ABSTRACTS from 16th International COnference on ... - CRRT Online

G07
Fluids and Solutions in the Critically Ill 1
Daniel De Backer MD
4:00-5:30
Tuesday, February 14
Educational Objectives:
To explain what is the safest way to administer fluids
To understand how to identify patient who respond and tolerate fluids
To discuss the different types of fluids and how relevant this could be for patient outcomes
Content Description:
Fluids are a key element of hemodynamic resuscitation. Fluids can improve tissue perfusion but a positive fluid
balance is associated with a poor outcome. It is thus important to identify, and if possible to predict, which
patients respond to fluids. It is also important to ensure that fluids are tolerated when administered. The fluid
challenge technique should thus be used to evaluate the response to fluids (not just fluid filling).
The type of fluid has also been amply debated for many years. The plasma expansion volume is larger with colloids
than crystalloids. No solution is perfect, and each carries some benefit/risk/cost profile and this balance can
even vary according to patients conditions (sepsis, AKI,…). A large scale randomized trial reassured on the safety
of human albumin. Some trials suggested that starches may increase the risk to develop AKI but several large
scales RCT are ongoing (results expected next few months).
Suggested Reading:
1. Brunkhorst,F. et al.. (2008). Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N.
Engl. J Med, 358, 125-139.
2. Finfer,S. et al. (2004). A comparison of albumin and saline for fluid resuscitation in the intensive care unit.
N. Engl. J Med, 350, 2247-2256.
3. Finfer,S.et al. (2011). Impact of albumin compared to saline on organ function and mortality of patients
with severe sepsis. Intensive Care Med, 37, 86-96.
4. Payen,D. et al. (2008). A positive fluid balance is associated with a worse outcome in patients with acute
renal failure. Crit Care, 12, R74.
5. Sakr,Y. et al. (2007). Effects of hydroxyethyl starch administration on renal function in critically ill patients.
Br. J. Anaesth., 98, 216-224.
6. Vincent,J.L. & Weil,M.H. (2006). Fluid challenge revisisted. Crit Care Med, 34, 1337.
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