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Anesthesia and Analgesia Jun 2009The management of massively transfused trauma patients has improved with a better understanding of trauma-induced coagulopathy, the limitations of crystalloid infusion,... (Review)
Review
The management of massively transfused trauma patients has improved with a better understanding of trauma-induced coagulopathy, the limitations of crystalloid infusion, and the implementation of massive transfusion protocols (MTPs), which encompass transfusion management and other patient care needs to mitigate the "lethal triad" of acidosis, hypothermia, and coagulopathy. MTPs are currently changing in the United States and worldwide because of recent data showing that earlier and more aggressive transfusion intervention and resuscitation with blood components that approximate whole blood significantly decrease mortality. In this context, MTPs are a key element of "damage control resuscitation," which is defined as the systematic approach to major trauma that addresses the lethal triad mentioned above. MTPs using adequate volumes of plasma, and thus coagulation factors, improve patient outcome. The ideal amounts of plasma, platelet, cryoprecipitate and other coagulation factors given in MTPs in relationship to the red blood cell transfusion volume are not known precisely, but until prospective, randomized, clinical trials are performed and more clinical data are obtained, current data support a target ratio of plasma:red blood cell:platelet transfusions of 1:1:1. Future prospective clinical trials will allow continued improvement in MTPs and thus in the overall management of patients with trauma.
Topics: Adult; Blood Coagulation Disorders; Blood Component Transfusion; Blood Transfusion; Child; Erythrocytes; Humans; Plasma Substitutes; Transfusion Reaction; Treatment Outcome; Wounds and Injuries
PubMed: 19448199
DOI: 10.1213/ane.0b013e3181a0b6c6 -
British Journal of Clinical Pharmacology Jun 2019A population kinetic model was developed for the body fluid shifts occurring when 20% albumin is given by intravenous infusion. The aim was to study whether its efficacy...
AIMS
A population kinetic model was developed for the body fluid shifts occurring when 20% albumin is given by intravenous infusion. The aim was to study whether its efficacy to expand the plasma volume is impaired after major surgery.
METHODS
An intravenous infusion of 3 mL/kg 20% albumin over 30 minutes was given to 15 volunteers and to 15 patients on the 1 day after major open abdominal surgery. Blood samples and urine were collected during 5 hours. Mixed-effect modelling software was used to develop a fluid volume kinetic model, using blood haemoglobin and urine excretion the estimate body fluid shifts, to which individual-specific covariates were added in sequence.
RESULTS
The rise in plasma albumin expanded the plasma volume in excess of the infused volume by relocating noncirculating fluid (rate constant k ), but it also increased losses of fluid from the kinetic system (k ). The balance between k and k maintained the rise in plasma albumin and plasma volume at a virtual steady-state for almost 2 hours. The rate constant for urinary excretion (k ) was slightly reduced by the preceding surgery, by a marked rise in plasma albumin, and by a high preinfusion urinary concentration of creatinine. The arterial pressure, body weight, and plasma concentrations of C-reactive protein and shedding products of the endothelial glycocalyx layer (syndecan-1, heparan sulfate, and hyaluronic acid) did not serve as statistically significant covariates.
CONCLUSIONS
There were no clinically relevant differences in the kinetics of 20% albumin between postoperative patients and volunteers.
Topics: Abdomen; Adult; Albumins; Female; Fluid Shifts; Fluid Therapy; Humans; Infusions, Intravenous; Male; Models, Biological; Plasma Substitutes; Postoperative Care; Sweden; Treatment Outcome; Young Adult
PubMed: 30756411
DOI: 10.1111/bcp.13897 -
The Surgical Clinics of North America Apr 1993The surgeon should be cognizant of both the intraoperative and postoperative consequences of intraoperative fluid administration. Optimal fluid management should take... (Comparative Study)
Comparative Study Review
The surgeon should be cognizant of both the intraoperative and postoperative consequences of intraoperative fluid administration. Optimal fluid management should take into consideration the patient's overall condition and should not be based solely on the cardiovascular response to volume loading. The selection of a particular fluid for resuscitation solution should be tailored to the patient's individual situation. No single fluid preparation will be appropriate for all clinical situations. Crystalloids, colloids, and hypertonic saline solutions have all been shown to be effective in restoring intravascular volume. Each has its own relative advantages and disadvantages and will be appropriate in differing situations. Colloid preparations should not be avoided for fear of inducing pulmonary edema, and the use of hypertonic solutions should not be precluded by fear of potential metabolic complications. The judicious use of both hypertonic solutions and colloids is safe. For the vast majority of routine surgical cases, where the patient is hemodynamically stable and postoperative fluid overloading is not a significant problem, isotonic crystalloids such as lactated Ringer's are both sufficient and cost effective.
Topics: Colloids; Crystalloid Solutions; Fluid Therapy; Humans; Intraoperative Care; Intraoperative Complications; Isotonic Solutions; Plasma Substitutes; Saline Solution, Hypertonic; Solutions
PubMed: 8456354
DOI: 10.1016/s0039-6109(16)45978-5 -
BMC Surgery Apr 2022A meta-analysis of randomized controlled trials was recently published in BMC Surgery that compared the use of human albumin with 6% hydroxyethyl starches 130/0.4 for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A meta-analysis of randomized controlled trials was recently published in BMC Surgery that compared the use of human albumin with 6% hydroxyethyl starches 130/0.4 for cardiopulmonary bypass prime and perioperative fluid management in pediatric and adult cardiac surgery patients. The two plasma expanding solutions are described as equivalent for efficacy and safety outcomes, and, on that basis, the preferential use of hydroxyethyl starches 130/0.4 was recommended for economic reasons because of the higher unit costs of human albumin solutions.
RESULTS
In addition to the fact that trials were mostly small, single-center studies and the number of total participants was low, making the meta-analysis underpowered for several outcomes, selective reporting of data for ICU length of stay was identified. Re-calculation of statistics at higher precision showed that ICU length of stay of patients in the human albumin group was significantly shorter than that of patients in the 6% hydroxyethyl starches 130/0.4 group (standard mean difference - 0.181, 95% confidence interval - 0.361 to - 0.001, P = 0.049), which may offset any proposed economic advantage of using 6% hydroxyethyl starches 130/0.4. At the same time, the renal safety of 6% hydroxyethyl starches 130/0.4 in surgical patients is under regulatory review.
CONCLUSIONS
Underpowered trials and selective reporting may impair the validity of the meta-analysis. A more cautious conclusion about the interchangeability between human albumin and 6% hydroxyethyl starches 130/0.4 in cardiac surgery should have been reached.
Topics: Adult; Albumins; Cardiac Surgical Procedures; Child; Humans; Hydroxyethyl Starch Derivatives; Plasma Substitutes; Serum Albumin, Human
PubMed: 35410195
DOI: 10.1186/s12893-022-01588-x -
Canadian Medical Association Journal Oct 1978
Topics: Exchange Transfusion, Whole Blood; Female; Humans; Plasma Substitutes; Plasmapheresis; Pregnancy; Waldenstrom Macroglobulinemia
PubMed: 101289
DOI: No ID Found -
British Journal of Anaesthesia Apr 2016
Topics: Colloids; Coronary Artery Bypass; Female; Humans; Isotonic Solutions; Male; Plasma Substitutes; Renal Circulation
PubMed: 26873176
DOI: 10.1093/bja/aev542 -
Neuroscience Bulletin Jan 2020
Review
Topics: Aging; Alzheimer Disease; Animals; Humans; Plasma Exchange; Plasma Substitutes
PubMed: 31111428
DOI: 10.1007/s12264-019-00394-5 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Apr 2021In recent years, it has been reported that the anti-shock effect of plasma substitutes in adult patients with major burn in shock stage is not good. However, due to the...
OBJECTIVES
In recent years, it has been reported that the anti-shock effect of plasma substitutes in adult patients with major burn in shock stage is not good. However, due to the shortage of clinical frozen plasma supply, it is impossible to guarantee that frozen plasma is used as colloidal solution for anti-shock treatment. The purpose of this study is to explore the effect of the infusion ration between frozen plasma and plasma substitutes on the prognosis of adult patients with major burn in shock stage.
METHODS
This study enrolled 586 adult patients with major burn by selecting the hospitalization burn patients, who had been hospitalized at the Jiangxi province burn center from September 2014 to April 2019. The patients with the infusion ratio of frozen plasma to plasma substitutes ≥2꞉1 at 48 hours after admission were included in the experimental group, otherwise they were included in the control group. The basic clinical data and clinical prognosis indicator in the 2 groups were compared. Logistic univariate regression analysis was used to screen the influential factors of 30-day mortality in adult patients with major burn, and logistic multivariate regression analysis was used to obtain independent risk and protective factors; Kaplan-Meier method was used to draw the survival curve of the 2 groups, and log-rank test was used to compare the 30-day survival rate of the 2 groups.
RESULTS
There were significant differences in the infusion volume of frozen plasma and plasma substitutes between the 2 groups at 48 hours after admission (both <0.05). The duration of mechanical ventilation in the experimental group was shorter than that in the control group, the percentage of continuous renal replacement therapy (CRRT) in the experimental group was lower than that in the control group, and the in-hospital mortality and 30-day mortality in the experimental group were lower than those in the control group, the differences were statistically significant (all <0.05). The percentage of burn area and total body surface area (TBSA) was an independent risk factor for 30-day mortality of adult patients with major burn (OR=1.228, 95% CI 1.010 to 1.439, =0.039), while the infusion ration between of frozen plasma and plasma substitutes 48 hours after admission was an independent protective factor (OR=0.016, 95% CI 0.001 to 0.960, =0.023). The 30-day survival rate of the experimental group was significantly higher than that in the control group (<0.001).
CONCLUSIONS
Infusion ration between frozen plasma to plasma substitutes at 48 hours after admission is an independent protective factor for 30-day mortality of adult patients with major burn. In the early stage of adult patients with major burn, frozen plasma should be used as the anti-shock therapy as far as possible (frozen plasma꞉plasma substitute ≥2꞉1) to improve the prognosis and reduce the of 30-day mortality.
Topics: Adult; Hospitalization; Humans; Plasma Substitutes; Prognosis; Retrospective Studies; Shock
PubMed: 33967086
DOI: 10.11817/j.issn.1672-7347.2021.190565 -
British Journal of Anaesthesia Nov 2020Buffered crystalloid solutions are increasingly recommended as first-line intravenous resuscitation fluids. However, guidelines do not distinguish between the different... (Comparative Study)
Comparative Study Review
BACKGROUND
Buffered crystalloid solutions are increasingly recommended as first-line intravenous resuscitation fluids. However, guidelines do not distinguish between the different types of buffered solutions. The aim of this scoping review was to assess the evidence on the use of lactate- vs acetate-buffered crystalloid solutions and their potential benefits and harms.
METHODS
We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We searched PubMed, Embase, Epistemonikos, and the Cochrane Library for studies assessing the effect of lactate- vs acetate-buffered crystalloid solutions on any outcome in adult hospitalised patients. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
We included a total of 29 studies, 25 of which were clinical trials and four were observational studies. Most studies were conducted in surgical settings and indications for use were poorly described. The most commonly administered solutions were Ringer's lactate vs Ringer's acetate or Plasma-Lyte™. Outcomes included acid/base and electrolyte status; haemodynamic variables; and markers of renal and liver function, metabolism, and coagulation. Only a few studies reported patient-centred outcomes. Overall, the data provided no firm evidence for benefit or harm of either solution, and the quantity and quality of evidence were low.
CONCLUSIONS
The quantity and quality of evidence on the use of different buffered crystalloid intravenous solutions were low, data were derived primarily from surgical settings, and patient-important outcomes were rarely reported; thus, the balance between benefits and harms between these solutions is largely unknown.
Topics: Buffers; Crystalloid Solutions; Fluid Therapy; Humans; Infusions, Intravenous; Isotonic Solutions; Plasma Substitutes; Ringer's Lactate
PubMed: 32892982
DOI: 10.1016/j.bja.2020.07.017 -
Postgraduate Medical Journal Sep 1967
Review
Topics: Blood Circulation; Blood Volume; Emergencies; Humans; Infusions, Parenteral; Plasma Substitutes; Resuscitation; Shock; Water-Electrolyte Balance
PubMed: 4863457
DOI: 10.1136/pgmj.43.503.592