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Iatrogenic salt water drowning and the hazards of a high central venous pressure

Overview of attention for article published in Annals of Intensive Care, June 2014
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (96th percentile)

Mentioned by

blogs
3 blogs
twitter
30 tweeters
facebook
5 Facebook pages
wikipedia
1 Wikipedia page
googleplus
1 Google+ user

Citations

dimensions_citation
116 Dimensions

Readers on

mendeley
196 Mendeley
Title
Iatrogenic salt water drowning and the hazards of a high central venous pressure
Published in
Annals of Intensive Care, June 2014
DOI 10.1186/s13613-014-0021-0
Pubmed ID
Authors

Paul E Marik

Abstract

Current teaching and guidelines suggest that aggressive fluid resuscitation is the best initial approach to the patient with hemodynamic instability. The source of this wisdom is difficult to discern, however, Early Goal Directed therapy (EGDT) as championed by Rivers et al. and the Surviving Sepsis Campaign Guidelines appears to have established this as the irrefutable truth. However, over the last decade it has become clear that aggressive fluid resuscitation leading to fluid overload is associated with increased morbidity and mortality across a diverse group of patients, including patients with severe sepsis as well as elective surgical and trauma patients and those with pancreatitis. Excessive fluid administration results in increased interstitial fluid in vital organs leading to impaired renal, hepatic and cardiac function. Increased extra-vascular lung water (EVLW) is particularly lethal, leading to iatrogenic salt water drowning. EGDT and the Surviving Sepsis Campaign Guidelines recommend targeting a central venous pressure (CVP) > 8 mmHg. A CVP > 8 mmHg has been demonstrated to decrease microcirculatory flow, as well as renal blood flow and is associated with an increased risk of renal failure and death. Normal saline (0.9% salt solution) as compared to balanced electrolyte solutions is associated with a greater risk of acute kidney injury and death. This paper reviews the adverse effects of large volume resuscitation, a high CVP and the excessive use of normal saline.

Twitter Demographics

The data shown below were collected from the profiles of 30 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 196 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Brazil 2 1%
Turkey 1 <1%
France 1 <1%
Norway 1 <1%
Chile 1 <1%
Sweden 1 <1%
United Kingdom 1 <1%
Mexico 1 <1%
Denmark 1 <1%
Other 0 0%
Unknown 186 95%

Demographic breakdown

Readers by professional status Count As %
Other 32 16%
Student > Postgraduate 24 12%
Student > Master 24 12%
Researcher 20 10%
Student > Ph. D. Student 19 10%
Other 58 30%
Unknown 19 10%
Readers by discipline Count As %
Medicine and Dentistry 151 77%
Nursing and Health Professions 4 2%
Psychology 3 2%
Engineering 3 2%
Agricultural and Biological Sciences 3 2%
Other 9 5%
Unknown 23 12%

Attention Score in Context

This research output has an Altmetric Attention Score of 44. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 24 January 2019.
All research outputs
#592,157
of 17,634,657 outputs
Outputs from Annals of Intensive Care
#59
of 808 outputs
Outputs of similar age
#7,659
of 207,117 outputs
Outputs of similar age from Annals of Intensive Care
#1
of 1 outputs
Altmetric has tracked 17,634,657 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 96th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 808 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 13.5. This one has done particularly well, scoring higher than 92% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 207,117 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 96% of its contemporaries.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them