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Euvolemia

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https://www.readbyqxmd.com/read/29596477/using-support-vector-machines-on-photoplethysmographic-signals-to-discriminate-between-hypovolemia-and-euvolemia
#1
Natasa Reljin, Gary Zimmer, Yelena Malyuta, Kirk Shelley, Yitzhak Mendelson, David J Blehar, Chad E Darling, Ki H Chon
Identifying trauma patients at risk of imminent hemorrhagic shock is a challenging task in intraoperative and battlefield settings given the variability of traditional vital signs, such as heart rate and blood pressure, and their inability to detect blood loss at an early stage. To this end, we acquired N = 58 photoplethysmographic (PPG) recordings from both trauma patients with suspected hemorrhage admitted to the hospital, and healthy volunteers subjected to blood withdrawal of 0.9 L. We propose four features to characterize each recording: goodness of fit (r2), the slope of the trend line, percentage change, and the absolute change between amplitude estimates in the heart rate frequency range at the first and last time points...
2018: PloS One
https://www.readbyqxmd.com/read/29594317/-prevention-of-acute-kidney-injury-in-critically-ill-patients-recommendations-from-the-renal-section-of-the-dgiin-%C3%A3-giain-and-divi
#2
REVIEW
M Joannidis, S J Klein, S John, M Schmitz, D Czock, W Druml, A Jörres, D Kindgen-Milles, J T Kielstein, M Oppert, V Schwenger, C Willam, A Zarbock
BACKGROUND: Acute kidney injury (AKI) has both high mortality and morbidity. OBJECTIVES: To prevent the occurrence of AKI, current recommendations from the renal section of the DGIIN (Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin), ÖGIAIN (Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin) and DIVI (Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin) are stated...
March 28, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29546600/focus-on-neonatal-and-infantile-onset-of-nephrogenic-syndrome-of-inappropriate-antidiuresis-12-years-later
#3
REVIEW
Flaminia Bardanzellu, Maria Cristina Pintus, Valentina Masile, Vassilios Fanos, Maria Antonietta Marcialis
Nephrogenic syndrome of inappropriate antidiuresis (NSIAD), first described in 2005, is a rare genetic X-linked disease, presenting with hyponatremia, hyposmolarity, euvolemia, inappropriately concentrated urine, increased natriuresis, and undetectable or very low arginine-vasopressine (AVP) circulating levels. It can occur in neonates, infants, or later in life. NSIAD must be early recognized and treated to prevent severe hyponatremia, which can show a dangerous impact on neonatal outcome. In fact, it potentially leads to death or, in case of survival, neurologic sequelae...
March 15, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/29483138/mechanisms-clinical-implications-and-treatment-of-intradialytic-hypotension
#4
REVIEW
Patrick B Reeves, Finnian R Mc Causland
Individuals with ESKD requiring maintenance hemodialysis face a unique hemodynamic challenge, typically on a thrice-weekly basis. In an effort to achieve some degree of euvolemia, ultrafiltration goals often involve removal of the equivalent of an entire plasma volume. Maintenance of adequate end-organ perfusion in this setting is dependent on the institution of a variety of complex compensatory mechanisms. Unfortunately, secondary to a myriad of patient- and dialysis-related factors, this compensation often falls short and results in intradialytic hypotension...
February 26, 2018: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29406186/current-concepts-of-fluid-management-in-enhanced-recovery-pathways
#5
REVIEW
R Makaryus, T E Miller, T J Gan
Perioperative fluid management impacts outcomes and plays a pivotal role in enhanced recovery pathways (ERPs). There have been major advances in understanding the effects of fluid therapy and administration during the perioperative period. Improving fluid management during this period leads to a decrease in complications, decrease in length of stay (LOS), and enhanced patient outcomes. It is important to consider preoperative and postoperative fluid management to be just as critical as intraoperative management given multiple associated benefits to the patients...
February 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29398586/prospective-study-of-enhanced-recovery-after-surgery-protocol-in-children-undergoing-reconstructive-operations
#6
K O Rove, M A Brockel, A F Saltzman, M I Dönmez, K E Brodie, D J Chalmers, B T Caldwell, V M Vemulakonda, D T Wilcox
BACKGROUND: Enhanced recovery after surgery (ERAS) protocol is a set of peri-operative strategies to increase speed of recovery. ERAS is well established in adults but has not been well studied in children. OBJECTIVE: The purpose of the current study was to establish the safety and efficacy of an ERAS protocol in pediatric urology patients undergoing reconstructive operations. It was hypothesized that ERAS would reduce length of stay and decrease complications when compared with historical controls...
February 1, 2018: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/29366423/therapeutic-approach-to-patients-with-heart-failure-with-reduced-ejection-fraction-and-end-stage-renal-disease
#7
Chakradhari Inampudi, Paulino Alvarez, Rabea Asleh, Alexandros Briasoulis
BACKGROUND: Several risk factors including Ischemic heart disease, uncontrolled hypertension, high output Heart Failure (HF) from shunting through vascular hemodialysis access, and anemia, contribute to development of HF in patients with End-Stage Renal Disease (ESRD). Guidelinedirected medical and device therapy for Heart Failure with Reduced Ejection Fraction (HFrEF) has not been extensively studied and may have limited safety and efficacy in patients with ESRD. RESULTS: Maintenance of interdialytic and intradialytic euvolemia is a key component of HF management in these patients but often difficult to achieve...
March 14, 2018: Current Cardiology Reviews
https://www.readbyqxmd.com/read/29056238/value-of-routine-investigations-to-predict-loop-diuretic-down-titration-success-in-stable-heart-failure
#8
Pieter Martens, Frederik H Verbrugge, Levinia Boonen, Petra Nijst, Matthias Dupont, Wilfried Mullens
AIMS: Guidelines advocate down-titration of loop diuretics in chronic heart failure (CHF) when patients have no signs of volume overload. Limited data are available on the expected success rate of this practice or how routine diagnostic tests might help steering this process. METHODS AND RESULTS: Fifty ambulatory CHF-patients on stable neurohumoral blocker/diuretic therapy for at least 3months without any clinical sign of volume overload were prospectively included to undergo loop diuretic down-titration...
January 1, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/28958355/acute-management-of-traumatic-brain-injury
#9
REVIEW
Michael A Vella, Marie L Crandall, Mayur B Patel
Traumatic brain injury (TBI) is a leading cause of death and disability in patients with trauma. Management strategies must focus on preventing secondary injury by avoiding hypotension and hypoxia and maintaining appropriate cerebral perfusion pressure (CPP), which is a surrogate for cerebral blood flow. CPP can be maintained by increasing mean arterial pressure, decreasing intracranial pressure, or both. The goal should be euvolemia and avoidance of hypotension. Other factors that deserve important consideration in the acute management of patients with TBI are venous thromboembolism, stress ulcer, and seizure prophylaxis, as well as nutritional and metabolic optimization...
October 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28934895/high-early-fluid-input-after-aneurysmal-subarachnoid-hemorrhage-combined-report-of-association-with-delayed-cerebral-ischemia-and-feasibility-of-cardiac-output-guided-fluid-restriction
#10
Leonie J M Vergouw, Mohamud Egal, Bas Bergmans, Diederik W J Dippel, Hester F Lingsma, Mervyn D I Vergouwen, Peter W A Willems, Annemarie W Oldenbeuving, Jan Bakker, Mathieu van der Jagt
BACKGROUND: Guidelines on the management of aneurysmal subarachnoid hemorrhage (aSAH) recommend euvolemia, whereas hypervolemia may cause harm. We investigated whether high early fluid input is associated with delayed cerebral ischemia (DCI), and if fluid input can be safely decreased using transpulmonary thermodilution (TPT). METHODS: We retrospectively included aSAH patients treated at an academic intensive care unit (2007-2011; cohort 1) or managed with TPT (2011-2013; cohort 2)...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28887070/decreased-serum-sodium-levels-predict-symptomatic-vasospasm-in-patients-with-subarachnoid-hemorrhage
#11
Yoichi Uozumi, Takashi Mizobe, Hirohito Miyamoto, Noriaki Ashida, Tsuyoshi Katsube, Shotaro Tatsumi, Mitsugu Nakamura, Eiji Kohmura
BACKGROUND: Symptomatic vasospasm is a major cause of morbidity and mortality in subarachnoid hemorrhage patients. Hyponatremia and dehydration due to natriuresis after subarachnoid hemorrhage are related to symptomatic vasospasm. Therefore, most institutions are currently targeting euvolemia and eunatremia in subarachnoid hemorrhage patients to avoid complications. We retrospectively investigated the predictors of symptomatic vasospasm with respect to water and sodium homeostasis, while maintaining euvolemia and eunatremia after subarachnoid hemorrhage...
December 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28711449/intrarenal-flow-alterations-during-transition-from-euvolemia-to-intravascular-volume-expansion-in-heart-failure-patients
#12
Petra Nijst, Pieter Martens, Matthias Dupont, W H Wilson Tang, Wilfried Mullens
OBJECTIVES: The goal of this study was to assess: 1) the intrarenal flow in heart failure (HF) patients during the transition from euvolemia to intravascular volume overload; and 2) the relationship between intrarenal flow and diuretic efficiency. BACKGROUND: Intrarenal blood flow alterations may help to better understand impaired volume handling in HF. METHODS: Resistance index (RI) and venous impedance index (VII) were assessed in 6 healthy subjects, 40 euvolemic HF patients with reduced ejection fraction (HFrEF), and 10 HF patients with preserved ejection fraction (HFpEF)...
September 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28699323/intra-procedural-continuous-dialysis-to-facilitate-interventional-catheterization-in-pediatric-patients-with-severe-renal-failure
#13
Angeline D Opina, Athar M Qureshi, Eileen Brewer, Ewa Elenberg, Sarah Swartz, Mini Michael, Henri Justino
BACKGROUND: Interventional catheterization procedures may be needed for patients with severe renal failure who are dependent on dialysis. To avoid the risk of fluid overload and electrolyte derangement during complex procedures in this oliguric/anuric patient population, we performed intra-procedural dialysis, either continuous renal replacement therapy (CRRT) or continous cycling peritoneal dialysis (CCPD). METHODS: We performed a retrospective review of a cohort of pediatric patients, ages 0-18 years, with dialysis-dependent renal failure who received CRRT or CCPD during catheterization procedures from January 2013 to March 2016...
July 12, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28631764/-hemodynamic-effects-of-positive-end-expiratory-pressure
#14
REVIEW
Marco Marini, Giorgio Caretta, Fabio Vagnarelli, Fabiana Lucà, Emilia Biscottini, Alberto Lavorgna, Vincenza Procaccini, Letizia Riva, Gabriele Vianello, Nadia Aspromonte, Andrea Mortara, Renata De Maria, Piera Capasso, Serafina Valente, Michele Massimo Gulizia
The application of a positive end-expiratory pressure (PEEP), the cornerstone of noninvasive ventilation (NIV), causes hemodynamic changes in the cardiovascular system. To understand the benefits of NIV it is necessary to resume concepts of cardiovascular physiology and pathophysiology about cardiac function determinants, venous return, ventricular interdependence and heart-lung interaction, and to understand how PEEP interacts with them. The hemodynamic effects of PEEP are mediated by the increase in transpulmonary pressure, which results in increased pulmonary vascular resistance and in an attending small reduction of venous return in conditions of euvolemia, in a substantial reduction of left ventricular afterload and a potential positive effect on left ventricular stroke volume...
June 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28581677/interplay-of-volume-blood-pressure-organ-ischemia-residual-renal-function-and-diet-certainties-and-uncertainties-with-dialytic-management
#15
REVIEW
Ercan Ok, Nathan W Levin, Gulay Asci, Charles Chazot, Huseyin Toz, Mehmet Ozkahya
Extracellular fluid volume overload and its inevitable consequence, hypertension, increases cardiovascular mortality in the long term by leading to left ventricular hypertrophy, heart failure, and ischemic heart disease in dialysis patients. Unlike antihypertensive medications, a strict volume control strategy provides optimal blood pressure control without need for antihypertensive drugs. However, utilization of this strategy has remained limited because of several factors, including the absence of a gold standard method to assess volume status, difficulties in reducing extracellular fluid volume, and safety concerns associated with reduction of extracellular volume...
September 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28550170/right-atrial-pressure-and-venous-return-during-cardiopulmonary-bypass
#16
Per W Moller, Bernhard Winkler, Samuel Hurni, Paul Philipp Heinisch, Andreas Bloch, Soren Sondergaard, Stephan M Jakob, Jukka Takala, David Berger
The relevance of right atrial pressure (RAP) as the backpressure for venous return (QVR ) and mean systemic filling pressure as upstream pressure is controversial during dynamic changes of circulation. To examine the immediate response of QVR (sum of caval vein flows) to changes in RAP and pump function, we used a closed-chest, central cannulation, heart bypass porcine preparation ( n = 10) with venoarterial extracorporeal membrane oxygenation. Mean systemic filling pressure was determined by clamping extracorporeal membrane oxygenation tubing with open or closed arteriovenous shunt at euvolemia, volume expansion (9...
August 1, 2017: American Journal of Physiology. Heart and Circulatory Physiology
https://www.readbyqxmd.com/read/28515029/tolvaptan-treatment-in-children-with-chronic-hyponatremia-due-to-inappropriate-antidiuretic-hormone-secretion-a-report-of-three-cases
#17
Gerdi Tuli, Daniele Tessaris, Silvia Einaudi, Luisa De Sanctis, Patrizia Matarazzo
Hyponatremia is the most common electrolyte disorder among hospitalized patients and it is sometimes considered as a poor outcome predictor. Its correction is thus indicated, even in asymptomatic patients. The conventional treatment consists of fluid restriction in presence of euvolemia or hypervolemia; loop diuretics are used in some hypervolemic conditions such as cardiac heart failure, liver cirrhosis and nephrotic syndrome, while intravenous isotonic or hypertonic solutions are administered in hypovolemic conditions...
September 1, 2017: Journal of Clinical Research in Pediatric Endocrinology
https://www.readbyqxmd.com/read/28437375/both-positive-and-negative-fluid-balance-may-be-associated-with-reduced-long-term-survival-in-the-critically-ill
#18
MULTICENTER STUDY
Vikram Balakumar, Raghavan Murugan, Florentina E Sileanu, Paul Palevsky, Gilles Clermont, John A Kellum
OBJECTIVES: Among critically ill patients with acute kidney injury, exposure to positive fluid balance, compared with negative fluid balance, has been associated with mortality and impaired renal recovery. However, it is unclear whether positive and negative fluid balances are associated with poor outcome compared to patients with even fluid balance (euvolemia). In this study, we examined the association between exposure to positive or negative fluid balance, compared with even fluid balance, on 1-year mortality and renal recovery...
August 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28352009/validation-of-bioelectrical-impedance-analysis-for-assessing-dry-weight-of-dialysis-patients-in-pakistan
#19
Huma Asmat, Romaina Iqbal, Fatima Sharif, Aamer Mahmood, Aamir Abbas, Waqar Kashif
Accurate dry weight estimation (DW) to achieve euvolemia is one of the key objectives of hemodialysis (HD). While conventionally DW is estimated by clinical examination, bioelectrical impedance analysis (BIA) has been proposed as an objective method to determine DW and has been tested extensively in the Western population. We aim to validate BIA for determining DW in a Pakistani population against the conventional clinician's method. This is a single-center validation study conducted at two outpatient HD units of Aga Khan Hospital, Karachi...
March 2017: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/28226325/lung-ultrasound-in-hemodialysis-a-card-to-be-played
#20
REVIEW
Pierpaolo Di Nicolò, Giacomo Magnoni, Antonio Granata
The end-stage renal disease is characterized by a profound impairment in the regulation of body fluid distribution, and volume assessment in hemodialysis is one of the challenging goals for the nephrologist. To determine a state of euvolemia, different validated techniques have been employed and among them lung ultrasonography (LUS) has recently attracted growing attention on account of its capacity to estimate accurately extra vascular lung water and to detect lung edema even in its early asymptomatic stage, that is, hidden lung congestion...
2017: Blood Purification
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