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OBJECTIVE: Expand upon the priorities of fluid resuscitation and vasopressor therapy research priorities identified by a group of experts assigned by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. DATA SOURCES: Original article, literature search. STUDY SELECTION: Several members of the original task force with expertise specific to the area of fluid resuscitation and vasopressor therapy. DATA EXTRACTION: None. DATA SYNTHESIS: None. CONCLUSION: In the second of a series of manuscripts subsequent to the original article, members with expertise in the subjects expound upon the three identified priorities related to fluid resuscitation and vasopressor therapies. This analysis summarizes what is known and what were identified as ongoing and future research. [ABSTRACT FROM AUTHOR]

Objective: Use of hyperchloremic IV fluids for resuscitation in sepsis may be associated with increased mortality and use of renal replacement therapy. After crystalloids, 5% human albumin represents the second most common resuscitation fluid in the ICU. Its chloride concentration is rarely considered in the clinical setting. This study quantifies previously undocumented chloride concentrations of three 5% albumin solutions using biochemical analysis. Design: We performed blinded analysis of the electrolyte concentration of albumin samples obtained directly from the national blood supplier (Canadian Blood Services). Two-tailed independent t tests were performed for all possible comparative analyses. Analysis of variance testing was performed for relevant three-way comparisons. Significance threshold was set at p less than 0.05. Setting: All samples were analyzed in the core laboratory at an academic hospital associated with McMaster University in Hamilton, Ontario, Canada. Subjects: We analyzed 65 albumin samples from three available brands obtained through Canadian Blood Services. They include Plasbumin (n = 21), Alburex (n = 24), Octalbin (n = 20). Intervention: Laboratory technologists blinded to product identification measured the concentration of electrolytes, extended electrolytes, lactate, and albumin of each sample using the Abbott ARCHITECT c8000 chemistry analyzer. Measurements and Main Results: The mean chloride concentration of Plasbumin, Alburex, and Octalbin, respectively, were 109.4 mmol/L (sd, 1.3), 123.6 mmol/L (sd, 1.3), and 136.8 mmol/L (sd, 0.4). The mean sodium concentration of Plasbumin, Alburex, and Octalbin, respectively, were 139.6 mmol/L (sd, 1.6), 137.3 mmol/L (sd, 2.2), and 149.4 mmol/L (sd, 0.5). The chloride and sodium concentration differed significantly for all two-way comparisons (p < 0.0001) and multiple comparison testing (p < 0.0001). Conclusion: This study is the first to identify and document a statistically significant variability in the chloride concentration of available 5% albumin products. This study has also informed a pilot randomized controlled trial examining the effect of administering high chloride versus low chloride fluids in critically ill patients with sepsis. [ABSTRACT FROM AUTHOR]

The article discusses the development in the treatment for sepsis and septic shock in the healthcare sector inorder prevent tissue damage in the body. It tells about the patient being given IV fluids inorder to maintain the blood pressure of these patient. It tells about the impact of demographics and aage in the treatment of sepsis.

The article discusses the efficacy and safety of liberal fluid resuscitation of adults with severe falciparum malaria. The impact of fluid resuscitation was analyzed on Systemic Hemodynamics, Microcirculation and Acidosis. The study shows a strong association between directly observed microvascular sequestration and clinical endpoints, and a failure of liberal fluid resuscitation to meaningfully improve sequestration, acid-base status, or renal function.

The article discusses a study which evaluated the effect of hemodynamic management guided by upper limits of cardiac filling volumes or pressures on durations of mechanical ventilation and lengths of stay in critically ill patients with shock. Study authors examined ventilator-free days, lengths of stay in the intensive care unit and organ failures. It concluded that the use of a transpulmonary thermodilution algorithm increase mechanical ventilation and intensive care unit length of stay.

The article discusses a study of the effect of tetrastarch and pentastarch with saline on pulmonary microvascular perfusion and gas exchange during systemic inflammation. The study used 32 female New Zealand white rabbits ventilated in a pressure-controlled mode unit from Sechrist Industries. Results showed that fluid resuscitation with tetrastarch can alter pulmonary microcirculation and gas exchange. The role of hydroxyethyl starch (HES) in pulmonary microcirculation is mentioned.

The article discusses findings of a study which determined whether central venous pressure and fluid balance after resuscitation for septic shock are linked with mortality. Several factors contributing to the deranged physiology of septic shock include the initial infection, the host response and subsequent medical interventions. The key components in the early management of septic shock include intravenous fluids along with antibiotics, source control, vasopressors, inotropic agents and mechanical ventilation.

The article discusses the results of a study on the effectiveness and safety of colloids or crystalloid infusion for resuscitation of fluids after heart surgery. According to the authors, the use of a colloid solution for volume resuscitation and a pulmonary artery catheter remarkably improved the hemodynamic condition of patients. They mention a lack of difference between colloids or crystalloid infusion in the daily creatinine level. The five physiologic principles that are used as the basis for the design of a fluid resuscitation are cited.

The author discusses aspects of the use of saline as solution for crystalloid fluid resuscitation in acutely ill patients. He examines the effect of saline administration on acid-base physiology which can cause metabolic acidosis. The author cites the outcomes of patients treated with fluid therapy in the intensive care unit (ICU).

The article discusses the comparison of dextran, gelatin, and hydroxyethyl starch to determine the effects of colloid solutions on ischemia-reperfusion-induced periosteal microcirculatory and inflammatory reactions. It notes that a therapeutic advantage was concluded after the comparison of the substance was made.

The author comments on the study "Computerized Decision Support System Improves Fluid Resuscitation Following Severe Burns: An Original Study," by J. Salinas and colleagues. According to the author, determining what is too little or what is too much fluid for burn patients is very difficult and Salinas and colleagues' paper may be a welcome addition in terms of determining this balance. He adds that the decision support system highlighted in the study should not be ignored by clinicians.

The article comments on conflicting issues concerning the risks and benefits of using hydroxyethyl starch (HES) as colloids for resuscitation in critically ill patients. According to the authors, the results of the Efficacy of Volume Substitution and Insulin Therapy in Severe Sepsis trial showed a trend toward greater mortality of patients who received 10 percent hypertonic solution of HES for fluid resuscitation. They add that the Saline versus Albumin Fluid Evaluation trial found a lack of difference between saline and albumin.

The article comments on results of the study "Volume assessment in patients with necrotizing pancreatitis: A comparison of intrathoracic blood volume index, central venous pressure, and hematocrit, and their correlation to cardiac index and extravascular lung water index," by W. Huber and colleagues. It praises the study's authors for not assuming that acute pancreatitis (AP) with necrosis and severe AP are the same entity.

The article offers information on the impact of crystalloid bolus on septic shock. Topics discussed include dysregulated host response triggered by a pathogen with symptoms like hypotension, life-threatening organ dysfunctions, and shock; rate of morbidity and mortality in patients with sepsis; and use of the fluid therapy in patients with sepsis and septic shock.

An editorial is presented which discusses a research study presented within the issue regarding the evaluation of automated systems for maintaining mean arterial pressure during controlled hemorrhage. It describes this with reference to semi-autonomous decision assist and fully autonomous closed loop resuscitation applications. Topics discussed include the control group for the study, restoration of mean arterial pressure and study test conditions.

The author reflects on the impact of fluid therapy on patients with acute respiratory distress syndrome (ARDS). He discusses the findings of the Fluid and Catheter Treatment Trial (FACTT) sponsored by the U.S. National Institutes of Health/National Heart Lung and Blood Institute and a study on the impact of the FACTT-lite fluid protocol on fluid accumulation. He also suggests future studies on the management of central venous pressure (CVP).

An introduction is presented in which the editors discuss the article "Effects of Fluid Resuscitation With 0.9% Saline Versus a Balanced Electrolyte Solution on Acute Kidney Injury in a Rat Model of Sepsis" published within the issue.

An introduction is presented in which the editor discusses various reports within the issue on Hemodynamic management used to downsize the mortality rate, which is presented by a randomized trial of early goal-directed therapy (EGDT) based on central venous saturation (Sco2).

The author reflects on the study by B. Bark and colleagues on the importance of infusion rate of different fluids to maintain normal plasma volume in septic rats. The study uses different types of colloids and crystalloids at fixed volume including 5% albumin, 6% hydroxythyl starch 130/0.4, 4% gelatin, and 0.9% sodium chloride (NaCl). He mentions that slow infusion of colloids, particularly albumin might have not only hemodynamic benefits, but also cost-effective.

The authors look at the findings of a study of the effect of various dengue fever severities on the heart published by S. Yacoub and colleagues within the issue. The study used an echocardiographic assessment of intravascular volume. They note that the study emphasized the importance of appropriate fluid management in severe dengue fever. Also cited is the increasing importance of focused echocardiography as a critical care skill.

The author comments on the study by Shellington et al which investigated the effectiveness of polynitroxylated pegylated hemoglobin (PNP-Hb) for fluid resuscitation of traumatic patients with hemorrhagic shock in rats. He stresses that the strength of the study includes the use of the combined in vitro and in vivo approach, experimental technique in vivo, the experimental protocol and the use of relevant control compounds. He also cites the weak points of the study including the lack of insight into the neuroprotective mechanisms of PNP-Hb.

The author comments on a study by John H. Boyd and colleagues within the issue of "Critical Care Medicine," which examined fluid balance during resuscitation of patients suffering from septic shock. The focus of the study were patients enrolled in the Vasopressin and Septic Shock Trial who suffered from septic shock and have received noradrenaline. One finding of the study revealed the unreliability of central venous pressure as marker of fluid balance.

The author comments on a study within the issue of "Critical Care Medicine," which determined whether albumin use may be beneficial for the subset of critically ill patients with sepsis. Compared with other fluid types, the study revealed an association between fluid resuscitation and lower mortality rate in sepsis patients. The significance of colloid osmotic pressure is described.

The author comments on a study by Jungner et al on the use of fluid resuscitation with albumin in a cat model of meningitis, published in this issue of "Critical Care Medicine." The author noted that benefits of albumin over saline, particularly after traumatic brain injury and hemorrhagic shock. However, the author asserted that the study did not consider direct pathogen-host interaction.

In this article the author discusses a study by Thiel and colleagues on care of patients with severe sepsis. He argues that the new term bacteremic severe sepsis introduced by the researchers may or may not clarify issues on sepsis. He also imparts that Thiel and colleagues were unable to provide more evidences on additional elements on their order set. Additionally, the author praised Thiel and his colleagues on their efforts to document hospital care quality.

The article discusses the study conducted by Renáta Varga comparing the effects of three normally used volume expanding colloids on microvascular hemodynamics and ischemia reperfusion injury. They found out that resuscitation with hydroxyethyl starch (HES) is associated with a reduction in local and systemic leukocyte activation. It suggests that although HES is commonly used in clinical practice, it could not be considered as evidence of clinical benefit.

The article comments on the paper "Relationship between global end-diastolic volume (GEDV) and cardiac output in critically ill infants and children," by C. Cecchetti and colleagues. According to the author, the greatest value of the study lies in the separation of children into relatively homogenous groups of critically ill patients. The author adds that although GEDV was shown to correlate with cardiac function, it was not studied as a tool to guide volume loading.