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Fluid Administration in Critically Ill Patients with Acute Kidney Injury

Robert W. Schrier
CJASN April 2010, 5 (4) 733-739; DOI: https://doi.org/10.2215/CJN.00060110
Robert W. Schrier
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    Figure 1.

    Survival comparison between patients assigned to receive albumin and those assigned to receive saline. Reprinted from reference 10, with permission.

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    Figure 2.

    Mortality rate by final fluid accumulation relative to baseline weight and stratified by dialysis status. Reprinted from reference 20, with permission.

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    Figure 3.

    Time course of the daily mean fluid balance while in ICU. ANOVA for repeated measures: *P < 0.05 pairwise compared with each of the two other subgroups; †P < 0.05 compared with the previous time point. Reprinted from reference 22, with permission.

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    Figure 4.

    Frequency of furosemide and fluid bolus therapies in liberal versus conservative groups. Reprinted from reference 16, with permission.

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    Figure 5.

    Comparison of cumulative fluid balance at day 7 with baseline between liberal and conservative groups who were (left) shock-free and (right) shock-present. Reprinted from reference 16, with permission.

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    Figure 6.

    Comparison of cumulative fluid balance in liberal versus conservative groups and previous ARDS network studies (ARMA and ALVEOLI). Reprinted from reference 16, with permission.

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    Figure 7.

    Stable CVP in liberal fluid group as CVP declines in conservative fluid group. Reprinted from reference 16 and 25, with permission.

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    Figure 8.

    Events in sepsis and endotoxemia leading to pulmonary edema, hypoxia, mechanical ventilation, ARDS, and high mortality. Reprinted from reference 28, with permission.

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    Table 1.

    Sepsis and septic shock (0 to 6 hours)a

    StandardEarly GoalP Value
    MAP (mmHg)81 ± 1688 ± 16<0.001
    SCVO2 ≥ 70%60.2%94.9%<0.001
    CVP, MAP, and UO Goals86.1%99.2%<0.001
    • MAP, mean arterial pressure; UO, urinary output.

    • ↵a Data from reference 2.

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    Table 2.

    Beneficial effects of EGDT of severe sepsis and septic shock (7 to 72 hours)a

    StandardEarly GoalP Value
    In-hospital mortality (%)46.530.5<0.009
    SCVO2 (%)65.370.4<0.02
    Lactate (mmol/L)3.93.0<0.02
    PH7.367.4<0.02
    Mechanical ventilation (%)16.82.6<0.001
    Fibrin split product (μg/dl)6239<0.001
    • ↵a Data from reference 2.

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    Table 3.

    Effects of albumin infusion on morbidity and mortality due to spontaneous bacterial peritonitisa

    Outcome VariableCefotaxime (n = 63)Cefotaxime + Albumin (n = 63)P Value
    Renal failure, n (%)21 (33%)6 (11%)<0.002
    Death in hospital, n (%)18 (29%)6 (10%)<0.01
    Death at 3 months, n (%)26 (41%)14 (22%)<0.03
    • ↵a Data from reference 12.

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Clinical Journal of the American Society of Nephrology
Vol. 5, Issue 4
1 Apr 2010
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Fluid Administration in Critically Ill Patients with Acute Kidney Injury
Robert W. Schrier
CJASN Apr 2010, 5 (4) 733-739; DOI: 10.2215/CJN.00060110

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Fluid Administration in Critically Ill Patients with Acute Kidney Injury
Robert W. Schrier
CJASN Apr 2010, 5 (4) 733-739; DOI: 10.2215/CJN.00060110
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  • Article
    • Abstract
    • Selection of Resuscitation Fluid
    • Fluid Overload in AKI
    • Mechanisms whereby Fluid Overload Could Lead to Increased Mortality in Patients with AKI
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More in this TOC Section

  • Assessing Physical Function and Physical Activity in Patients with CKD
  • Effect of Red Cell Transfusions on Future Kidney Transplantation
  • Management of Crush Victims in Mass Disasters: Highlights from Recently Published Recommendations
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