D Orbegozo Cortes

Isotonic crystalloid solutions: a structured review of the literature

BACKGROUND Several different crystalloid solutions are available for i.v. fluid administration but there is little information about their specific advantages and disadvantages. METHODS We performed a systematic search of MEDLINE, EMBASE, and CENTRAL up until May 17, 2012, selecting all prospective human studies that directly compared any near-isotonic crystalloids and reported any outcome. RESULTS From the 5060 articles retrieved in the search, only 28 met the selection criteria. There was considerable heterogeneity among the studies. Several articles reported an increased incidence of hyperchloraemic acidosis with the use of normal saline, and others an increase in blood lactate levels when large amounts of Ringers lactate solutions were infused. From the limited data available, normal saline administration appears to be associated with increased blood loss and greater red blood cell transfusion volumes in high-risk populations compared to Ringers lactate. Possible effects of the different solutions on renal function, inflammatory response, temperature, hepatic function, glucose metabolism, and splanchnic perfusion are also reported. The haemodynamic profiles of all the solutions were similar. CONCLUSIONS Different solutions have different effects on acid-base status, electrolyte levels, coagulation, renal, and hepatic function. Whether these differences have clinical consequences remains unclear.

Elevated endocan levels are associated with development of renal failure in ARDS patients.

Objectives The aim of the study was to determine whether plasma endocan levels were correlated with renal function in patients with acute respiratory distress syndrome (ARDS) and could predict the need for renal replacement therapy (RRT), as an indicator of acute renal dysfunction, during the ICU stay. Methods This was a post hoc analysis of prospectively collected data from 96 consecutive patients with ARDS (Berlin definition) who were not receiving RRT at diagnosis. Plasma endocan concentrations were measured using a quantitative ELISA method (Lunginov, France). We analyzed the predictive value of creatinine and endocan levels at diagnosis on the subsequent need for RRT using the area under the receiver operating characteristic curve (ROC AUC). We dichotomized values of creatinine (using a renal SOFA cut-off of 1.2 mg/dL) and endocan (best sensitivity and specificity based on the ROC curve) to predict need for RRT. All analyses were performed using SPSS 22.0 and a p value < 0.05 was considered as significant. Al values are presented as median with p25-75.

Thermal challenge of the microcirculation in patients after cardiac surgery

Microcirculatory alterations have been correlated with poorer outcomes in different populations of critically ill patients. A controlled increase in the local skin temperature (thermal challenge) induces vasodilation, which may represent a measure of microcirculation recruitability and can be easily evaluated non-invasively using skin laser Doppler (SLD) (1). We previously demonstrated lower SLD values during thermal challenge in patients with circulatory shock, particularly in non-survivors (2).

Angiotensin converting enzymes in patients with acute respiratory distress syndrome

Angiotensin converting enzymes (ACEs) are important in the control of the cardiovascular function and their inhibition have a primary role in the treatment of hypertension and heart failure. However they have effects beyond the cardiovascular system. Angiotensin 2 production by ACE and stimulation of the angiotensin 1 (AT1) receptor subtype reduces nitric oxide bioavailability, promotes inflammation and fibrosis. The ACE type 2 (ACE2) increases angiotensin 1-7 production and counterbalances ACE effects. Some animal data have shown a beneficial role of the up-regulation of the ACE2 pathway and a detrimental role for the up-regulation of the ACE classic pathway in different ARDS, but there are no data in patients with ARDS.

0727. Normal saline versus ringer´s lactate in experimental sepsis

The development of hyperchloremic acidosis associated with normal saline (NS) administration may be deleterious in septic shock.

0092. Ischemic pre/post-conditioning protects the microcirculation in experimental sepsis

Ischemic preconditioning induces complex physiological adaptations to improve the tolerance of cells and tissues to future ischemic episodes. This phenomenon has been most studied in myocardial cells but also occurs in other tissues.

0888. Administration of tetrahydrobiopterin (BH4) protects renal microcirculation after ischemia and reperfusion

Abdominal aortic aneurysm surgery with supra-renal clamping is associated with potential development of renal insufficiency. Ischemia and reperfusion (I-R) produced during the procedure induces endothelial dysfunction with a decrease in tetrahydrobiopterin (BH4), a cofactor used in nitric oxide synthesis.