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fluid overload in icu

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https://www.readbyqxmd.com/read/29657372/targeted-interventions-in-critically-ill-children-with-severe-dengue
#1
Suchitra Ranjit, Gokul Ramanathan, Balasubramaniam Ramakrishnan, Niranjan Kissoon
Background: The World Health Organization guidelines provide suggestions on early recognition and treatment of severe dengue (SD); however, mortality in this group can be high and is related both to disease severity and the treatment complications. Subjects and Methods: In this prospective observational study, we report our results where standard therapy (ST) was enhanced by Intensive Care Unit (ICU) supportive measures that have proven beneficial in other conditions that share similar pathophysiology of capillary leak and fluid overload...
March 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29597227/from-continuous-renal-replacement-therapies-to-multiple-organ-support-therapy
#2
Zaccaria Ricci, Stefano Romagnoli, Claudio Ronco, Gaetano La Manna
The incidence of the multiple organ dysfunction syndrome (MODS) is rapidly increasing in intensive care units (ICU). It usually combines with sepsis and is the most frequent cause of death in the ICU patients. The nature of the ICU patients has changed in the last years. It includes a variety of patients with severe cases due to major surgical interventions, trauma, hemodynamic instability, sepsis, and so on but also older people than previous times. All these situations can easily lead to MODS. In the prior years, the only available and efficient therapy was renal replacement therapy (RRT) for treating acute renal failure, but the development of technology also gives us devices to support the other systems...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29589054/maintenance-fluid-therapy-and-fluid-creep-impose-more-significant-fluid-sodium-and-chloride-burdens-than-resuscitation-fluids-in-critically-ill-patients-a-retrospective-study-in-a-tertiary-mixed-icu-population
#3
Niels Van Regenmortel, Walter Verbrugghe, Ella Roelant, Tim Van den Wyngaert, Philippe G Jorens
PURPOSE: Research on intravenous fluid therapy and its side effects, volume, sodium, and chloride overload, has focused almost exclusively on the resuscitation setting. We aimed to quantify all fluid sources in the ICU and assess fluid creep, the hidden and unintentional volume administered as a vehicle for medication or electrolytes. METHODS: We precisely recorded the volume, sodium, and chloride burdens imposed by every fluid source administered to 14,654 patients during the cumulative 103,098 days they resided in our 45-bed tertiary ICU and simulated the impact of important strategic fluid choices on patients' chloride burdens...
March 27, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29534186/early-initiation-of-peritoneal-dialysis-improves-postoperative-recovery-in-children-with-right-ventricular-outflow-tract-obstructive-lesions-at-high-risk-of-fluid-overload-a-propensity-score-matched-analysis
#4
Tuo Pan, Dan Li, Shoujun Li, Jun Yan, Xu Wang
OBJECTIVES: Postoperative fluid overload is common in children after cardiac surgery, especially for those with right ventricular outflow tract obstruction, which is associated with poor outcomes. This study was conducted to investigate whether early peritoneal dialysis (PD) was associated with improved outcomes in these children at high risk of fluid overload. METHODS: Between January 2010 and January 2015, a total of 2555 consecutive patients with right ventricular outflow tract obstruction underwent anatomical repair...
March 9, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29519651/determinants-of-urinary-catheter-removal-practices-in-the-pediatric-intensive-care-unit-a-survey
#5
Karen Trudel, Samara Zavalkoff, Nicholas Winters, Caroline Quach, Jacques Lacroix, Patricia S Fontela
BACKGROUND: Prolonged use of indwelling catheters is associated with hospital-acquired urinary tract infections (UTIs). Literature is scarce about the factors influencing urinary catheter removal and maintenance in children. This study aims to describe the determinants of urinary catheter removal in pediatric intensive care unit (PICU) patients. METHODS: Cross-sectional survey of 171 physicians and nurses working at 2 tertiary PICUs in Montreal, Canada. We used focus groups and literature review to design the survey questions and 3 clinical scenarios...
March 5, 2018: American Journal of Infection Control
https://www.readbyqxmd.com/read/29512107/fluid-accumulation-during-acute-kidney-injury-in-the-intensive-care-unit
#6
R E Berthelsen, A Perner, A K Jensen, J-U Jensen, M H Bestle
INTRODUCTION: Fluid therapy is a ubiquitous intervention in patients admitted to the intensive care unit, but positive fluid balance may be associated with poor outcomes and particular in patients with acute kidney injury. Studies describing this have defined fluid overload either at specific time points or considered patients with a positive mean daily fluid balance as fluid overloaded. We wished to detail this further and performed joint model analyses of the association between daily fluid balance and outcome represented by mortality and renal recovery in patients admitted with acute kidney injury...
March 7, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29502930/a-comparison-of-compliance-in-the-estimation-of-body-fluid-status-using-daily-fluid-balance-charting-and-body-weight-changes-during-continuous-renal-replacement-therapy
#7
Hugh Davies, Gavin D Leslie, David Morgan, Geoff J Dobb
BACKGROUND: The risk of fluid overload and mortality is increased in patients with severe acute kidney injury. Charting of daily fluid balance is a key component of fluid assessment but not without problems affecting accuracy. The introduction of electronic bed scales has made routine patient-weighing easier and focused attention on monitoring fluid-related weight changes. OBJECTIVES: This paper investigated the frequency of compliance in weighing patients daily using electronic bed scales and evaluated the relationship between calculated fluid balance and body weight changes in patients receiving continuous renal replacement therapy (CRRT)...
March 1, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29454528/continuous-infusion-versus-intermittent-bolus-injection-of-furosemide-in-critically-ill-patients-a-systematic-review-and-meta-analysis
#8
REVIEW
Ka Ting Ng, Aslinah Velayit, Delton Kah Yeang Khoo, Amirah Mohd Ismail, Marzida Mansor
OBJECTIVE: Fluid overload is a common phenomenon seen in intensive care units (ICUs). However, there is no general consensus on whether continuous or bolus furosemide is safer or more effective in these hemodynamically unstable ICU patients. The aim of this meta-analysis was to examine the clinical outcomes of continuous versus bolus furosemide in a critically ill population in ICUs. DATA SOURCES: MEDLINE, EMBASE, PubMed, and the Cochrane Database of Systematic reviews were searched from their inception until June 2017...
January 10, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29439683/elevated-central-venous-pressure-is-associated-with-increased-mortality-in-pediatric-septic-shock-patients
#9
Seung Jun Choi, Eun-Ju Ha, Won Kyoung Jhang, Seong Jong Park
BACKGROUND: Central venous pressure (CVP) is an important factor affecting capillary blood flow, and it is associated with poor outcomes in adult septic shock patients. However, whether a similar association exists in pediatric patients remains unclear. METHODS: We retrospectively analyzed data from patients admitted to our pediatric intensive care unit (PICU) between February 2009 and July 2015. Patients were divided into two groups-survivors and nonsurvivors-according to 28-day mortality...
February 13, 2018: BMC Pediatrics
https://www.readbyqxmd.com/read/29427013/assessment-of-fluid-responsiveness-in-spontaneously-breathing-patients-a-systematic-review-of-literature
#10
REVIEW
Renato Carneiro de Freitas Chaves, Thiago Domingos Corrêa, Ary Serpa Neto, Bruno de Arruda Bravim, Ricardo Luiz Cordioli, Fabio Tanzillo Moreira, Karina Tavares Timenetsky, Murillo Santucci Cesar de Assunção
Patients who increase stoke volume or cardiac index more than 10 or 15% after a fluid challenge are usually considered fluid responders. Assessment of fluid responsiveness prior to volume expansion is critical to avoid fluid overload, which has been associated with poor outcomes. Maneuvers to assess fluid responsiveness are well established in mechanically ventilated patients; however, few studies evaluated maneuvers to predict fluid responsiveness in spontaneously breathing patients. Our objective was to perform a systematic review of literature addressing the available methods to assess fluid responsiveness in spontaneously breathing patients...
February 9, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29404689/hyperchloremia-is-independently-associated-with-mortality-in-critically-ill-children-who-ultimately-require-continuous-renal-replacement-therapy
#11
Matthew F Barhight, Jennifer Lusk, John Brinton, Timothy Stidham, Danielle E Soranno, Sarah Faubel, Jens Goebel, Peter M Mourani, Katja M Gist
BACKGROUND: The optimal fluid management in critically ill children is currently under investigation with several studies suggesting that hyperchloremia, chloride load, and the use of chloride-rich fluids contribute to worse outcomes. METHODS: This is a single-center retrospective cohort study of Pediatric Intensive Care Unit patients from 2008 to 2016 requiring continuous renal replacement therapy (CRRT). Patients were excluded if they had end-stage renal disease, a disorder of chloride transport, or concurrent provision of extracorporeal membrane oxygenation therapy...
February 5, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/29389698/goal-directed-fluid-resuscitation-protocol-based-on-arterial-waveform-analysis-of-major-burn-patients-in-a-mass-burn-casualty
#12
Hao-Yu Chiao, Chang-Yi Chou, Yuan-Sheng Tzeng, Chih-Hsin Wang, Shyi-Gen Chen, Niann-Tzyy Dai
BACKGROUND: Adequate fluid titration during the initial resuscitation period of major burn patients is crucial. This study aimed to evaluate the feasibility and efficacy of a goal-directed fluid resuscitation protocol that used hourly urine output plus the arterial waveform analysis FloTrac (Edwards LifeSciences, Irvine, Calif) system for major burns to avoid fluid overload. METHODS: We conducted a retrospective cohort study of 43 major burn patients at the Tri-Service General Hospital after the Formosa Fun Coast Dust Explosion on June 27, 2015...
February 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29367093/a-mini-fluid-challenge-of-150ml-predicts-fluid-responsiveness-using-modelflowr-pulse-contour-cardiac-output-directly-after-cardiac-surgery
#13
Annemieke Smorenberg, Thomas G V Cherpanath, Bart F Geerts, Robert B P de Wilde, Jos R C Jansen, Jacinta J Maas, A B Johan Groeneveld
STUDY OBJECTIVE: The mini-fluid challenge may predict fluid responsiveness with minimum risk of fluid overloading. However, the amount of fluid as well as the best manner to evaluate the effect is unclear. In this prospective observational pilot study, the value of changes in pulse contour cardiac output (CO) measurements during mini-fluid challenges is investigated. DESIGN: Prospective observational study. SETTING: Intensive Care Unit of a university hospital...
January 19, 2018: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/29356810/association-between-fluid-balance-and-outcomes-in-critically-ill-children-a-systematic-review-and-meta-analysis
#14
Rashid Alobaidi, Catherine Morgan, Rajit K Basu, Erin Stenson, Robin Featherstone, Sumit R Majumdar, Sean M Bagshaw
Importance: After initial resuscitation, critically ill children may accumulate fluid and develop fluid overload. Accruing evidence suggests that fluid overload contributes to greater complexity of care and worse outcomes. Objective: To describe the methods to measure fluid balance, define fluid overload, and evaluate the association between fluid balance and outcomes in critically ill children. Data Sources: Systematic search of MEDLINE, EMBASE, Cochrane Library, trial registries, and selected gray literature from inception to March 2017...
March 1, 2018: JAMA Pediatrics
https://www.readbyqxmd.com/read/29351128/fluid-removal-with-ultrasound-guided-protocol-improves-the-efficacy-and-safety-of-dehydration-in-post-resuscitated-critically-ill-patients-a-quasi-experimental-before-and-after-study
#15
Luhao Wang, Chunfang Qiu, Xiangdong Guan, Minying Chen, Juan Chen, Xiang Si, Zhicheng Du, Yanqiu Liu, Bin Ouyang
Fluid overload is associated with increased morbidity and mortality in critically ill patients. However, researches rarely study the precise start or end point of fluid removal and no protocol was developed to control the fluid removal process. We hypothesized that individualized fluid removal with ultrasound-guided protocol could improve the efficacy and safety of fluid removal in post-resuscitated critically ill patients. A quasi-experimental, before and after trial was conducted to identify the benefits of ultrasound-guided fluid removal...
January 18, 2018: Shock
https://www.readbyqxmd.com/read/29317968/b-type-natriuretic-peptide-a-predictor-for-mortality-intensive-care-unit-length-of-stay-and-hospital-length-of-stay-in-patients-with-resolving-sepsis
#16
Harsimar Singh, Daryl Ramai, Harshil Patel, Marina Iskandir, Sarina Sachdev, Rabjot Rai, Jay Patolia, Getaw Worku Hassen
Background: B-type natriuretic peptide (BNP) is a hormone secreted by cardiomyocytes in response to myocardial ischemia, increased ventricular wall tension, and overload. BNP is utilized as a diagnostic and prognostic marker in congested heart failure (CHF). Its prognostic value in sepsis is unknown. The aim of this study is to determine if BNP correlates with increased in-hospital mortality for septic patients. Methods: This was a retrospective study of 505 patients admitted for sepsis or severe sepsis or septic shock during the period of January 2013 and August 2014...
December 2017: Cardiology Research
https://www.readbyqxmd.com/read/29297387/personalised-fluid-resuscitation-in-the-icu-still-a-fluid-concept
#17
REVIEW
Frank van Haren
The administration of intravenous fluid to critically ill patients is one of the most common, but also one of the most fiercely debated, interventions in intensive care medicine. Even though many thousands of patients have been enrolled in large trials of alternative fluid strategies, consensus remains elusive and practice is widely variable. Critically ill patients are significantly heterogeneous, making a one size fits all approach unlikely to be successful.New data from basic, animal, and clinical research suggest that fluid resuscitation could be associated with significant harm...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29248144/renal-replacement-therapy-for-aki-when-how-much-when-to-stop
#18
REVIEW
Stefano Romagnoli, William R Clark, Zaccaria Ricci, Claudio Ronco
Severe acute kidney injury (AKI) requiring renal replacement therapy (RRT) is a serious clinical disorder in the intensive care unit (ICU), occurring in a significant proportion of critically ill patients. However, many questions remain about the optimal administration of RRT with regard to several important considerations, including treatment dose, timing of treatment initiation and cessation, therapy mode, type of anticoagulation, and management of fluid overload. While Level 1 evidence exists for RRT dosing in AKI, all the studies contributing to this evidence base employed fixed-dose regimens throughout a patient's continuous RRT (CRRT) course, without regard for the possibility of individualizing treatment dose according to the clinical status of a given patient at a specific time...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29238981/incidence-risk-factors-and-outcome-of-transfusion-associated-circulatory-overload-in-a-mixed-intensive-care-unit-population-a-nested-case-control-study
#19
Joachim J Bosboom, Robert B Klanderman, Maarten Zijp, Markus W Hollmann, Denise P Veelo, Jan M Binnekade, Bart F Geerts, Alexander P J Vlaar
BACKGROUND: The objective of this study was to determine the incidence, risk factors, and outcome of transfusion-associated circulatory overload (TACO) in a cohort of mixed intensive care unit patients and to compare risk factors with those for cardiac overload in the absence of transfusion. STUDY DESIGN AND METHODS: In a retrospective cohort study, patients who developed TACO were compared using multivariate analysis of two control groups: patients without pulmonary deterioration who received transfusion and patients who developed circulatory overload in the absence of transfusion...
February 2018: Transfusion
https://www.readbyqxmd.com/read/29194057/approaches-and-techniques-to-avoid-development-or-progression-of-acute-respiratory-distress-syndrome
#20
François Beloncle, Alain Mercat
PURPOSE OF REVIEW: Despite major improvement in ventilation strategies, hospital mortality and morbidity of the acute respiratory distress syndrome (ARDS) remain high. A lot of therapies have been shown to be ineffective for established ARDS. There is a growing interest in strategies aiming at avoiding development and progression of ARDS. RECENT FINDINGS: Recent advances in this field have explored identification of patients at high-risk, nonspecific measures to limit the risks of inflammation, infection and fluid overload, prevention strategies of ventilator-induced lung injury and patient self-inflicted lung injury, and pharmacological treatments...
February 2018: Current Opinion in Critical Care
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