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fluid overload in icu

M C O van IJzendoorn, H Buter, W P Kingma, G J Navis, E C Boerma
Background. ICU acquired hypernatremia (IAH, serum sodium concentration (sNa) ≥ 143 mmol/L) is mainly considered iatrogenic, induced by sodium overload and water deficit. Main goal of the current paper was to answer the following questions: Can the development of IAH indeed be explained by sodium intake and water balance? Or can it be explained by renal cation excretion? Methods. Two retrospective studies were conducted: a balance study in 97 ICU patients with and without IAH and a survey on renal cation excretion in 115 patients with IAH...
2016: Critical Care Research and Practice
Timo Sturm, Julia Leiblein, Verena Schneider-Lindner, Thomas Kirschning, Manfred Thiel
PURPOSE: Clinically unapparent microcirculatory impairment is common and has a negative impact on septic shock, but specific therapy is not established so far. This prospective observational study aimed at identifying candidate parameters for microcirculatory-guided hemodynamic therapy. CLINICALTRIALSGOV: NCT01530932. MATERIALS AND METHODS: Microcirculatory flow and postcapillary venous oxygen saturation were detected during vaso-occlusive testing (VOT) on days 1 (T0), 2 (T24), and 4 (T72) in 20 patients with septic shock at a surgical intensive care unit using a laser Doppler spectrophotometry system (O2C)...
September 29, 2016: Journal of Intensive Care Medicine
Rakesh Bhadade, Rosemarie de'Souza, Minal Harde, Dileep Asgaonkar, Nilesh Tuplondhe
BACKGROUND: Acute respiratory distress syndrome (ARDS) is a clinical syndrome of severe dyspnoea of rapid onset, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure in the absence of cardiac failure. We did the study to asses various aetiologies of ARDS, to determine the correlation between the diagnostic criteria, mortality predictors, need of mechanical ventilation and the outcome of patients. This was an observational, prospective study in medical intensive care unit (MICU) of a tertiary care hospital, over a period of 15 months...
November 2015: Journal of the Association of Physicians of India
Erin Frazee, Kianoush Kashani
BACKGROUND: Intravenous fluids (IVF) are frequently utilized to restore intravascular volume in patients with distributive and hypovolemic shock. Although the benefits of the appropriate use of fluids in intensive care units (ICUs) and hospitals are well described, there is growing knowledge regarding the potential risks of volume overload and its impact on organ failure and mortality. To avoid volume overload and its associated complications, strategies to identify fluid responsiveness are developed and utilized more often among ICU patients...
June 2016: Kidney Diseases
Rolando Claure-Del Granado, Ravindra L Mehta
BACKGROUND: Fluid overload is frequently found in acute kidney injury patients in critical care units. Recent studies have shown the relationship of fluid overload with adverse outcomes; hence, manage and optimization of fluid balance becomes a central component of the management of critically ill patients. DISCUSSION: In critically ill patients, in order to restore cardiac output, systemic blood pressure and renal perfusion an adequate fluid resuscitation is essential...
August 2, 2016: BMC Nephrology
Chandra Rath, Pradeep Suryawanshi
Context: Knowledge and skills of heart, head, lung, gut and basic abdominal ultrasound is of immense utility to clinicians in their day-to-day patient management, and in acute events, in the absence of specialist service back-up. This review examines the potential role of clinician-performed ultrasound in the neonatal intensive care unit. Evidence Acquisition: The bibliographic search of English-language literature was performed electronically using PubMed and EMBASE databases for the different topics we have covered under this review...
June 1, 2016: Indian Pediatrics
Jiao Chen, Xiaozhong Li, Zhenjiang Bai, Fang Fang, Jun Hua, Ying Li, Jian Pan, Jian Wang, Xing Feng, Yanhong Li
OBJECTIVE: To evaluate whether early and acquired daily fluid overload (FO), as well as fluctuations in fluid accumulation, were associated with adverse outcomes in critically ill children with severe sepsis. METHODS: This study enrolled 202 children in a pediatric intensive care unit (PICU) with severe sepsis. Early fluid overload was defined as ≥5% fluid accumulation occurring in the first 24 hours of PICU admission. The maximum daily fluid accumulation ≥5% occurring during the next 6 days in patients with at least 48 hours of PICU stay was defined as PICU-acquired daily fluid overload...
2016: PloS One
Sujata Chakravarti, Yasir Al-Qaqaa, Meghan Faulkner, Puneet Bhatla, Michael Argilla, Michelle Ramirez
Fluid overload (FO) is a common complication for pediatric patients in the intensive care unit. When conventional therapy fails, hemodialysis or peritoneal dialysis is classically used for fluid removal. Unfortunately, these therapies are often associated with cardiovascular or respiratory instability. Ultrafiltration, using devices such as the Aquadex™ system (Baxter Healthcare, Deerfield, IL, USA), is an effective tool for fluid removal in adult patients with congestive heart failure. As compared to hemodialysis, ultrafiltration can be performed using smaller catheters, and the extracorporeal volume and minimal blood flow rates are lower...
June 15, 2016: Pediatric Reports
Candice Torres de Melo Bezerra Cavalcante, Klébia Magalhães Castelo Branco, Valdester Cavalcante Pinto Júnior, Gdayllon Cavalcante Meneses, Fernanda Macedo de Oliveira Neves, Nayana Maria Gomes de Souza, Kiarelle Lourenço Penaforte, Alice Maria Costa Martins, Alexandre Braga Libório
OBJECTIVE: Acute kidney injury is a common occurrence after pediatric cardiac surgery and is associated with adverse patient outcomes. Syndecan-1 is a biomarker of endothelial glycocalyx damage, and its early increment after surgery can be associated with acute kidney injury. METHODS: We performed a prospective cohort study with 289 patients aged less than 18 years who underwent cardiac surgery at 1 reference institution. Postoperative plasma syndecan-1 was collected within the first 2 hours after cardiac surgery...
July 2016: Journal of Thoracic and Cardiovascular Surgery
F Garzotto, M Ostermann, D Martín-Langerwerf, M Sánchez-Sánchez, J Teng, R Robert, A Marinho, M E Herrera-Gutierrez, H J Mao, D Benavente, E Kipnis, A Lorenzin, D Marcelli, C Tetta, C Ronco
BACKGROUND: The previously published "Dose Response Multicentre International Collaborative Initiative (DoReMi)" study concluded that the high mortality of critically ill patients with acute kidney injury (AKI) was unlikely to be related to an inadequate dose of renal replacement therapy (RRT) and other factors were contributing. This follow-up study aimed to investigate the impact of daily fluid balance and fluid accumulation on mortality of critically ill patients without AKI (N-AKI), with AKI (AKI) and with AKI on RRT (AKI-RRT) receiving an adequate dose of RRT...
June 23, 2016: Critical Care: the Official Journal of the Critical Care Forum
Chao Wu, Xinying Wang, Wenkui Yu, Pei Li, Sitong Liu, Jieshou Li, Ning Li
BACKGROUND AND OBJECTIVES: Fluid overload and hypermetabolism frequently occur in sepsis patients in the intensive care unit (ICU) setting. These abnormalities correlate with inflammatory mediators released under stressful conditions. Continuous renal replacement therapy (CRRT) is an extracorporeal life support technology that persistently and stably eliminates overhydration and cytokines. This study investigated the short-term consequence of CRRT on body composition and pattern of energy expenditure...
2016: Asia Pacific Journal of Clinical Nutrition
Luhao Wang, Xiangdong Guan, Minying Chen, Juan Chen, Xiang Si, Zhiyi Jiang, Yongjun Liu, Zimeng Liu, Jianfeng Wu, Bin Ouyang
OBJECTIVE: To investigate the clinical value of lung ultrasound in the late goal -directed fluid removal in critically ill patients underwent fluid resuscitation. METHODS: A prospective study was conducted. Forty patients underwent fluid resuscitation were enrolled in the Department of Surgical Intensive Care Unit of The First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to June 2015. Lung and heart ultrasound were conducted for lung B-lines and left ventricular ejection fraction (EF)...
May 10, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
U Janssens, M Joannidis
Heart and kidney are closely interacting organs which function interdependently. Organ crosstalk between these two organs is based on humoral regulation and by inflammatory mediators, which are similar to those dominating systemic inflammation syndrome. The close interaction between heart and kidney results in organ dysfunction following both chronic and acute functional impairment of the respective counterpart. These changes are summarized under the term cardiorenal syndrome (CRS) which is subdivided into 5 types...
May 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Kianoush Kashani, Ravindra L Mehta
From the initial version of an extended renal replacement therapy, the initiative to provide safer, more efficient means for detoxification and volume removal in comparison with intermittent renal replacement therapies (IRRT) has been evaluated. As a result, the Kidney Disease Improving Global Outcomes guidelines for acute kidney injury recommend the preferential use of continuous renal replacement therapy (CRRT) in patients who are hemodynamically unstable or who suffer from intracranial hypertension. The choice of dialysis modality is also influenced by other factors including clinical expertise, and the availability of each treatment option in individual medical centers...
July 2016: Seminars in Dialysis
Sara Samoni, Valentina Vigo, Luis Ignacio Bonilla Reséndiz, Gianluca Villa, Silvia De Rosa, Federico Nalesso, Fiorenza Ferrari, Mario Meola, Alessandra Brendolan, Paolo Malacarne, Francesco Forfori, Raffaele Bonato, Carlo Donadio, Claudio Ronco
BACKGROUND: Studies have demonstrated a positive correlation between fluid overload (FO) and adverse outcomes in critically ill patients. The present study aims at defining the impact of hyperhydration on the Intensive Care Unit (ICU) mortality risk, comparing Bioelectrical Impedance Vector Analysis (BIVA) assessment with cumulative fluid balance (CFB) recording. METHODS: We performed a prospective, dual-centre, clinician-blinded, observational study of consecutive patients admitted to ICU with an expected length of ICU stay of at least 72 hours...
2016: Critical Care: the Official Journal of the Critical Care Forum
Sarah A Ingelse, Roelie M Wösten-van Asperen, Joris Lemson, Joost G Daams, Reinout A Bem, Job B van Woensel
The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric acute respiratory distress syndrome (PARDS). Patients with ARDS have widespread damage of the alveolar-capillary barrier, potentially making them vulnerable to fluid overload with the development of pulmonary edema leading to prolonged course of disease...
2016: Frontiers in Pediatrics
Tanaya Sparkle, Staci Cameron
BACKGROUND: We present a case in which extremely rapid massive transfusion was successfully used to combat severe acute bleeding during a parietooccipital tumor resection in a 14-month-old patient. CASE REPORT: An 8-kg patient was found to have a 4 × 5 × 5-cm parietooccipital tumor on computed tomography scan, for which resection was urgently planned. Sudden acute bleeding was encountered, which was communicated to the anesthesia team. Transfusion was initiated and a total of 5 units of packed red blood cells, 3 units of fresh frozen plasma, 160 ml of platelets, 200 ml of albumin, and 500 ml of 0...
2016: American Journal of Case Reports
Nicole S Wilder, Sunkyung Yu, Janet E Donohue, Caren S Goldberg, Neal B Blatt
OBJECTIVES: Acute kidney injury is a severe complication of cardiac surgery associated with increased morbidity and mortality; yet, acute kidney injury classification for neonates remains challenging. We characterized patterns of postoperative fluid overload as a surrogate marker for acute kidney injury and as a risk factor of poor postoperative outcomes in neonates undergoing cardiac surgery. DESIGN: Retrospective cohort study. SETTING: Single, congenital heart center destination program...
May 2016: Pediatric Critical Care Medicine
Sang Taek Lee, Heeyeon Cho
BACKGROUND: Continuous renal replacement therapy (CRRT) has emerged as the modality of choice for the management of high-risk neonates with acute kidney injury (AKI), inborn errors of metabolism and multi-organ dysfunction. The aim of this study was to evaluate fluid overload (FO) and investigate the factors associated with outcomes in neonates undergoing CRRT. METHODS: We retrospectively reviewed the medical records of 34 neonates with AKI who were admitted to the neonatal intensive care unit (NICU) of Samsung Medical Center, Seoul, Republic of Korea between January 2007 and December 2014 where they underwent at least 24 h of CRRT...
November 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
David S Cooper, Rajit K Basu, Jack F Price, Stuart L Goldstein, Catherine D Krawczeski
The field of cardiac intensive care continues to advance in tandem with congenital heart surgery. The focus of intensive care unit care has now shifted to that of morbidity reduction and eventual elimination. Acute kidney injury (AKI) after cardiac surgery is associated with adverse outcomes, including prolonged intensive care and hospital stays, diminished quality of life, and increased long-term mortality. Acute kidney injury occurs frequently, complicating the care of both postoperative patients and those with heart failure...
March 2016: World Journal for Pediatric & Congenital Heart Surgery
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