Do hypooncotic fluids for shock increase the risk of late-onset acute respiratory distress syndrome?

OBJECTIVE: In patients with shock, late-onset acute respiratory distress syndrome (ARDS) carries poor prognosis. Hypooncotic fluids may improve kidney function preservation, whereas hyperoncotic fluids may in theory decrease the risk of late-onset ARDS. Our objective was to determine whether predominant or exclusive use of crystalloids and/or hypooncotic colloids for shock resuscitation influenced the risk of late-onset ARDS. PARTICIPANT AND SETTINGS: International prospective cohort of consecutive adults who were free of ARDS on admission and who received fluid resuscitation for shock in 115 intensive care units (ICUs) during a 4-week period. MEASUREMENTS AND RESULTS: Severity scores, hemodynamic status, indication for fluids, risk factors for ARDS, plasma expander use, transfusions, and late-onset ARDS were recorded prospectively. Logistic regression models were tested to determine whether predominant or exclusive use of hypooncotic fluids was associated with higher incidence of late-onset ARDS. Of 905 patients, 81 [8.9%; 95% confidence interval (CI) 7.2-11.0] developed ARDS, with no difference between patients given only hypooncotic fluids (10.4%; 95% CI 7.6-13.7) and the other patients (7.7%; 95% CI 5.5-10.5; p = 0.16). Late-onset ARDS was significantly associated with sepsis [odds ratio (OR) 1.90; 95% CI 1.06-3.40], worse chest X-ray score at fluid initiation (1.55; 95% CI 1.27-1.91), positive fluid balance (1.06 per l; 95% CI 1.02-1.09), and greater transfusion volume (1.14 per l; 95% CI 1.01-1.29). The proportion of hypooncotic fluids in the plasma expander regimen was not associated with late-onset ARDS (1.01 per %; 95% CI 0.99-1.01). CONCLUSIONS: Based on this observational study, there is no evidence that in patients with shock the use of hypooncotic fluids increases the risk of late-onset ARDS. This finding needs to be confirmed

The risk associated with hyperoncotic colloids in patients with shock

International audienceObjective Crystalloids, artificial and natural colloids have been opposed as representing different strategies for shock resuscitation, but it may be relevant to distinguish fluids based on their oncotic characteristics. This study assessed the risk of renal adverse events in patients with shock resuscitated using hypooncotic colloids, artificial hyperoncotic colloids, hyperoncotic albumin or crystalloids, according to physician’s choice. Participants and setting International prospective cohort study including 1,013 ICU patients needing fluid resuscitation for shock. Patients suffering from cirrhosis or receiving plasma were excluded. Measurements and results Influence of different types of colloids and crystalloids on the occurrence of renal events (twofold increase in creatinine or need for dialysis) and mortality was assessed using multivariate analyses and propensity score. Statistical adjustment was based on severity at the time of resuscitation, risks factor for renal failure, and on variables influencing physicians’ preferences regarding fluids. A renal event occurred in 17% of patients. After adjustment on potential confounding factors and on propensity score for the use of hyperoncotic colloids, the use of artificial hyperoncotic colloids [OR: 2.48 (1.24–4.97)] and hyperoncotic albumin [OR: 5.99 (2.75–13.08)] was significantly associated with occurrence of renal event. Overall ICU mortality was 27.1%. The use of hyperoncotic albumin was associated with an increased risk of ICU death [OR: 2.79 (1.42–5.47)]. Conclusions This study suggests that harmful effects on renal function and outcome of hyperoncotic colloids may exist. Although an improper usage of these compounds and confounding factors cannot be ruled out, their use should be regarded with caution, especially because suitable alternatives exist.</p

Decadal demographic trends of a long-lived temperate encrusting sponge

12 pages, 5 figures, 2 tables, supplementary appendix http://www.int-res.com/abstracts/meps/v375/p113-124/Demographic data play a central role in determining the overall dynamics of species and forecasting the effects of global change. We examined a decadal pattern of population dynamics and its underlying mechanisms in a population of the encrusting sponge Crambe crambe. A photographic series monitored yearly for 14 yr (1993 to 2007) was analyzed. A total of 133 genets and 157 ramets were individually identified and followed over 14 yr to record their fates: survivorship, partial mortality, recruitment via larvae, asexual events (fission and fusion), and growth. The number of genets varied little over time; their survival was high and differed significantly with size class (52, 82, and 100% for size classes 0–250, 250–700, and >700 mm2, respectively), while recruitment via larvae was very low. Overall, the population was characterized by the inputs and outputs of asexual ramets. Patterns of partial mortality were (1) significantly related to size and (2) did not differ significantly among years, and (3) no patch >500 mm2 suffered any type of mortality. We give the first evidence that net growth over more than a decade was close to zero for the larger specimens, while the smallest specimens exhibited the highest growth rates, quadrupling in size over 14 yr. Low mortality combined with the slow growth of large specimens indicates that C. crambe may live for several decades. This study provides rigorous baseline information necessary to uncover general patterns in the demography of marine sessile species and better predict the long-term fate of populationsThis study was funded by Direcció General de Pesca Marítima (Generalitat de Catalunya) project no. PCC68003/9, Direcció de Medi Natural (Generalitat de Catalunya) project no. 10.05.227.07/5, and the Agence National de la Recherche (Medchange project)Peer reviewe