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      Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS Translated title: Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS

      research-article
      1 , 2 , 2 , 3 , 4 , 5 , 4 , 4 , 6 , 7 , 1 , 8 , 9 , 10 , 11 , 7 , 12 , 12 , 13 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 12 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 31 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 5 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 1 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 69 , 71 , 72 , 73 , 74 , 75 , 39 , 31 , 76 , 77 , 78 , 79 , 31 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 1 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 54 , 100 , 101 , 4 , 102 , 103 , 104 , 1 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 28 , 112 , 113 , 114 , 72 , 115 , 116 , 39 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 39 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 54 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 103 , 178 , 179 , 180 , 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 28 , 189 , 190 , 191 , 192 , 2 , 1
      Revista Brasileira de Terapia Intensiva
      Associação de Medicina Intensiva Brasileira - AMIB
      Fluid therapy, Critical care, Colloids, Crystalloid solutions, Hemodynamics, Shock, Hidratação, Cuidados críticos, Coloides, Soluções cristaloides, Hemodinâmica, Choque

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          Abstract

          Objective

          To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS.

          Methods

          This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice.

          Results

          On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only.

          Conclusion

          Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.

          Translated abstract

          Objetivo

          Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS.

          Métodos

          Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos.

          Resultados

          No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides.

          Conclusão

          Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.

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          Most cited references27

          • Record: found
          • Abstract: found
          • Article: not found

          Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

          To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012".
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            • Record: found
            • Abstract: found
            • Article: not found

            Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine

            Objective Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock. Methods The European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575–590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit? (2) Should we monitor preload and fluid responsiveness in shock? (3) How and when should we monitor stroke volume or cardiac output in shock? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock? Four types of statements were used: definition, recommendation, best practice and statement of fact. Results Forty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring. Conclusions This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock.
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              • Record: found
              • Abstract: found
              • Article: not found

              Fluid challenges in intensive care: the FENICE study

              Background Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC. Methods This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC. Results 2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500–1000). The median time was 24 min (40–60 min), and the median rate of FC was 1000 [500–1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57–61 %). In 43 % (CI 41–45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34–37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20–24 %). No safety variable for the FC was used in 72 % (CI 70–74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response. Conclusions The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account. Electronic supplementary material The online version of this article (doi:10.1007/s00134-015-3850-x) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Rev Bras Ter Intensiva
                Rev Bras Ter Intensiva
                rbti
                Revista Brasileira de Terapia Intensiva
                Associação de Medicina Intensiva Brasileira - AMIB
                0103-507X
                1982-4335
                Apr-Jun 2021
                Apr-Jun 2021
                : 33
                : 2
                : 206-218
                Affiliations
                [1 ] Discipline of Anesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo - São Paulo (SP), Brazil.
                [2 ] Critical Care and Trauma Division, The George Institute for Global Health - Sydney, Austrália.
                [3 ] Hospital Sírio-Libanês - São Paulo (SP), Brazil.
                [4 ] Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
                [5 ] Instituto de Pesquisa, HCor - Hospital do Coração - São Paulo (SP), Brazil.
                [6 ] Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil.
                [7 ] Hospital de Clínicas Mário Lioni - Rio de Janeiro (RJ), Brazil.
                [8 ] Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos - São Paulo (SP), Brazil.
                [9 ] Hospital Samaritano - São Paulo (SP), Brazil.
                [10 ] Hospital Paulistano - São Paulo (SP), Brazil.
                [11 ] Hospital São José - Criciúma (SC), Brazil.
                [12 ] Instituto D’Or de Ensino e Pesquisa - Rio de Janeiro (RJ), Brazil.
                [13 ] Hospital Municipal São José - Joinville (SC), Brazil.
                [14 ] Hospital Israelita Albert Einstein - São Paulo (SP), Brazil.
                [15 ] Hospital Santa Rita - Porto Alegre (RS), Brazil.
                [16 ] Hospital de Base, Faculdade de Medicina de São Jose do Rio Preto - São José do Rio Preto (SP), Brazil.
                [17 ] Hospital Unimed de Belo Horizonte - Belo Horizonte (MG), Brazil.
                [18 ] Hospital Santa Lúcia - Divinópolis (MG), Brazil.
                [19 ] Hospital Evangélico de Sorocaba - Sorocaba (SP), Brazil.
                [20 ] Hospital PIO XII - São José dos Campos (SP), Brazil.
                [21 ] Hospital São Camilo Pompéia - São Paulo (SP), Brazil.
                [22 ] Hospital Alvorada Brasília - Brasília (DF), Brazil.
                [23 ] Hospital Ecoville - Curitiba (PR), Brazil.
                [24 ] Hospital do Trabalhador - Curitiba (PR), Brazil.
                [25 ] Hospital Vita Batel - Curitiba (PR), Brazil.
                [26 ] Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual “Júlio de Mesquita Filho” - Botucatu (SP), Brazil.
                [27 ] Hospital Geral Dr. César Cals - Fortaleza (CE), Brazil.
                [28 ] Hospital Copa D’Or - Rio de Janeiro (RJ), Brazil.
                [29 ] Associação Beneficente Hospital Unimar - Marília (SP), Brazil.
                [30 ] Hospital Casa de Saúde de Santos - Santos (SP), Brazil.
                [31 ] Hospital Estadual Getúlio Vargas - Rio de Janeiro (RJ), Brazil.
                [32 ] Hospital e Maternidade Otaviano Neves - Belo Horizonte (MG), Brazil.
                [33 ] Instituto Estadual do Cérebro Paulo Niemeyer- Rio de Janeiro (RJ), Brazil.
                [34 ] Hospital Universitário, Universidade Federal de Juiz de Fora- Juiz de Fora (MG), Brazil.
                [35 ] Lifecenter - Belo Horizonte (MG), Brazil.
                [36 ] Hospital Geral de Fortaleza - Fortaleza (CE), Brazil.
                [37 ] Hospital Municipal Dr. Moysés Deutsch (M’Boi Mirim) - São Paulo (SP), Brazil.
                [38 ] Santa Casa de Misericórdia de Presidente Prudente - Presidente Prudente (SP), Brazil.
                [39 ] Hospital 9 de julho - São Paulo (SP), Brazil.
                [40 ] Hospital Estadual Rocha Faria - Rio de Janeiro (RJ), Brazil.
                [41 ] Hospital Municipal Santa Isabel - João Pessoa (PA), Brazil.
                [42 ] Hospital e Maternidade Municipal Dr. Odelmo Leão Carneiro - Uberlândia (MG), Brazil.
                [43 ] Hospital Evangélico de Londrina - Londrina (PR), Brazil.
                [44 ] Universidade Estadual de Londrina - Londrina (SC), Brazil.
                [45 ] Hospital Samaritano João Pessoa - João Pessoa (PB), Brazil.
                [46 ] Hospital de Caridade Astrogildo de Azevedo - Santa Maria (RS), Brazil.
                [47 ] Vitória Apart Hospital - Vitória (ES), Brazil.
                [48 ] Instituto de Ortopedia e Traumatologia - Passo Fundo (RS), Brazil.
                [49 ] Hospital do Subúrbio - Salvador (BA), Brazil.
                [50 ] Hospital Renascentista - Pouso Alegre (MG), Brazil.
                [51 ] Hospital Felício Rocho - Belo Horizonte (MG), Brazil.
                [52 ] Hospital Municipal Irmã Dulce - Praia Grande (SP), Brazil.
                [53 ] Hospital Universitário Júlio Müller, Universidade Federal do Mato Grosso - Cuiabá (MT), Brazil.
                [54 ] Hospital de Urgência - Goiânia (GO), Brazil.
                [55 ] Hospital Geral de Goiânia - Goiânia (GO), Brazil.
                [56 ] Fundação Doutor Amaral Carvalho - Jaú (SP), Brazil.
                [57 ] Hospital Adventista de Belém - Belém (PA), Brazil.
                [58 ] Hospital Santa Juliana - Rio Branco (AC), Brazil.
                [59 ] Hospital Dom Vicente Scherer - Porto Alegre (RS), Brazil.
                [60 ] Hospital Primavera - Aracaju (SE), Brazil.
                [61 ] Hospital Carlos da Silva Lacaz - Francisco Morato (SP), Brazil.
                [62 ] Hospital Escola, Faculdade de Medicina de Jundiaí - Jundiaí (SP), Brazil.
                [63 ] Hospital Sepaco - São Paulo (SP), Brazil.
                [64 ] Hospital Professor Edmundo Vasconcelos - São Paulo (SP), Brazil.
                [65 ] Hospital Paulo Sacramento - Jundiaí (SP), Brazil.
                [66 ] Clínica Dom Rodrigo - João Pessoa (PA), Brazil.
                [67 ] Complexo Hospitalar Ortotrauma de Mangabeira - Fortaleza (CE), Brazil.
                [68 ] Hospital Nossa Senhora da Conceição - Tubarão (SC), Brazil.
                [69 ] Hospital Regional de Samambaia - Brasília (DF), Brazil.
                [70 ] Hospital São Camilo Ipiranga - São Paulo (SP), Brazil.
                [71 ] Hospital da Restauração - Recife (PE), Brazil.
                [72 ] Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
                [73 ] Hospital Santa Rita - São Paulo (SP), Brazil.
                [74 ] Hospital Estadual Jayme Santos Neves - Recife (PE), Brazil.
                [75 ] Hospital SOS Cárdio - Florianópolis (SC), Brazil.
                [76 ] Hospital da Luz Vila Mariana - São Paulo (SP), Brazil.
                [77 ] Hospital Maternidade e Pronto-Socorro Santa Luci - Poços de Caldas (MG), Brazil.
                [78 ] Santa Casa de Misericórdia de Vitória da Conquista - Vitória da Conquista (BA), Brazil.
                [79 ] Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brazil.
                [80 ] Hospital São Francisco de Assis - Porto Real (RJ), Brazil.
                [81 ] Hospital Memorial São José - Recife (PE), Brazil.
                [82 ] Hospital Regional de Jundiaí - Jundiaí (SP), Brazil.
                [83 ] Hospital Universitário, Faculdade de Medicina de Jundiaí - Jundiaí (SP), Brazil.
                [84 ] Hospital Regional de Presidente Prudente - Presidente Prudente (SP), Brazil.
                [85 ] Santa Casa de Misericórdia de Assis - Assis (SP), Brazil.
                [86 ] Hospital de Clínicas Gaspar Vianna - Belém (PA), Brazil.
                [87 ] Hospital do Coração do Brasil - Brasília (DF), Brazil.
                [88 ] Hospital Hélio Anjos Ortiz - Curitibanos (SC), Brazil.
                [89 ] Hospital Vila da Serra - Belo Horizonte (MG), Brazil.
                [90 ] Hospital Nereu Ramos - Florianópolis (SC), Brazil.
                [91 ] Hospital Santa Maria Intensibarra - Barra Mansa (RJ), Brazil.
                [92 ] Santa Casa de Misericórdia de Santo Amaro - São Paulo (SP), Brazil.
                [93 ] Santa Casa de Caridade de Don Pedrito - Dom Pedrito (RS), Brazil.
                [94 ] Santa Casa de Misericórdia de Santana do Livramento - Santana do Livramento (RS), Brazil.
                [95 ] Hospital Unimed de Macaé - Macaé (RJ), Brazil.
                [96 ] Hospital Municipal Pedro II - Rio de Janeiro (RJ), Brazil.
                [97 ] Hospital Federal dos Servidores do Estado - Rio de Janeiro (RJ), Brazil.
                [98 ] Hospital São Mateus - Fortaleza (CE), Brazil.
                [99 ] Hospital IBR - Vitória da Conquista (BA), Brazil.
                [100 ] Hospital Uniclinic - Fortaleza (CE), Brazil.
                [101 ] Santa Casa de Misericórdia de Paraguaçu Paulista - Paraguaçu Paulista (SP), Brazil.
                [102 ] Associação Hospitalar Beneficente São Vicente de Paulo - Passo Fundo (RS), Brazil.
                [103 ] Hospital do Servidor Público Municipal de São Paulo - São Paulo (SP), Brazil.
                [104 ] Hospital Santa Isabel - Blumenau (SC), Brazil.
                [105 ] Hospital Municipal Dr Jose Soares Hungria - São Paulo (SP), Brazil.
                [106 ] Hospital Fernandes Távora - Fortaleza (CE), Brazil.
                [107 ] Hospital Distrital Evandro Ayres de Moura - Fortaleza (CE), Brazil.
                [108 ] Hospital Saúde da Mulher - Belém (PA), Brazil.
                [109 ] Hospital Estadual de Urgência e Emergência de Vitória - Vitória (ES), Brazil.
                [110 ] Samur - Vitória da Conquista (BA), Brazil.
                [111 ] Hospital e Pronto-Socorro 28 de Agosto - Manaus (AM), Brazil.
                [112 ] Hospital Assunção - São Bernardo do Campo (SP), Brazil.
                [113 ] Hospital Universitário de Santa Maria - Santa Maria (RS), Brazil.
                [114 ] Hospital Universitário Cajuru - Curitiba (PR), Brazil.
                [115 ] Instituto do Câncer do Estado de São Paulo - São Paulo (SP), Brazil.
                [116 ] Hospital Unimed de Limeira - Limeira (SP), Brazil.
                [117 ] Hospital Amecor - Cuiabá (MT), Brazil.
                [118 ] Santa Casa de Caridade de Diamantina - Diamantina (MG), Brazil.
                [119 ] Hospital das Clínicas, Faculdade Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brazil.
                [120 ] HCor - Hospital do Coração - São Paulo (SP), Brazil.
                [121 ] Hospital Goiânia Leste - Goiânia (GO), Brazil.
                [122 ] Hospital Ortopédico - Goiânia (GO), Brazil.
                [123 ] Hospital Santa Maria - Goiânia (GO), Brazil.
                [124 ] Hospital Municipal Dr. Munir Rafful - Volta Redonda (RJ), Brazil.
                [125 ] Hospital Jardim Amália - Volta Redonda (RJ), Brazil.
                [126 ] Hospital Madre Regina Prottman - Santa Tereza (ES), Brazil.
                [127 ] Hospital Universitário São Francisco de Paula, Universidade Católica de Pelotas - Pelotas (RS), Brazil.
                [128 ] Hospital São Joao de Deus - Divinópolis (MG), Brazil.
                [129 ] Hospital Nossa Senhora Monte Serrat - Salto (SP), Brazil.
                [130 ] Hospital Unimed Salto - Salto (SP), Brazil.
                [131 ] Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
                [132 ] Hospital Geral de Vitória da Conquista - Vitória da Conquista (BA), Brazil.
                [133 ] Hospital Marcelino Champagnat - Curitiba (PR), Brazil.
                [134 ] Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brazil.
                [135 ] Hospital Universitário, Universidade Federal da Grande Dourados - Dourados (GO), Brazil.
                [136 ] Hospital Português - Salvador (BA), Brazil.
                [137 ] Hospital Brigadeiro - São Paulo (SP), Brazil.
                [138 ] Hospital Regional de Sousa - Sousa (PB), Brazil.
                [139 ] Hospital das Clínicas, Universidade Federal do Espírito Santo - Vitória (ES), Brazil.
                [140 ] Santa Casa de Misericórdia de Ribeirão Preto - Ribeirão Preto (SP), Brazil.
                [141 ] Hospital Universitário Lauro Wanderley - João Pessoa (PB), Brazil.
                [142 ] Santa Casa de Belo Horizonte - Belo Horizonte (MG), Brazil.
                [143 ] Hospital Adventista de Manaus - Manaus (AM), Brazil.
                [144 ] Santa Casa Maringá, Universidade Estadual Maringá - Maringá (PR), Brazil.
                [145 ] Hospital Total Cor - Rio de Janeiro (RJ), Brazil.
                [146 ] Hospital Universitário, Universidade de Santa Cruz do Sul - Santa Cruz do Sul (RS), Brazil.
                [147 ] Hospital Dom Hélder - Cabo (PE), Brazil.
                [148 ] Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil.
                [149 ] Hospital Anis Rassi - Goiânia (GO), Brazil.
                [150 ] Instituto de Infectologia Emílio Ribas II - São Paulo (SP), Brazil.
                [151 ] Hospital Unimed Rio de Janeiro - Rio de Janeiro (RJ), Brazil.
                [152 ] Hospital Alemão Oswaldo Cruz - São Paulo (SP), Brazil.
                [153 ] Hospital Samaritano Rio de Janeiro - Rio de Janeiro (RJ), Brazil.
                [154 ] São Bernardo Apart Hospital - Colatina (ES), Brazil.
                [155 ] Hospital Nossa Senhora dos Prazeres - Lages (SC), Brazil.
                [156 ] Hospital Unimed ABC - São Bernardo do Campo (SP), Brazil.
                [157 ] Hospital Municipal de Paracatu - Paracatu (MG), Brazil.
                [158 ] Hospital Municipal Padre Germano Lauck - Foz do Iguaçu (RS), Brazil.
                [159 ] Hospital Santa Helena - São Paulo (SP), Brazil.
                [160 ] Hospital Santa Izabel - São Paulo (SP), Brazil.
                [161 ] Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil.
                [162 ] Hospital Tereza Ramos - Lages (SC), Brazil.
                [163 ] Hospital Alvorada Taguatinga - Brasília (DF), Brazil.
                [164 ] Hospital Maternidade São José - Colatina (ES), Brazil.
                [165 ] Hospital Universitário Ciências Médicas, Fundação Educacional Lucas Machado - Belo Horizonte (MG), Brazil.
                [166 ] Santa Casa de Belém do Pará - Belém (PA), Brazil.
                [167 ] Instituto Nacional de Cardiologia - Rio de Janeiro (RJ), Brazil.
                [168 ] Hospital Novo Atibaia - Atibaia (SP), Brazil.
                [169 ] BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brazil.
                [170 ] Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul - Campo Grande (MS), Brazil.
                [171 ] Hospital do Servidor Público Estadual “Francisco Morato de Oliveira” - São Paulo (SP), Brazil.
                [172 ] Hospital Norte D’Or - Rio de Janeiro (RJ), Brazil.
                [173 ] Hospital Estadual Ipiranga - São Paulo (SP), Brazil.
                [174 ] Hospital Universitário de Maringá, Universidade Estadual de Maringá - Maringá (PR), Brazil.
                [175 ] Albert Sabin Hospital e Maternidade - Juiz de Fora (MG), Brazil.
                [176 ] Casa de Caridade de Carangola - Carangola (MG), Brazil.
                [177 ] Irmandade de Misericórdia de Guaxupé - Guaxupé (MG), Brazil.
                [178 ] Disciplina de Emergências Clínicas, Universidade Estadual de Campinas - Campinas (SP), Brazil.
                [179 ] Hospital São Lucas - Aracaju (SE), Brazil.
                [180 ] Fundação Pio XII- Hospital de Câncer de Barretos - Barretos (SP), Brazil.
                [181 ] Clínica Campo Grande - Campo Grande (MS), Brazil.
                [182 ] Hospital das Clínicas, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.
                [183 ] Casa de Saúde Santa Lúcia - Rio de Janeiro (RJ), Brazil.
                [184 ] Hospital Regional de Itapetininga São Camilo - São Paulo (SP), Brazil.
                [185 ] Santa Casa de Angra dos Reis - Angra dos Reis (RJ), Brazil.
                [186 ] Grupo Hospitalar Nossa Senhora da Conceição - Porto Alegre (RS), Brazil.
                [187 ] Irmandade Misericórdia Hospital Santa Casa de Monte Alto - Monte Alto (SP), Brazil.
                [188 ] Hospital São Marcos - Recife (PE), Brazil.
                [189 ] Hospital Unimed de Manaus - Manaus (AM), Brazil.
                [190 ] Hospital Universitário Getúlio Vargas, Universidade Federal do Amazonas - Manaus (AM), Brazil.
                [191 ] Casa de Saúde Campinas - Campinas (SP), Brazil.
                [192 ] Hospital e Maternidade Galileo - Valinhos (SP), Brazil.
                Author notes
                Corresponding author: Flavio Geraldo Rezende Freitas, Disciplina de Anestesiologia Dor e Medicina Intensiva Universidade Federal de São Paulo, Rua Napoleão de Barros, 737, 6º andar, Zip code: 04024900 - São Paulo (SP), Brazil. E-mail: flaviogrf@ 123456yahoo.com.br
                Author information
                http://orcid.org/0000-0002-7144-6494
                http://orcid.org/0000-0003-2798-6263
                http://orcid.org/0000-0003-4384-0408
                http://orcid.org/0000-0002-9444-9890
                http://orcid.org/0000-0003-3003-8977
                http://orcid.org/0000-0003-4878-0256
                http://orcid.org/0000-0002-8164-1453
                http://orcid.org/0000-0001-9581-7141
                http://orcid.org/0000-0003-2503-6088
                http://orcid.org/0000-0002-0741-4869
                Article
                10.5935/0103-507X.20210028
                8275089
                34231801
                7c444ba4-9db9-4bc5-b563-e8285b8f74ef

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 September 2020
                : 08 December 2020
                Categories
                Original Article

                fluid therapy,critical care,colloids,crystalloid solutions,hemodynamics,shock,hidratação,cuidados críticos,coloides,soluções cristaloides,hemodinâmica,choque

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