl starch solutions following concerns about safety. But are the available data sufficient to clearly assess the risk-benefit balance for all patients, and is there enough evidence of harm to justify removing these drugs completely from our hospitals?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871763/pdf/cc13027.pdf
Riesgo de insuficiencia renal aguda en pacientes tratados con soluciones que tienen hidroxietil almidón
The risk of AKI in patients treated with intravenous solutions containing hydroxyethyl starch.
Shaw AD, Kellum JA.
Clin J Am Soc Nephrol. 2013 Mar;8(3):497-503. doi: 10.2215/CJN.10921012. Epub 2013 Jan 18.
Abstract
Intravenous fluids are arguably one of the most commonly administered inpatient therapies and for the most part have been viewed as part of the nephrologist's toolkit in the management of acute kidney disease. Recently, findings have suggested that intravenous fluids may be harmful if given in excess (quantitative toxicity) and that some may be more harmful than others (qualitative toxicity), particularly for patients who already have AKI. Recent clinical trials have investigated hydroxyethyl starch solutions and found worrying results for the renal community. In this brief review, we consider the published literature on the role of hydroxyethyl starch solutions in AKI, with particular emphasis on two large recent randomized clinical trials conducted in Europe and Australia.
http://cjasn.asnjournals.org/content/8/3/497.full.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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