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fluid volum and critical patient

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https://www.readbyqxmd.com/read/28431428/computational-and-in-vitro-experimental-investigation-of-intrathecal-drug-distribution-parametric-study-of-the-effect-of-injection-volume-cerebrospinal-fluid-pulsatility-and-drug-uptake
#1
Kevin M Tangen, Roxanne Leval, Ankit I Mehta, Andreas A Linninger
BACKGROUND: Intrathecal drug delivery is an attractive option to circumvent the blood-brain barrier for pain management through its increased efficacy of pain relief, reduction in adverse side effects, and cost-effectiveness. Unfortunately, there are limited guidelines for physicians to choose infusion or drug pump settings to administer therapeutic doses to specific regions of the spine or the brain. Although empiric trialing of intrathecal drugs is critical to determine the sustained side effects, currently there is no inexpensive in vitro method to guide the selection of spinal drug delivery parameters...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28400680/changes-in-b-type-natriuretic-peptide-and-related-hemodynamic-parameters-following-a-fluid-challenge-in-critically-ill-patients-with-severe-sepsis-or-septic-shock
#2
Shahed Omar, Ahmad Ali, Yahya Atiya, Rudo Lufuno Mathivha, Joel M Dulhunty
CONTEXT: Severe sepsis or septic shock. AIMS: The aim of this study is to examine the effect of a fluid challenge on the B-type natriuretic peptide (BNP) and the hemodynamic state. SETTINGS AND DESIGN: This observational study was conducted in an intensivist-led academic, mixed medical-surgical Intensive Care Unit. SUBJECTS AND METHODS: Focused transthoracic echocardiogram, plasma BNP, and hemodynamic measurements were recorded at baseline and following a 500 ml fluid challenge in thirty patients...
March 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28396935/state-of-the-art-in-fluid-and-volume-therapy-a%C3%A2-user-friendly-staged-concept-english-version
#3
M Rehm, N Hulde, T Kammerer, A S Meidert, K Hofmann-Kiefer
Adequate intraoperative infusion therapy is essential for the perioperative outcome of a patient. Both hypo- and hypervolemia can lead to an increased rate of perioperative complications and to a worse outcome. Perioperative infusion therapy should therefore be needs-based. The primary objective is the maintenance of preoperative normovolemia using a rational infusion strategy. Perioperative fluid losses should be differentiated from volume losses due to surgical bleeding or protein losses into the interstitial space...
April 10, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28391426/comparison-of-stroke-volume-measurement-between-non-invasive-bioreactance-and-esophageal-doppler-in-patients-undergoing-major-abdominal-pelvic-surgery
#4
Gennaro De Pascale, Mervyn Singer, David Brealey
PURPOSE: Bioreactance is a non-invasive technology for measuring stroke volume (SV) in the operating room and critical care setting. We evaluated how the NICOM(®) bioreactance device performed against the CardioQ(®) esophageal Doppler monitor in patients undergoing major abdominal-pelvic surgery, focusing on the effect of different hemodynamic interventions. METHODS: SVNICOM and SVODM were simultaneously measured intraoperatively, including before and after interventions including fluid challenge, vasopressor boluses, peritoneal gas insufflation/removal, and Trendelenburg/reverse Trendelenburg patient positioning...
April 8, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28372500/clinical-significance-of-bioimpedance-spectroscopy-in-critically-ill-patients
#5
Shang-Feng Yang, Ching-Min Tseng, I-Fan Liu, Shin-Hung Tsai, Wein-Shung Kuo, Tien-Ping Tsao
BACKGROUND: Early fluid resuscitation is a key aspect in the successful management of critically ill patients, but the optimal goal for volume control after the acute stage of critical illness remains unclear. This study aimed to evaluate the prognostic value of bioimpedance spectrometry for fluid management in critically ill patients. METHODS: In this prospective observational study, patients who consented to participate were screened within the first 24 hours of admission to a medical intensive care unit (ICU) from February 4, 2015, to January 31, 2016...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28367600/microfluidic-processing-of-synovial-fluid-for-cytological-analysis
#6
John C Krebs, Yunus Alapan, Barbara A Dennstedt, Glenn D Wera, Umut A Gurkan
Cytological analysis of synovial fluid is widely used in the clinic to assess joint health and disease. However, in general practice, only the total number of white blood cells (WBCs) are available for cytologic evaluation of the joint. Moreover, sufficient volume of synovial aspirates is critical to run conventional analyses, despite limited volume of aspiration that can normally be obtained from a joint. Therefore, there is a lack of consistent and standardized synovial fluid cytological tests in the clinic...
June 2017: Biomedical Microdevices
https://www.readbyqxmd.com/read/28365648/passive-leg-raising-and-prediction-of-fluid-responsiveness-systematic-review
#7
Joya D Pickett, Elizabeth Bridges, Patricia A Kritek, JoAnne D Whitney
Fluid boluses are often administered with the aim of improving tissue hypoperfusion in shock. However, only approximately 50% of patients respond to fluid administration with a clinically significant increase in stroke volume. Fluid overload can exacerbate pulmonary edema, precipitate respiratory failure, and prolong mechanical ventilation. Therefore, it is important to predict which hemodynamically unstable patients will increase their stroke volume in response to fluid administration, thereby avoiding deleterious effects...
April 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28340895/post-operative-consequences-of-hemodynamic-optimization
#8
A Lazkani, G Lebuffe
Hemodynamic optimization begins with a medical assessment to identify the high-risk patients. This stratification is needed to customize the choice of hemodynamic support that is best adapted to the patient's level of risk, integrating the use of the least invasive procedures. The macro-circulatory hemodynamic approach aims to maintain a balance between oxygen supply (DO2) and oxygen demand (VO2). Volume replacement plays a crucial role based on the titration of fluid boluses according to their effect on measured stroke volume or indices of preload dependency...
December 2016: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/28323719/passive-leg-raising-for-assessment-of-volume-responsiveness-a-review
#9
Jaume Mesquida, Guillem Gruartmoner, Ricard Ferrer
PURPOSE OF REVIEW: To evaluate the existing evidence on the passive leg raising (PLR) test for fluid responsiveness prediction. RECENT FINDINGS: It has been well established that either insufficient or excessive fluid administration derives in worse outcomes in critically ill patients, highlighting that a more accurate assessment of fluid management is required. Accordingly, several cardiovascular indices have been tested to improve our ability to predict patients' response to fluid loading at the bedside, the so-called functional hemodynamic monitoring...
March 20, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28299589/respiratory-variation-in-peak-aortic-velocity-accurately-predicts-fluid-responsiveness-in-children-undergoing-neurosurgery-under-general-anesthesia
#10
Kavita G Morparia, Srijaya K Reddy, Laura J Olivieri, Michael C Spaeder, Jennifer J Schuette
The determination of fluid responsiveness in the critically ill child is of vital importance, more so as fluid overload becomes increasingly associated with worse outcomes. Dynamic markers of volume responsiveness have shown some promise in the pediatric population, but more research is needed before they can be adopted for widespread use. Our aim was to investigate effectiveness of respiratory variation in peak aortic velocity and pulse pressure variation to predict fluid responsiveness, and determine their optimal cutoff values...
March 16, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28292533/assessment-of-hydration-status-using-bioelectrical-impedance-vector-analysis-in-critical-patients-with-acute-kidney-injury
#11
Ana Cláudia da Rosa Hise, Maria Cristina Gonzalez
BACKGROUND & AIMS: The state of hyperhydration in critically ill patients with acute kidney injury (AKI) is associated with increased mortality. Bioelectrical impedance vector analysis (BIVA) appears to be a viable method to access the fluid status of critical patients but has never been evaluated in critical patients with AKI. The objective of this study is to evaluate the hydration status measured using BIVA in critical patients under intensive care at the time of AKI diagnosis and to correlate this measurement with mortality...
February 21, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28265323/bladder-and-bowel-dysfunction-in-children-an-update-on-the-diagnosis-and-treatment-of-a-common-but-underdiagnosed-pediatric-problem
#12
REVIEW
Joana Dos Santos, Roberto I Lopes, Martin A Koyle
Bladder and bowel dysfunction (BBD) describes a spectrum of lower urinary symptoms (LUTS) accompanied by fecal elimination issues that manifest primarily by constipation and/or encopresis. This increasingly common entity is a potential cause of significant physical and psychosocial burden for children and families. BBD is commonly associated with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTIs), which at its extreme may lead to renal scarring and kidney failure. Additionally, BBD is frequently seen in children diagnosed with behavioural and neuropsychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD)...
January 2017: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
https://www.readbyqxmd.com/read/28259855/restrictive-versus-liberal-fluid-therapy-in-major-abdominal-surgery-relief-rationale-and-design-for-a-multicentre-randomised-trial
#13
Paul Myles, Rinaldo Bellomo, Tomas Corcoran, Andrew Forbes, Sophie Wallace, Philip Peyton, Chris Christophi, David Story, Kate Leslie, Jonathan Serpell, Shay McGuinness, Rachel Parke
INTRODUCTION: The optimal intravenous fluid regimen for patients undergoing major abdominal surgery is unclear. However, results from many small studies suggest a restrictive regimen may lead to better outcomes. A large, definitive clinical trial evaluating perioperative fluid replacement in major abdominal surgery, therefore, is required. METHODS/ANALYSIS: We designed a pragmatic, multicentre, randomised, controlled trial (the RELIEF trial). A total of 3000 patients were enrolled in this study and randomly allocated to a restrictive or liberal fluid regimen in a 1:1 ratio, stratified by centre and planned critical care admission...
March 3, 2017: BMJ Open
https://www.readbyqxmd.com/read/28246141/vasopressor-use-following-traumatic-injury-protocol-for-a-systematic-review
#14
Mathieu Hylands, Augustin Toma, Nicolas Beaudoin, Anne-Julie Frenette, Frederick D'Aragon, Emilie Belley-Côté, Morten Hylander, François Lauzier, Reed Alexander Siemieniuk, Emmanuel Charbonney, Joey Kwong, Jon Henrik Laake, Gordon Guyatt, Per Olav Vandvik, Bram Rochwerg, Robert Green, Ian Ball, Damon Scales, Srinivas Murthy, Sandro Rizoli, Pierre Asfar, François Lamontagne
INTRODUCTION: Worldwide, traumatic casualties are projected to exceed 8 million by year 2020. Haemorrhagic shock and brain injury are the leading causes of death following trauma. While intravenous fluids have traditionally been used to support organ perfusion in the setting of haemorrhage, recent investigations have suggested that restricting fluid therapy by tolerating more severe hypotension may improve survival. However, the safety of permissive hypotension remains uncertain, particularly among patients who have suffered a traumatic brain injury...
February 28, 2017: BMJ Open
https://www.readbyqxmd.com/read/28213648/-state-of-the-art-in-fluid-and-volume-therapy-a%C3%A2-user-friendly-staged-concept
#15
REVIEW
M Rehm, N Hulde, T Kammerer, A S Meidert, K Hofmann-Kiefer
Adequate fluid therapy is highly important for the perioperative outcome of our patients. Both, hypovolemia and hypervolemia can lead to an increase in perioperative complications and can impair the outcome. Therefore, perioperative infusion therapy should be target-oriented. The main target is to maintain the patient's preoperative normovolemia by using a sophisticated, rational infusion strategy.Perioperative fluid losses should be discriminated from volume losses (surgical blood loss or interstitial volume losses containing protein)...
March 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28212219/drug-infusion-systems-technologies-performance-and-pitfalls
#16
Uoo R Kim, Robert A Peterfreund, Mark A Lovich
This review aims to broadly describe drug infusion technologies and raise subtle but important issues arising from infusion therapy that can potentially lead to patient instability and morbidity. Advantages and disadvantages of gravity-dependent drug infusion are described and compared with electromechanical approaches for precise control of medication infusion, including large-volume peristaltic and syringe pumps. This review discusses how drugs and inert carriers interact within infusion systems and outlines several complexities and potential sources of drug error...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28168706/flow-field-simulations-and-hemolysis-estimates-for-the-food-and-drug-administration-critical-path-initiative-centrifugal-blood-pump
#17
Margaret L Heck, Allen Yen, Trevor A Snyder, Edgar A O'Rear, Dimitrios V Papavassiliou
The design of blood pumps for use in ventricular assist devices, which provide life-saving circulatory support in patients with heart failure, require remarkable precision and attention to detail to replicate the functionality of the native heart. The United States Food and Drug Administration (FDA) initiated a Critical Path Initiative to standardize and facilitate the use of computational fluid dynamics in the study and development of these devices. As a part of the study, a simplified centrifugal blood pump model generated by computer-aided design was released to universities and laboratories nationwide...
February 7, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28153190/acute-pd-evidence-guidelines-and-controversies-%C3%A2
#18
REVIEW
Daniela Ponce, Andre Balbi, Brett Cullis
Peritoneal dialysis (PD) may be a feasible, safe, and complementary alternative to hemodialysis not only in the chronic setting, but also in the acute setting. It previously was widely accepted for acute kidney injury (AKI) treatment, but its practice decreased in favor of other types of extracorporeal therapies. The interest in PD to manage AKI patients has been reignited and PD now frequently is used in developing countries because of its lower cost and minimal infrastructural requirements. Studies from these countries have shown that, with careful thought and planning, critically ill patients can be treated successfully using PD...
January 2017: Seminars in Nephrology
https://www.readbyqxmd.com/read/28146331/plasma-exchange-in-the-intensive-care-unit-technical-aspects-and-complications
#19
Aurélie Lemaire, Nathalie Parquet, Lionel Galicier, David Boutboul, Rémi Bertinchamp, Marion Malphettes, Guillaume Dumas, Eric Mariotte, Marie-Noëlle Peraldi, Virginie Souppart, Benoit Schlemmer, Elie Azoulay, Emmanuel Canet
BACKGROUND: Data on plasma exchange therapy in the intensive care unit (ICU) setting are scarce. We aimed to describe the technical aspects and the adverse events associated with the procedure in critically ill patients. METHODS: All adult patients treated by plasma exchange in the medical ICU of the Saint-Louis university hospital between January 1, 2013 and March 31, 2015 were prospectively included. RESULTS: We report on 260 plasma exchange procedures performed in 50 patients...
February 1, 2017: Journal of Clinical Apheresis
https://www.readbyqxmd.com/read/28143505/fluid-overload-is-an-independent-risk-factor-for-acute-kidney-injury-in-critically-ill-patients-results-of-a-cohort-study
#20
Nawal Salahuddin, Mustafa Sammani, Ammar Hamdan, Mini Joseph, Yasir Al-Nemary, Rawan Alquaiz, Ranim Dahli, Khalid Maghrabi
BACKGROUND: Acute Kidney injury (AKI) is common and increases mortality in the intensive care unit (ICU). We carried out this study to explore whether fluid overload is an independent risk factor for AKI. METHODS: Single-center prospective, observational study. Consecutively admitted, ICU patients were followed for development of AKI. Intravenous fluid volumes, daily fluid balances were measured, hourly urine volumes, daily creatinine levels were recorded. RESULTS: Three hundred thirty nine patients were included; AKI developed in 141 (41...
February 1, 2017: BMC Nephrology
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