Abstract:
OBJECTIVE:We sought to investigate if the chloride content of fluids used in resuscitation was associated with short- and long-term outcomes. DESIGN:We identified patients who received large-volume fluid resuscitation, defined as greater than 60 mL/kg over a 24-hour period. Chloride load was determined for each patient based on the chloride ion concentration of the fluids they received during large-volume fluid resuscitation multiplied by the volume of fluids. We compared the development of hyperchloremic acidosis, acute kidney injury, and survival among those with higher and lower chloride loads. SETTING:University Medical Center. PATIENTS:Patients admitted to ICUs from 2000 to 2008. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Among 4,710 patients receiving large-volume fluid resuscitation, hyperchloremic acidosis was documented in 523 (11%). Crude rates of hyperchloremic acidosis, acute kidney injury, and hospital mortality all increased significantly as chloride load increased (p < 0.001). However, chloride load was no longer associated with hyperchloremic acidosis or acute kidney injury after controlling for total fluids, age, and baseline severity. Conversely, each 100 mEq increase in chloride load was associated with a 5.5% increase in the hazard of death even after controlling for total fluid volume, age, and severity (p = 0.0015) over 1 year. CONCLUSIONS:Chloride load is associated with significant adverse effects on survival out to 1 year even after controlling for total fluid load, age, and baseline severity of illness. However, the relationship between chloride load and development of hyperchloremic acidosis or acute kidney injury is less clear, and further research is needed to elucidate the mechanisms underlying the adverse effects of chloride load on survival.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Sen A,Keener CM,Sileanu FE,Foldes E,Clermont G,Murugan R,Kellum JAdoi
10.1097/CCM.0000000000002063subject
Has Abstractpub_date
2017-02-01 00:00:00pages
e146-e153issue
2eissn
0090-3493issn
1530-0293journal_volume
45pub_type
杂志文章abstract::We analyzed 35 samples of fresh frozen plasma (FFP), finding mean concentrations of 535 mg/dl glucose, 172 mEq/L sodium, 73 mEq/L chloride, 3.5 mEq/L potassium, 15 mEq/L bicarbonate, and 5.5 g/dl protein with 60% albumin. Thus, FFP is a hyperosmolal, hyperglycemic, hypernatremic, and hypochloremic solution which may b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198602000-00015
更新日期:1986-02-01 00:00:00
abstract::The authors evaluated the effectiveness of 6% hydroxyethyl starch (hetastarch) solution for treatment of hypovolemia in 46 critically ill patients. Thirty-two of the patients were studied retrospectively and in 14 patients, cardiopulmonary variables were prospectively measured. A total of 29 patients were in shock sec...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198112000-00006
更新日期:1981-12-01 00:00:00
abstract:OBJECTIVES:Formal guidelines recommend that therapeutic hypothermia be considered after in-hospital cardiac arrest. The rate of therapeutic hypothermia use after in-hospital cardiac arrest and details about its implementation are unknown. We aimed to determine the use of therapeutic hypothermia for adult in-hospital ca...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318287f2c4
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVES:Lung contusion is a major risk factor for the development of acute respiratory distress syndrome. We set to determine the role of toll-like receptor 3 and the binding of double-stranded RNA in the pathogenesis of sterile injury following lung contusion. DESIGN:Toll-like receptor 3 expression was analyzed in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001879
更新日期:2016-11-01 00:00:00
abstract::Twenty-seven surgical patients who developed post-extubation hypoxemia unresponsive to routine respiration therapy (incentive spirometry and chest physical therapy) received continuous positive airway pressure (CPAP) delivered through a mask at an inspired oxygen fraction (FIO2) of 0.45. All patients responded with an...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198501000-00012
更新日期:1985-01-01 00:00:00
abstract::Hemodynamic effects of iso-oncotic 3% dextran-60, 6% dextran-70, and Ringer's acetate were compared in 28 male pigs (25 to 30 kg) subjected to experimental trauma and hemorrhage. The animals were kept anesthetized with 75% N2O/25% O2, 0.8% halothane. Hemodynamic and respiratory conditions were allowed to stabilize for...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198804000-00008
更新日期:1988-04-01 00:00:00
abstract:OBJECTIVES:Targeted temperature management has been shown to improve survival with good neurological outcome in patients after out-of-hospital cardiac arrest. The optimal approach to inducing and maintaining targeted temperature management, however, remains uncertain. The objective of this study was to evaluate these p...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000000551
更新日期:2014-12-01 00:00:00
abstract::The applicability of continuous arteriovenous hemofiltration (CAVH) for renal replacement therapy was evaluated in three infants and two young children with catastrophic medical and surgical illnesses. In the first four patients, CAVH was used in conjunction with either peritoneal or hemodialysis. In the fifth patient...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198612000-00014
更新日期:1986-12-01 00:00:00
abstract:OBJECTIVES:a) To quantify the use of do-not-resuscitate orders in a tertiary care children's hospital; and b) to characterize the circumstances in which such orders are written. DESIGN:Retrospective chart review. SETTING:University teaching hospital. PATIENTS:All inpatients who died in an urban children's hospital o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199301000-00012
更新日期:1993-01-01 00:00:00
abstract:OBJECTIVE:We hypothesized that deficiency in 25-hydroxyvitamin D before hospital admission would be associated with all-cause mortality in the critically ill. DESIGN:Multicenter observational study of patients treated in medical and surgical intensive care units. SETTING:A total of 209 medical and surgical intensive ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318206ccdf
更新日期:2011-04-01 00:00:00
abstract:INTRODUCTION:Ventilator settings for patients with severe acute respiratory distress syndrome supported by venovenous extracorporeal membrane oxygenation are currently set arbitrarily. The impact on serum and pulmonary biotrauma markers of the transition to ultra-protective ventilation settings following extracorporeal...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0000000000003894
更新日期:2019-11-01 00:00:00
abstract:OBJECTIVE:Pump-driven extracorporeal gas exchange systems have been advocated in patients suffering from severe acute respiratory distress syndrome who are at risk for life-threatening hypoxemia and/or hypercapnia. This requires extended technical and staff support. DESIGN:We report retrospectively our experience with...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000215111.85483.BD
更新日期:2006-05-01 00:00:00
abstract:OBJECTIVE:To investigate the relationship between behavioral alterations and changes in monoaminergic systems provoked by ischemia-reperfusion liver injury in rats. DESIGN:Prospective, randomized, controlled animal study. SETTING:University animal laboratory. SUBJECTS:Male Wistar rats. INTERVENTIONS:Acute liver fai...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199804000-00021
更新日期:1998-04-01 00:00:00
abstract::We report a case of an amniotic fluid embolism (AFE) causing a cardiorespiratory arrest associated temporally with ingestion of castor oil in a full-term normal pregnancy. Risk factors usually associated with AFE were not found in this patient. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198806000-00016
更新日期:1988-06-01 00:00:00
abstract:OBJECTIVE:Inadequate nutrition is common in critical illness due in part to gastric stasis. However, recent data suggest that altered small intestinal mucosal function may be a contributing factor. The aim of this study was to examine the effects of critical illness on sucrose absorption, permeability, and mucosal morp...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31827ca2fa
更新日期:2013-05-01 00:00:00
abstract:OBJECTIVE:To assess the possibility that acute respiratory distress syndrome (ARDS) of pulmonary and nonpulmonary origins represent two distinct syndromes. DESIGN:Analysis of data collected prospectively from an inception cohort of 117 patients with ARDS. SETTING:Adult intensive care unit (ICU), university/postgradua...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200103000-00016
更新日期:2001-03-01 00:00:00
abstract:OBJECTIVE:To determine whether a cellular phone would interfere with the operation of mechanical ventilators. DESIGN:Laboratory study. SETTING:University medical center. SUBJECTS:Fourteen mechanical ventilators. INTERVENTIONS:We evaluated change in operation and malfunction of the mechanical ventilators. MEASUREME...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000120061.01431.db
更新日期:2004-04-01 00:00:00
abstract:OBJECTIVES:Interventions that reduce the generation or the effects of reactive oxygen species exert controversial effects in animal models of lung injury, and these could be secondary to the pro-oxidant effects of antioxidants generally by their interaction with iron. We here describe the effects of N-acetylcysteine, d...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000199069.19193.89
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVE:Trauma induces a complex immune response that requires a systems biology research approach. Here, we used a novel technology, mass cytometry by time-of-flight, to comprehensively characterize the multicellular response to trauma. DESIGN:Peripheral blood mononuclear cells samples were stained with a 38-marker...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002577
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVES:A cuffed tracheostomy tube facilitates prolonged mechanical ventilation and weaning but usually leads to prolonged voicelessness, which can be one of the most negative experiences of hospitalization. No randomized trials have examined the effects of targeted early communication intervention for the restorati...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0000000000001610
更新日期:2016-06-01 00:00:00
abstract:BACKGROUND:Neurologic dysfunction, coma, and seizures are common in obstetric patients in the intensive care unit. OBJECTIVE:To review common neurologic disorders resulting in critical illness in pregnancy. REVIEW:Obstetric disorders causing coma and seizures include eclampsia, acute fatty liver of pregnancy, and amn...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000182790.35728.f7
更新日期:2005-10-01 00:00:00
abstract::In a prospective randomized study to determine whether prevention of colonization of Gram-negative bacteria results in prevention of Gram-negative bacterial infections, 96 intensive care patients were randomly allocated into a control group and a study group. The study group received oral nonabsorbable antimicrobial a...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-198811000-00001
更新日期:1988-11-01 00:00:00
abstract:OBJECTIVES:To determine the outcome of oxygen consumption (VO2) and energy expenditure after cessation of sedation in severe head-injured patients and to assess its usefulness as a predictor of neurologic severity. DESIGN:Prospective, descriptive study. SETTING:Neurosurgical intensive care unit (ICU) in a university ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199407000-00011
更新日期:1994-07-01 00:00:00
abstract:OBJECTIVES:To investigate family perceptions of having a nurse participating in family conferences and to assess the psychologic well being of the same families after ICU discharge. DESIGN:Mixed-method design with a qualitative study embedded in a single-center randomized study. SETTING:Twelve-bed medical-surgical IC...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0000000000001632
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVES:To assess the specific host responses to systemic endotoxemia and tumor necrosis factor (TNF) activation after abdominal aortic aneurysm surgery by measuring antiendotoxin core antibodies (EndoCab) immunoglobulin (Ig)G and IgM, and soluble p55TNF receptor concentrations. The role of the gut in initiating the...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199709000-00013
更新日期:1997-09-01 00:00:00
abstract:OBJECTIVES:To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the ICU, a physical function measure designed for the ICU. DESIGN:Clinimetric analysis. SETTINGS:Five international datasets from the United States, Australia, and Brazil. PA...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001949
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:Chronic diabetes mellitus (DM) is a known cause of multisystem injury. The effect of DM in acute critical illness may also be detrimental, but is not specifically known. We hypothesized that the preexisting diagnosis of DM is an independent risk factor for mortality in critically ill patients. DESIGN:Paralle...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181b9eaa5
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:Acute respiratory distress syndrome is occasionally seen in newborn infants due to a severe inflammatory process in the lungs that affects capillary-alveolar permeability, epithelial integrity, and type I and II pneumocyte function. The aim of this study was to investigate the effect of a topically applied nu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000166371.18066.5e
更新日期:2005-06-01 00:00:00
abstract::Critical care clinicians no longer consider family members as visitors in the intensive care unit. Family-centered care has emerged from the results of qualitative and quantitative studies evaluating the specific needs of families of patients dying in the intensive care unit. In addition, interventional studies have e...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000237049.44246.8C
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:Cytokine response after cardiac surgery may be genetically influenced. A study was carried out to investigate the relation between cytokine gene expression in peripheral blood mononuclear cells, genotype, and clinical events after cardiac surgery. DESIGN:A case-control study was performed. SETTING:Cardiac i...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000227647.77356.AB
更新日期:2006-08-01 00:00:00