Hypervolemia as one of the predictors of poor outcome in the patients at the resuscitation and intensive care unit

Yu.Р. Orlov1,2, N.V. Govorova1, A.V. Glushchenko1,2, M.S. Nejfeld1, I.A. Gorst1

1 Federal State Budgetary Educational Institution of Further Professional Education Omsk State Medical University of the Ministry of Healthcare of Russian Federation, Omsk

2 GBU City clinical emergency hospital No. 1, Omsk

For correspondence: Orlov Yuriy Petrovich — Dr. Med. Sci., Professor of Anesthesiology and reanimatology FGBOU in Omsk State Medical University of the Ministry of health, Omsk; e-mail: orlovup@mail.ru

For citation: Orlov Yu.Р., Govorova N.V., Glushchenko A.V., Nejfeld M.S., Gorst I.A. Hypervolemia as one of the predictors of poor outcome in the patients at the resuscitation and intensive care unit. Alexander Saltanov Intensive Care Herald. 2018;4:51–56.

DOI: 10.21320/1818-474X-2018-4-51-56

Objective: to assess three-day positive water balance when conducting fluid therapy and to evaluate its impact on the survival of patients hospitalized in the ICU with a diagnosis of polytrauma.

Methods. In a retrospective study included data 2 groups: I group — transferred to other offices with improved status (n = 20), group II — ICU deaths (n = 20) in the period up to 30 days. The average period of patient in the ICU in II group amounted to 14.5 ± 7.1 days. The average age of the patients was 49.8 ± 0.6 years, 27 patients were age under 60 years old, 13-over 60 years. Patients included in the sample, there were only diagnosed with multiple trauma, hypovolemic shock, with no effect on volemic load and the need to use vazopressors. When aggregating establish probability p < 0.05, studentʼs applied t-test, Wald–Wolfowitz criteria, Mann–Whitney and Kolmogorov–Smirnov, ROC curve analysis and analysed the odds ratio and relative risk of death for each group of patients.

The results. Found that the average value of a positive water balance for three days was statistically significantly higher in the deceased patients (5427.2 ± 1040.3 ml) than in survivors (3345 ± 1268 ml). In patients with a large amount of the positive balance of water for 3 days mortality risk is observed in 5.1 times greater (95% CI [0.773–0.992] in p < 0.005) than among patients, a positive water balance, which in total for 3 nights was less 4075 ml.

Conclusion. In patients with a large amount of positive water balance (more 4075 ml) for 3 days of stay in ICU mortality risk is observed in 5.1 times more common than among patients whose water balance for 3 days was less 4075 ml. Using the three-day figure is a positive water balance can be accurate to 96.7 % define an adverse outcome severely traumatized patients (< 0.05, 95% CI [0.773–0.992]).

Keywords: hypervolemia, infusion therapy, polytrauma

Received: 22.10.2018

Read in PDF


  1. Шанин В.Ю. Патофизиология критических состояний. 2-еизд. Санкт Петербург: ЭЛБИ-СПб, 2018. [Shanin V.Yu. Pathophysiology of critical states. 2nd ed. St-Petersbourg: ELBI-SPb, 2018. (In Russ)]
  2. Chappell D., Bruegger D., Potzel J., et al. Hypervolemia increases release of atrial natriuretic peptide and shedding of the endothelial glycocalyx. Crit Care. 2014; 18(5): 538. DOI: 10.1186/s13054-014-0538-5.
  3. Daniel A. Reuter, Daniel Chappell, Azriel Perel. The dark sides of fluid administration in the critically ill patient. Intensive Care Med. 2018; 44(7): 1138–1140. DOI: 10.1007/s00134-017-4989-4.
  4. Della Rocca G., Vetrugno L., Tripi G., et al. Liberal or restricted fluid administration: are we ready for a proposal of a restricted intraoperative approach? BMC Anesthesiol. 2014; 14: 62. DOI: 10.1186/1471-2253-14-62.
  5. Goldstein S., Bagshaw S., Cecconi M., et al. Pharmacological management of fluid overload. Br. J. Anaesth. 2014; 113: 756–763.
  6. Coons B.E., Tam S., Rubsam J., et al. High volume crystalloid resuscitation adversely affects pediatric trauma patients. J. Pediatr. Surg. 2018; 53(11): 2202–2208. DOI: 10.1016/j.jpedsurg.2018.07.009.
  7. Shen Y., Huang X., Zhang W. Association between fluid intake and mortality in critically ill patients with negative fluid balance: a retrospective cohort study. Crit Care. 2017; 21: 104. DOI: 10.1186/s13054-017-1692-3.
  8. Balogh Z., Offner P.J., Moore E.E., et al. NISS predicts post injury multiple organ failure better than the ISS. J. Trauma. 2000; 48(4): 624–627.
  9. Goris R.J.A., Boekhorst T.P.A., Nuytinick J.K., Gimbere J.S. Multiple-organ failure. Arch. Surg. 1985; 120: 1109–1115.
  10. Singer M., Deutschman C.S., Seymour C.W., et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8): 801–810. DOI: 10.1001/jama.2016.0287.
  11. Jacob М., Chappell D., Becker B.F. Regulation of blood flow and volume exchange across the microcirculation. Crit. Care. 2016; 20: 319. DOI: 10.1186/s13054-016-1485-0.
  12. Baker L.B., Jeukendrup A.E. Optimal composition of fluid-replacement beverages. Compr. Physiol. 2014; 4(2): 575–620. DOI: 10.1002/cphy.
  13. Intravenous Fluid Therapy. Intravenous Fluid Therapy in Adults in Hospital. NICE Clinical Guidelines, No. 174. National Clinical Guideline Centre (UK). London: Royal College of Physicians (UK), 2013.
  14. Bhave G., Neilson E.G. Body fluid dynamics: back to the future. J. Am. Soc. Nephrol. 2011; 22(12): 2166–2181. DOI: 10.1681/ASN. 2011080865.
  15. Marik P.E. Iatrogenic salt water drowning and the hazards of a high central venous pressure. Ann. Intensive Care. 2014; 4: 21. DOI: 10.1186/s13613-014-0021-0.
  16. Malbrain M.L.N.G., Van Regenmortel N., Saugel B., et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four Dʼs and the four phases of fluid therapy. Ann. Intensive Care. 2018; 8(1): 66. DOI: 10.1186/s13613-018-0402-x.
  17. Bonanno F.G. Hemorrhagic shock: The «physiology approach». J. Emerg. Trauma Shock. 2012; 5(4): 285–295. DOI: 10.4103/0974–2700.102357.
  18. Ley E.J., Clond M.A., Srour M.K., et al. Emergency department crystalloid resuscitation of 1.5 L or more is associated with increased mortality in elderly and nonelderly trauma patients. J. Trauma Acute Care Surg. 2011; 70(2): 398–400.
  19. Kerwin A.J., Haut E.R., Burns J.B., et al. The Eastern Association of the Surgery of Trauma approach to practice management guideline development using grading of recommendations, assessment, development, and evaluation (GRADE) methodology. J. Trauma Acute Care Surg. 2012; 73(5 Suppl. 4): S283–S287.
  20. Albreiki M., Voegeli D. Permissive hypotensive resuscitation in adult patients with traumatic haemorrhagic shock: a systematic review. Eur.J. Trauma Emerg. Surg. 2018; 44(2): 191–202. DOI: 10.1007/s00068-017-0862-y.

Remaxol dose-dependent effect on central hemodynamics and metabolism in generalized peritonitis

Yu.P. Orlov, V.N. Lukacs, N.V. Govorova, A.V. Glushchenko, O.D. Dmitrieva

GBOY VPO “Omsk State Medical University” Ministry of Health of Russia, Omsk

For citation: Orlov YuP, Lukach VN, Govorova NV et al. Remaxol dose-dependent effect on central hemodynamics and metabolism in generalized peritonitis. Intensive Care Herald. 2016;1:27–32.

The aim of the study was to investigate the effectiveness of inclusion in remaxol regimens on hemodynamic parameters and processes of cellular metabolism in patients with severe generalized peritonitis.

Results of treatment of 24 patients who received preoperative medication preparation and surgical treatment in accordance with the standards of conduct, in the postoperative period 2 groups with the same intensive treatment protocol were formed. Patients of the first group (n=12) were administered for 5 days remaxol 800 ml per day. The second group (control) (n=12) in the program which remaxol infusion therapy was not used.

Results of the study showed that the inclusion of infusion therapy remaxol scheme in the postoperative period in patients with generalized peritonitis ensures efficient utilization of glucose and oxygen, reduces the severity of oxygen debt at the tissue level, providing mechanisms of oxidation on the more familiar processes for fabrics way, providing at the same time kateholaminomimetichesky effect, providing an earlier period when the central and stabilization of hemodynamic parameters during its injection velocity of 30 to 60 ml per hour.

Keywords: generalized peritonitis, remaxol, infusion therapy, lactate.


  1. Shapiro N., Howell M.D., Bates D.W, et al. The association of sepsis syndrome and organ dysfunction with mortality in emergency department patients with suspected infection. Ann Emerg Med. 2006; 48(5): 583-590.
  2. Kleinpell R.M., Graves B.T, Ackerman M.H. Incidence, pathogenesis, and management of sepsis: an overview. AACN Adv Crit Care. 2006; 17(4): 385-
  3. Whelan S.P., Carchman E.H, Kautza B., Nassour I. et al. Polymicrobial sepsis is associated with decreased hepatic oxidative phosphorylation and an altered metabolic profile. J Surg Res. 2014 Jan; 186 (1): 297-303.
  4. Zang Q.S., Wolf S.E., Minei J.P. Sepsis-induced Cardiac Mitochondrial Damage and Potential Therapeutic Interventions in the Elderly. Aging Dis. 2014 Apr 1; 5 (2): 137-149.
  5. Calandra T., Cohen J. The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med 2005; 33, (7): 1538-1548.
  6. Sims C.A., Wattanasirichaigoon S., Menconi M.J., Ajami A.M., Fink M.P. Ringer’s ethyl pyruvate solution ameliorates ischemia/reperfusion-induced intestinal mucosa injury in rats. Crit Care Med. 2001; 29 (8): 1513-
  7. Tawadrous Z.S., Delude R.L., Fink M.P. Resuscitation from hemorrhagic shock with Ringer’s ethyl pyruvate solution improves survival and ameliorates intestinal mucosal hyperpermeability in rats. Shock. 2002; 17 (6):473-
  8. Guo J., Zhang J., Luo X., et al. Effects of ethyl pyruvate on cardiac function recovery and apoptosis reduction after global cold ischemia and reperfusion. Exp Ther Med. 2014; 7(5): 1197-
  9. Hu X., Cui B., Zhou X., et al. Ethyl pyruvate reduces myocardial ischemia and reperfusion injury by inhibiting high mobility group box 1 protein in rats. Mol Biol Rep. 2012; 39 (1): 227-
  10. Руднов В.А., Миронов П.И. Клинические рекомендации по ведению больных с тяжелым сепсисом и септическим шоком (Surviving sepsis campaign 2008): анализ и комментарии. Клин микробиол антимикроб химиотер 2008.- т.10, №3.-192-200.