Revisiones_bibliográficas TyO_Web: Líquidos intravenosos / IV fluids therapy

lunes, 13 de marzo de 2017

Líquidos intravenosos / IV fluids therapy

Marzo 12, 2017. No. 2626

El dilema hemodinámico en la atención de emergencia: ¿Es la respuesta al fluido la solución? Una revisión sistemática.

The haemodynamic dilemma in emergency care: Is fluid responsiveness the answer? A systematic review.

Elwan MH1,2, Roshdy A3,4, Elsharkawy EM5, Eltahan SM5, Coats TJ6.

Scand J Trauma Resusc Emerg Med. 2017 Mar 6;25(1):25. doi: 10.1186/s13049-017-0370-4.

Abstract

BACKGROUND: Fluid therapy is a common and crucial treatment in the emergency department (ED). While fluid responsiveness seems to be a promising method to titrate fluid therapy, the evidence for its value in ED is unclear. We aim to synthesise the existing literature investigating fluid responsiveness in ED. METHODS: MEDLINE, Embase and the Cochrane library were searched for relevant peer-reviewed studies published from 1946 to present. RESULTS: A total of 249 publications were retrieved of which 22 studies underwent full-text review and eight relevant studies were identified. Only 3 studies addressed clinical outcomes - including 2 randomised controlled trials and one feasibility study. Five articles evaluated the diagnostic accuracy of fluid responsiveness techniques in ED. Due to marked heterogeneity, it was not possible to combine results in a meta-analysis. CONCLUSION: High quality, adequately powered outcome studies are still lacking, so the place of fluid responsiveness in ED remains undefined. Future studies should have standardisation of patient groups, the target response and the underpinning theoretic concept of fluid responsiveness. The value of a fluid responsiveness based fluid resuscitation protocol needs to be established in a clinical trial.

KEYWORDS: Cardiac output; Emergency; Fluid responsiveness; Fluid therapy; Haemodynamics; Resuscitation; Shock

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Líquidos en shock séptico. ¿Qué fluidos deben de utilizarse?

Fluid therapy for septic shock resuscitation: which fluid should be used?

[Article in English, Portuguese]

Corrêa TD1, Rocha LL1, Pessoa CM1, Silva E1, de Assuncao MS1.

Einstein (Sao Paulo). 2015 Jul-Sep;13(3):462-8. doi: 10.1590/S1679-45082015RW3273. Epub 2015 Aug 21.

Abstract

Early resuscitation of septic shock patients reduces the sepsis-related morbidity and mortality. The main goals of septic shock resuscitation include volemic expansion, maintenance of adequate tissue perfusion and oxygen delivery, guided by central venous pressure, mean arterial pressure, mixed or central venous oxygen saturation and arterial lactate levels. An aggressive fluid resuscitation, possibly in association with vasopressors, inotropes and red blood cell concentrate transfusion may be necessary to achieve those hemodynamic goals. Nonetheless, even though fluid administration is one of the most common interventions offered to critically ill patients, the most appropriate type of fluid to be used remains controversial. According to recently published clinical trials, crystalloid solutions seem to be the most appropriate type of fluids for initial resuscitation of septic shock patients. Balanced crystalloids have theoretical advantages over the classic solutions, but there is not enough evidence to indicate it as first-line treatment. Additionally, when large amounts of fluids are necessary to restore the hemodynamic stability, albumin solutions may be a safe and effective alternative. Hydroxyethyl starches solutions must be avoided in septic patients due to the increased risk of acute renal failure, increased need for renal replacement therapy and increased mortality. Our objective was to present a narrative review of the literature regarding the major types of fluids and their main drawbacks in the initial resuscitation of the septic shock patients.

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