RESUMEN
This update aims to provide an evidence based review of natural and synthetic colloids with a special emphasis on the various generations of the synthetic colloid hydroxyethyl starch. The effect of 1(st), 2(nd) and 3(rd) generation hetastarches on bleeding, coagulopathy, acute kidney injury and mortality will be discussed. The results of randomised controlled trials addressing morbidity and mortality outcomes of colloid versus crystalloid resuscitation in critically ill patients will be described. In addition, the rationale and evidence behind early goal directed fluid therapy (EGDFT) including a practical approach to assessment of dynamic measures of fluid responsiveness will be presented.
Asunto(s)
Fluidoterapia , Derivados de Hidroxietil Almidón/uso terapéutico , Sustitutos del Plasma/uso terapéutico , Resucitación/métodos , Choque/terapia , Animales , Coloides , Cuidados Críticos , Enfermedad Crítica , Soluciones Cristaloides , Fluidoterapia/efectos adversos , Fluidoterapia/mortalidad , Hemodinámica , Humanos , Derivados de Hidroxietil Almidón/efectos adversos , Derivados de Hidroxietil Almidón/análogos & derivados , Derivados de Hidroxietil Almidón/clasificación , Soluciones Isotónicas/uso terapéutico , Atención Perioperativa , Sustitutos del Plasma/efectos adversos , Sustitutos del Plasma/clasificación , Resucitación/efectos adversos , Resucitación/mortalidad , Choque/mortalidad , Choque/fisiopatología , Resultado del TratamientoRESUMEN
Hipovolemia em pacientes agudamente enfermos é um evento relativamente comum, e com importância clínica para o paciente, sendo a rápida e vigorosa reposição volêmica capaz de diminuir o risco de morte inicialmente e de evolução para falência renal na sequência. Neste artigo revisaremos os diferentes tipos de expansores, suas propriedades, vantagens e desvantagens. Os cristaloides se mantêm como preferência pela segurança, eficácia e baixo custo, com a desvantagem da importante formação de edema. As soluções hipertônicas têm indicação no atendimento pré-hospitalar por ser eficaz, porém com estabilização hemodinâmica de caráter efêmero, e pela possibilidade de distúrbios eletrolíticos. Estudos clínicos randomizados não demonstraram superioridade da albumina aos cristalóides e assim como são de custo alto ficam como segunda alternativa ou casos selecionados.
Hypovolemia in critically ill patients is a common event in intensive care patients, and it is clinically relevant for the patient. The fluid replacement is used to try to reduce risk of death and evolution to renal failure. In this article we review different types of expansors, their properties, advantages and disadvantages. Crystalloids are indicated for the safety, efficacy and low cost, the only disadvantage is oedema formation. Hypertonic crystalloid are indicated only in prehospitalar fluid resuscitation, because of your efficacy, but for a short period of time, and the possibility of hydroeletrolitic derangements. There is no evidence that colloids are more effective than crystalloids in reducing mortality in people who are critically ill or injured, and the high cost, turn them the second choice.
Asunto(s)
Humanos , Masculino , Femenino , Hipovolemia/prevención & control , Sustitutos del Plasma/clasificación , Sustitutos del Plasma/uso terapéutico , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia , Soluciones Hipertónicas/administración & dosificación , Soluciones Hipertónicas/clasificación , Soluciones Hipertónicas/farmacocinética , Soluciones Hipertónicas/uso terapéutico , Soluciones Isotónicas/administración & dosificación , Soluciones Isotónicas/clasificación , Soluciones Isotónicas/farmacocinética , Soluciones Isotónicas/uso terapéuticoRESUMEN
Assessment of hydration and perfusion is essential in patient evaluation. The acid-base and electrolyte disturbances that accompany many illnesses should also be considered. The duration of illness and body systems involved are also of major importance in patient evaluation. Fluid therapy is an important and potentially life-saving treatment of many and varied problems. The clinician must be able to assess the patient and determine whether the intravascular or extravascular compartments, or both, are deficient. Of primary concern is the status of the intravascular volume, then restoration of total body water and electrolytes. Fluid therapy is divided into three phases; the emergency phase, the rehydration phase, and the maintenance phase; not all patients require the three-phase therapy. The clinician must also be able to select (1) the appropriate solution to treat the volume deficit and correct the acid-base and electrolyte abnormalities and (2) the rate of administration to optimize outcome. Therefore, knowledge of electrolyte composition in plasma and of the various types of commercially available fluids is essential in order to select the appropriate therapy for the individual animal. In addition to the therapeutic aspects of fluid therapy, a knowledge of the side effects and complications of inappropriate fluid selection and rate of delivery is also important. With the individual requirements of each patient seen in a practice, the prescription approach to parenteral fluid therapy will optimize patient response to this extremely important aspect of overall patient management as well as make the practice of fluid therapy intellectually stimulating. This article has introduced the clinician to the parenteral fluids available and their indications in veterinary patients; it also contains a discussion of how to utilize preferred solutions for treatment of specific diseased states. Although there are definite "right" and "wrong" fluids to select for specific problems, there also remains individual preference in fluid choice, which is based on appropriate laboratory data and the practitioner's clinical judgment of the status of the individual patient vis-à-vis the spectrum of its disease. Recommendations for selection of different fluid types to treat similar conditions are usually based on these variables.