Review
Medicine, General & Internal
Azizullah Beran, Nehaya Altorok, Omar Srour, Saif-Eddin Malhas, Waleed Khokher, Mohammed Mhanna, Hazem Ayesh, Nameer Aladamat, Ziad Abuhelwa, Khaled Srour, Asif Mahmood, Nezam Altorok, Mohammad Taleb, Ragheb Assaly
Summary: This study aimed to compare the efficacy of balanced crystalloids (BC) and normal saline (NS) in patients with sepsis. The meta-analysis showed that BC had a significant effect in reducing overall mortality, 28/30-day mortality, and acute kidney injury (AKI) compared to NS. However, there was no significant difference between the two groups in terms of 90-day mortality, need for renal replacement therapy, and ICU length of stay. Subgroup analysis of randomized controlled trials did not show significant differences in overall mortality and AKI between the groups.
JOURNAL OF CLINICAL MEDICINE
(2022)
Review
Anesthesiology
Muralie Vignarajah, Annie Berg, Zahra Abdallah, Naman Arora, Arshia Javidan, Tyler Pitre, Shannon M. Fernando, Jessica Spence, John Centofanti, Bram Rochwerg
Summary: This study aimed to summarize the data from RCTs to determine whether the use of balanced crystalloids compared with saline in the perioperative period leads to differences in patient-important outcomes. The results of the study showed an uncertain effect on postoperative mortality and the need for renal replacement therapy, but a probable improvement in postoperative acid-base status with the use of balanced crystalloids. Further research is needed to determine the impact of balanced crystalloid use on patient-important outcomes.
BRITISH JOURNAL OF ANAESTHESIA
(2023)
Article
Pediatrics
Andrea Scioscia, Christopher Horvat, Michael L. Moritz, Dana Fuhrman
Summary: There is limited understanding about the impact of maintenance fluid choice on clinical outcomes in children with critical asthma. This study found that patients who received 0.9% saline had significantly higher serum chloride levels compared to those who received balanced solutions. However, the choice of fluid therapy did not have any impact on serum bicarbonate levels, the development of AKI, or hospital and ICU LOS.
Article
Critical Care Medicine
Karen E. Jackson, Li Wang, Jonathan D. Casey, Gordon R. Bernard, Wesley H. Self, Todd W. Rice, Matthew W. Semler
Summary: This study analyzed the impact of different fluid resuscitation strategies on outcomes for patients with sepsis, and found that balanced crystalloids may improve outcomes for patients primarily in the ED and ICU period.
Article
Pediatrics
Sirawut Trepatchayakorn, Manee Sakunpunphuk, Rujipat Samransamruajkit
Summary: Current evidence suggests that different types of crystalloid fluid used in pediatric sepsis resuscitation do not lead to different outcomes, but a significant reduction in urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels was observed in patients receiving a large dose of Ringer lactate solution compared to other fluids.
INDIAN JOURNAL OF PEDIATRICS
(2021)
Review
Medicine, General & Internal
Charalampos D. Moschopoulos, Dimitra Dimopoulou, Anastasia Dimopoulou, Konstantina Dimopoulou, Konstantinos Protopapas, Nikolaos Zavras, Sotirios Tsiodras, Anastasia Kotanidou, Paraskevi C. Fragkou
Summary: Fluid resuscitation therapy is important in the early stages of sepsis management. The use of balanced solutions (BSs) instead of normal saline (NS) has been shown to have better outcomes in septic patients. However, careful fluid administration is necessary to avoid fluid overload. Personalized fluid management based on patient-specific hemodynamic indices is needed for better patient outcomes.
MEDICINA-LITHUANIA
(2023)
Article
Critical Care Medicine
Sarah Lombardo, Michael C. Smith, Matthew W. Semler, Li Wang, Mary Lynn Dear, Christopher J. Lindsell, Robert E. Freundlich, Oscar D. Guillamondegui, Wesley H. Self, Todd W. Rice
Summary: The study investigated the effects of balanced crystalloids and saline on clinical outcomes in patients with traumatic brain injury, and found that balanced crystalloids may lead to worse discharge disposition.
JOURNAL OF NEUROTRAUMA
(2022)
Article
Medicine, General & Internal
Fernando G. Zampieri, Flavia R. Machado, Rodrigo S. Biondi, Flavio G. R. Freitas, Viviane C. Veiga, Rodrigo C. Figueiredo, Wilson J. Lovato, Cristina P. Amendola, Ary Serpa-Neto, Jorge L. R. Paranhos, Marco A. V. Guedes, Eraldo A. Lucio, Lucio C. Oliveira-Junior, Thiago C. Lisboa, Fabio H. Lacerda, Israel S. Maia, Cintia M. C. Grion, Murillo S. C. Assuncao, Airton L. O. Manoel, Joao M. Silva-Junior, Pericles Duarte, Rafael M. Soares, Tamiris A. Miranda, Lucas M. de Lima, Rodrigo M. Gurgel, Denise M. Paisani, Thiago D. Correa, Luciano C. P. Azevedo, John A. Kellum, Lucas P. Damiani, Nilton Brandao da Silva, Alexandre B. Cavalcanti
Summary: This study aimed to compare the effect of a balanced solution vs saline solution on 90-day survival in ICU patients, and found that the use of a balanced solution did not significantly reduce mortality.
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
(2021)
Article
Medicine, General & Internal
Simon Finfer, Sharon Micallef, Naomi Hammond, Leanlove Navarra, Rinaldo Bellomo, Laurent Billot, Anthony Delaney, Martin Gallagher, David Gattas, Qiang Li, M. Biostat, Diane Mackie, Jayanthi Mysore, Manoj Saxena, Colman Taylor, Paul Young, John Myburgh
Summary: There is no evidence that the use of balanced multielectrolyte solution (BMES) reduces the risk of death or acute kidney injury in critically ill patients compared to saline, according to a double-blind, randomized, controlled trial.
NEW ENGLAND JOURNAL OF MEDICINE
(2022)
Article
Medicine, General & Internal
Joseph Bledsoe, Ithan D. Peltan, R. J. Bunnell, Samuel M. Brown, Al Jephson, Danielle Groat, Nicholas M. Levin, Emily Wilson, Jon Newbold, Gabriel Fontaine, Joe Frandsen, David Hasleton, Paul Krakovitz, Kim Brunisholz, Todd Allen
Summary: In this comparative effectiveness study, an implementation program was associated with an increase in the proportion of fluids administered as lactated Ringer solution compared with normal saline and was associated with a reduction in MAKE30 events among patients treated in a large integrated health care system.
Article
Emergency Medicine
Tony Zitek, Ramsey Ataya, Lian Farino, Salman Mohammed, Glenn Miller
Summary: The study did not find an association between receiving more than 1 L of IV crystalloid and in-hospital mortality or the volume of PRBCs transfused among trauma patients, but receiving more than 1 L of crystalloids was associated with a longer hospital length of stay.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Review
Medicine, General & Internal
Stephen Macdonald, Sandra L. Peake, Alasdair R. Corfield, Anthony Delaney
Summary: Intravenous fluid resuscitation is recommended as the first-line treatment for sepsis-associated hypotension and/or hypoperfusion, but there is limited high-level evidence to support this practice. Recent studies have found potential harms associated with large volume fluid resuscitation, leading to recommendations for a more conservative approach and earlier use of vasopressors. However, there is currently uncertainty and variation in practice regarding the choice between fluids or vasopressors for initial resuscitation in septic shock.
FRONTIERS IN MEDICINE
(2022)
Article
Urology & Nephrology
Blake E. Funke, Karen E. Jackson, Wesley H. Self, Sean P. Collins, Christina T. Saunders, Li Wang, Jeffrey D. Blume, Nancy Wickersham, Ryan M. Brown, Jonathan D. Casey, Gordon R. Bernard, Todd W. Rice, Edward D. Siew, Matthew W. Semler
Summary: In a study comparing balanced crystalloids and saline among 261 critically ill adults, balanced crystalloids were associated with significantly lower urinary NGAL levels but similar KIM-1 levels compared to saline. These results suggest a modest reduction in early biomarkers of acute kidney injury with the use of balanced crystalloids.
Review
Medicine, General & Internal
Yuhan Zhu, Nan Guo, Maifen Song, Fei Xia, Yanqing Wu, Xusheng Wang, Tengfei Chen, Zhihai Yang, Siwen Yang, Yu Zhang, Xin Zhang, Qingquan Shi, Xiaoxu Shen
Summary: The meta-analysis showed that there was no significant difference in safety between balanced crystalloids and saline among critically ill patients, and they had similar clinical outcomes.
Article
Critical Care Medicine
Nikhil Jagan, Lee E. Morrow, Ryan W. Walters, Robert W. Plambeck, Tej M. Patel, Karson F. Kalian, Jeffrey C. Macaraeg, Emily D. Dyer, Adam A. Bergh, Aaron J. Fried, Douglas R. Moore, Mark A. Malesker
Summary: In this single-center retrospective study, a conservative initial IV fluid resuscitation strategy did not correlate with decreased rates of hypoxemic respiratory failure when broadly defining respiratory failure as an increase in oxygen requirements.
Review
Cardiac & Cardiovascular Systems
Gurmeet Singh, Darren Hudson, Andrew Shaw
CANADIAN JOURNAL OF CARDIOLOGY
(2020)
Article
Cardiac & Cardiovascular Systems
Mihaela Tiru, Anis John Kadado, Vida Rastegar, Kanval Shah, Kirti K. Joshi, Peter Lindenauer, Tara Lagu, Mihaela S. Stefan
Article
Health Care Sciences & Services
Mihaela S. Stefan, Doug Salvador, Tara K. Lagu
AMERICAN JOURNAL OF MEDICAL QUALITY
(2021)
Article
Anesthesiology
David R. McIlroy, Bennett Roman, Frederic T. Billings, Bruce A. Bollen, Amanda Fox, Mariya Geube, Hong Liu, Linda Shore-Lesserson, Alexander Zarbock, Andrew D. Shaw
Summary: A survey of perioperative practice in adult patients undergoing cardiac surgery revealed that many strategies are believed to affect renal injury, with a focus on intraoperative target blood pressure and choice of vasopressor agent for potential renoprotection.
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
(2021)
Article
Critical Care Medicine
Mihaela S. Stefan, Penelope S. Pekow, Aruna Priya, Richard ZuWallack, Kerry A. Spitzer, Tara C. Lagu, Quinn R. Pack, Victor M. Pinto-Plata, Kathleen M. Mazor, Peter K. Lindenauer
Summary: Initiating pulmonary rehabilitation within 90 days of discharge can reduce the risk of rehospitalization for COPD patients among Medicare beneficiaries. These findings support results from randomized controlled clinical trials and emphasize the importance of identifying effective strategies to increase participation in pulmonary rehabilitation.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2021)
Article
Anesthesiology
Rabail Chaudhry, Jonathan P. Wanderer, Talha Mubashir, Felix Kork, Jennifer Morse, Rida Waseem, John F. Zaki, Andrew D. Shaw, Holger K. Eltzschig, Yafen Liang
Summary: This retrospective cohort study aimed to determine the incidence and predictive factors of acute kidney injury (AKI) after off-pump lung transplantation. The study included 148 adult patients who underwent lung transplant without cardiopulmonary bypass or extracorporeal membrane oxygenator at the Vanderbilt University Medical Center between 2006 and 2016. The results showed that AKI is a common complication after off-pump lung transplantation, associated with increased hospital length of stay, and independently associated with younger age, unilateral lung transplant, and diagnosis of chronic obstructive pulmonary disease.
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
(2022)
Article
Medicine, Research & Experimental
Mihaela S. Stefan, Penelope S. Pekow, Christopher M. Shea, Ashley M. Hughes, Nicholas S. Hill, Jay S. Steingrub, Mary Jo S. Farmer, Dean R. Hess, Karen L. Riska, Taylar A. Clark, Peter K. Lindenauer
Summary: There is significant variation in NIV use across hospitals, impacting morbidity and mortality rates. Researchers aimed to improve NIV uptake in COPD patients by studying the effectiveness of online education versus interprofessional education strategies, making adjustments to their study design due to the COVID-19 pandemic.
Article
Medicine, General & Internal
Mihaela S. Stefan, Ahmed Eltanbedawi, Neil C. Devoe, Sabiha Khan, Ya Zhou, Taroob Latef, Anthony Esposito, Anum Fatima, Alexander B. Knee, Tara C. Lagu
Summary: This study found that slightly less than half (40%) of patients who died of complications of COVID-19 had unexpected deaths. For the 60% of patients for whom death was not a surprise, the findings suggest opportunities to improve end-of-life discussions and implement shared decision-making in high-risk patients early on or prior to hospitalization.
JOURNAL OF HOSPITAL MEDICINE
(2022)
Review
Health Care Sciences & Services
Mihaela S. Stefan, Alexander B. Knee, Audrey Ready, Vida Rastegar, Jennifer Burgher Seaman, Bridget Gunn, Ehryn Shaw, Raveendhara R. Bannuru
Summary: This meta-analysis examined the effectiveness of non-physician provider-led palliative care interventions on patient-reported outcomes and advance care planning. The results showed no significant improvement in quality of life, anxiety, or depression, but a positive impact on advance care planning discussions and documentation.
BMJ SUPPORTIVE & PALLIATIVE CARE
(2022)
Editorial Material
Anesthesiology
Andrew D. Shaw, Nicole R. Guinn, Jessica K. Brown, Rakesh C. Arora, Kevin W. Lobdell, Michael C. Grant, Tong J. Gan, Daniel T. Engelman
Summary: The advances in cardiac surgical techniques have improved outcomes, but have also led to complications and mortality outside of the operating room. To address this issue, a focus on evidence-based practice and standardized perioperative care is needed. The POQI and ERAS (R) Cardiac have identified significant evidence gaps in areas related to cardiac surgery, including patient blood management, goal-directed therapy, acute kidney injury, opioid analgesic reduction, and delirium.
PERIOPERATIVE MEDICINE
(2022)
Editorial Material
Critical Care Medicine
Marlies Ostermann, Andrew D. Shaw, Michael Joannidis
INTENSIVE CARE MEDICINE
(2023)
Article
Respiratory System
Laura C. Maclagan, Fangyun Wu, Ning Liu, Peter Tanuseputro, Therese A. Stukel, Jun Guan, Tetyana Kendzerska, Mihaela S. Stefan, Peter K. Lindenauer, Andrea S. Gershon
Summary: This study examined the association between palliative care and rates of days at home, locations of death, and acute healthcare use in patients with COPD. The results showed that receiving palliative care did not reduce days at home or healthcare use, but was associated with a slight increase in the proportion of patients who died at home.
ANNALS OF THE AMERICAN THORACIC SOCIETY
(2022)
Article
Health Policy & Services
Amy Mills, Asta Sorensen, Emily Gillen, Nicole M. Coomer, Elysha Theis, Stephanie Scope, Christopher Beadles, Jihan Quraishi
JOURNAL OF HEALTHCARE MANAGEMENT
(2020)
Article
Health Care Sciences & Services
Lexie R. Grove, Marisa Elena Domino, Joel F. Farley, Karen E. Swietek, Christopher Beadles, Alan R. Ellis, Carlos T. Jackson, C. Annette DuBard
AMERICAN JOURNAL OF MANAGED CARE
(2020)
Article
Health Care Sciences & Services
Musetta Leung, Christopher Beadles, Melissa Romaire, Monika Gulledge, Donald Nichols, Susan Haber, Joshua M. Wiener, Kevin Smith, Nathan West, Asta Sorensen, Kathleen Farrell, Leila Kahwati, Jerry Cromwell, Pamela Spain, Noelle Richa Siegfried, Amy Kandilov, Vincent Keyes, Will Parish, Ann Larsen, Carol Urato, Ellen Wilson, Lisa Lines, Stephanie Kissam, Rebecca Perry, Patrick Edwards, Shellery Ebron, Mark Graber, Yiyan (Echo) Liu, Benjamin Koethe, Jenna Brophy, Andrew Kueffer, Amy Mills, Lindsay Morris, Rebecca Lewis, Sarah Arnold, Sophia Kwon, Konny Kim, Heather Beil, Kent Parks, Rose Feinberg, Timothy O'Brien, Matt Urato, Alon Evron, Elise Hooper, Huiling Pan, Laxminarayana Ganapathi, Brendan DeCenso, Martijn Van Hasselt, Nancy McCall, Stephen Zuckerman, Nicole Cafarella Lallemand, Rachel Burton, Rebecca Peters, Robert Berenson, Kelly Devers, Kathy Witgert, Neva Kaye, Diane Justice, Barbara Wirth, Charles Townley, Rachel Yalowich, Mary Takach
AMERICAN JOURNAL OF MANAGED CARE
(2019)