REVISIÓNCristaloides y coloides en la reanimación del paciente críticoCrystalloids and colloids in critical patient resuscitation
Section snippets
Introducción
La administración de fluidos es uno de los actos terapéuticos que con mayor frecuencia realizan en su práctica asistencial cotidiana los médicos que atienden a pacientes críticamente enfermos. Este aporte ocurre en mayor cuantía durante las primeras horas y días de estancia, dado que durante las mismas es cuando se lleva a cabo la reanimación del paciente que con frecuencia ingresa en UCI por shock o hipotensión de cualquier etiología. Hay que tener muy presente que los fluidos deben ser
Objetivos
En esta situación, un grupo de especialistas en Medicina Intensiva han realizado una revisión narrativa de la literatura para elaborar unas recomendaciones prácticas sobre el empleo de fluidos (cristaloides y coloides) en la fase de reanimación del paciente crítico adulto con hipotensión. En esta revisión nos hemos centrado específicamente en los estudios que evalúan la mortalidad o el impacto en el desarrollo de fracaso renal o necesidad de técnicas de depuración extrarrenal. Quedan fuera de
Metodología
Se realizó una búsqueda en PubMed de todos los estudios tanto observacionales como ensayos clínicos (excluyendo pacientes pediátricos) con las siguientes palabras clave: fluid therapy, colloids, crystalloides, sodium chloride, Ringer, albumin, balanced solution, hetastarch, pentastarch, hydroxyethyl starch, gelatin, AND hyperchloremic acidosis, resuscitation, shock, severe sepsis, septic shock, trauma, major surgery, kidney, renal, mortality, injury, failure, complication, anaphylactoid
Fluidos disponibles: características
Los fluidos se pueden agrupar en cristaloides y coloides. Los cristaloides son soluciones que contienen agua, electrólitos y/o azúcares en diferentes proporciones, y con respecto al plasma, pueden ser hipotónicos, isotónicos o hipertónicos. Su capacidad de expandir la volemia va a estar relacionada con la concentración de sodio, ya que es el factor que determina un gradiente osmótico entre los compartimentos extra e intravasculares.
¿Cuál de estas alternativas debemos emplear en la fase de reanimación del enfermo crítico?
Una vez revisadas las características generales de los distintos cristaloides y coloides, nuestra intención es posicionar cada una de ellas en la reanimación del enfermo crítico basándonos en la literatura científica disponible y en nuestra opinión como clínicos. Para ello, formulamos una serie de preguntas, y tras sintetizar los datos más relevantes disponibles en las publicaciones científicas, concluimos cómo y cuándo creemos, a día de hoy, deben emplearse dichas soluciones.
Futuras líneas de investigación
Como se ha expuesto, quedan aún muchos aspectos que aclarar respecto a qué fluidos emplear en la reanimación del paciente crítico, tanto en el grupo de cristaloides como de coloides. En este último grupo, y con los datos positivos del ensayo clínico CRISTAL65, pensamos que no puede afirmarse de forma categórica que no debemos utilizar coloides en el enfermo en shock. Por ello, proponemos que se realicen más estudios para evaluar la eficacia y seguridad de la albúmina y las gelatinas, o se
Conflicto de intereses
JGM ha participado en asesorías de B. Braun. EFM es asesor científico de CSL Behring, B. Braun y miembro del MAB de Pulsion. RFR ha participado en asesorías de Grifols y B. Braun. MHC ha participado en asesorías de B. Braun. JALB ha participado en asesorías de B. Braun. SRS declara no poseer conflicto de intereses en relación con este manuscrito. AA ha participado en asesorías de B. Braun y Laboratorios Rubió; en conferencias organizadas por Grifols, Astute, Philips, y posee una beca de
Agradecimientos
El grupo desea expresar su agradecimiento al Dr. Jaime Latour por la lectura crítica de este manuscrito y sus valiosas aportaciones y sugerencias.
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Cited by (21)
History of the coloids
2023, Acta Colombiana de Cuidado IntensivoChoice of fluids in the perioperative period of kidney transplantation
2017, NefrologiaCitation Excerpt :The perioperative period in renal transplantation has traditionally been a period of time in which large amounts of resuscitation fluids are administered, with the ultimate aim of ensuring the function of the graft after renal transplantation.1,8,10 The selection of patients who required a limited amounts fluid for resuscitation has been one of the criticisms of large studies, which sought to find differences in the renal protection exerted by the balanced solutions against NS.40,41 In the last decade, several studies have compared changes the ionic and acid–base produced by different crystalloids administration during the perioperative period of renal transplantation.
Crystalloid versus colloid fluids for reduction of postoperative ileus after abdominal operation under combined general and epidural anesthesia
2017, Surgery (United States)Citation Excerpt :However, the grading guidelines are weak and recommendations are low in quality.14 Additionally, hydroxyethyl starch has been associated with increased incidence of acute kidney injury, but the findings were mostly limited to publications in critically ill patients.15 It also is known that different fluid replacement strategies independently affect the duration of postoperative ileus.
Fluid Resuscitation: Principles of Therapy and “Kidney Safe” Considerations
2017, Advances in Chronic Kidney DiseaseCitation Excerpt :Like albumin, dextrans were also introduced in the 1940s but have fallen into disfavor in the United States because of their propensity to cause adverse reactions, such as severe anaphylactic reactions and inhibition of platelet aggregation leading to dose-related bleeding tendencies.30 The 2 most common preparations are the 10% dextran-40 and the 6% dextran-70 which are both diluted in isotonic saline25 but are hyperoncotic to plasma (which has a colloid osmotic pressure of about 28 mm Hg) with a colloid osmotic pressure of up to 60 mm Hg.34,35 Although dextran-40 causes a larger increase in plasma volume than dextran-70, dextran-70 has a protracted action time.25,35
Maintenance fluid therapy in a tertiary hospital: A prevalence study
2017, Revista Espanola de Anestesiologia y Reanimacion