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Margaret Kathleen Menzel Ellis, Mitchell Brett Sally, Darren Malinoski
INTRODUCTION: Despite continuous advances in transplant medicine, there is a persistent worldwide shortage of organs available for donation. There is a growing body of research that supports that optimal management of deceased organ donors in Intensive Care Unit can substantially increase the availability of organs for transplant and improve outcomes in transplant recipients. METHODS: A systematic literature review was performed, comprising a comprehensive search of the PubMed database for relevant terms, as well as individual assessment of references included in large original investigations, and comprehensive society guidelines...
July 2016: Indian Journal of Urology: IJU: Journal of the Urological Society of India
Eleftheria Kalogera, Sean C Dowdy
A paucity of data exists regarding traditional perioperative practices (bowel preparation, NPO at midnight, liberal narcotics, PCA use, liberal fluids, prolonged bowel and bed rest). Enhanced Recovery after Surgery (ERAS) is an evidence-based approach to peri-operative care associated with improved outcomes including earlier return of gastrointestinal function, reduced opioid use, shorter hospital stay, and substantial cost reductions with stable complication and readmission rates. Basic principles include patient education, minimizing preoperative fasting, avoiding bowel preparation, preemptive analgesia, nausea/vomiting prophylaxis, perioperative euvolemia, no routine use of drain and nasogastric tubes, early mobilization, oral intake, and catheter removal, non-opioid analgesics, and preemptive laxatives...
September 2016: Obstetrics and Gynecology Clinics of North America
Jeremy S Dority, Jeffrey S Oldham
Subarachnoid hemorrhage (SAH) is a debilitating, although uncommon, type of stroke with high morbidity, mortality, and economic impact. Modern 30-day mortality is as high as 40%, and about 50% of survivors have permanent disability. Care at high-volume centers with dedicated neurointensive care units is recommended. Euvolemia, not hypervolemia, should be targeted, and the aneurysm should be secured early. Neither statin therapy nor magnesium infusions should be initiated for delayed cerebral ischemia. Cerebral vasospasm is just one component of delayed cerebral edema...
September 2016: Anesthesiology Clinics
Yusra Habib Khan, Azmi Sarriff, Azreen Syazril Adnan, Amer Hayat Khan, Tauqeer Hussain Mallhi
BACKGROUND: Despite promising role of diuretics to manage fluid overload among chronic kidney disease (CKD) patients, their use is associated with adverse renal outcomes. Current study aimed to determine the extent of renal deterioration with diuretic therapy. METHODS: A total 312 non-dialysis dependent CKD (NDD-CKD) patients were prospectively followed-up for one year. Fluid overload was assessed via bioimpedance spectroscopy. Estimated GFR (eGFR) was calculated from serum creatinine values by using Chronic Kidney Disease- Epidemiology Collaboration (CKD-EPI) equation...
2016: PloS One
David Berger, Per W Moller, Alberto Weber, Andreas Bloch, Stefan Bloechlinger, Matthias Haenggi, Soren Sondergaard, Stephan M Jakob, Sheldon Magder, Jukka Takala
According to Guyton's model of circulation, mean systemic filling pressure (MSFP), right atrial pressure (RAP), and resistance to venous return (RVR) determine venous return. MSFP has been estimated from inspiratory hold-induced changes in RAP and blood flow. We studied the effect of positive end-expiratory pressure (PEEP) and blood volume on venous return and MSFP in pigs. MSFP was measured by balloon occlusion of the right atrium (MSFPRAO), and the MSFP obtained via extrapolation of pressure-flow relationships with airway occlusion (MSFPinsp_hold) was extrapolated from RAP/pulmonary artery flow (QPA) relationships during inspiratory holds at PEEP 5 and 10 cmH2O, after bleeding, and in hypervolemia...
September 1, 2016: American Journal of Physiology. Heart and Circulatory Physiology
Yusra Habib Khan, Azmi Sarriff, Azreen Syazril Adnan, Amer Hayat Khan, Tauqeer Hussain Mallhi
INTRODUCTION: The relationship between hypertension and fluid overload in pre-dialysis CKD patients need to be elucidated. Current study aimed to find relationship between fluid overload and hypertension along with prescribed diuretic therapy using bioimpedance spectroscopy (BIS). METHODOLOGY: A prospective observational study was conducted by inviting pre-dialysis CKD patients. Fluid overload was assessed by BIS. RESULTS: A total of 312 CKD patients with mean eGFR 24...
July 11, 2016: Clinical and Experimental Nephrology
Mathieu van der Jagt
Maintenance fluids in critically ill brain-injured patients are part of routine critical care. Both the amounts of fluid volumes infused and the type and tonicity of maintenance fluids are relevant in understanding the impact of fluids on the pathophysiology of secondary brain injuries in these patients. In this narrative review, current evidence on routine fluid management of critically ill brain-injured patients and use of haemodynamic monitoring is summarized. Pertinent guidelines and consensus statements on fluid management for brain-injured patients are highlighted...
May 31, 2016: Critical Care: the Official Journal of the Critical Care Forum
Chikezie I Eseonu, Karim ReFaey, Romergryko G Geocadin, Alfredo Quinones-Hinojosa
PURPOSE: Cerebral vasospasm following a transsphenoidal resection of a pituitary adenoma is a devastating occurrence that can lead to delayed cerebral ischemia and poor neurologic outcome if not diagnosed and treated in a timely manner. The etiology of this condition is not well understood but can lead to significant arterial vasospasm that causes severe ischemic insults. In this paper, we identify common presenting symptoms and essential management strategies to treat this harmful disease...
August 2016: World Neurosurgery
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
Kyle M Hocking, Ban Sileshi, Franz J Baudenbacher, Richard B Boyer, Kelly L Kohorst, Colleen M Brophy, Susan S Eagle
BACKGROUND: Unrecognized hemorrhage and unguided resuscitation is associated with increased perioperative morbidity and mortality. The authors investigated peripheral venous waveform analysis (PIVA) as a method for quantitating hemorrhage as well as iatrogenic fluid overload during resuscitation. METHODS: The authors conducted a prospective study on Yorkshire Pigs (n = 8) undergoing hemorrhage, autologous blood return, and administration of balanced crystalloid solution beyond euvolemia...
October 2016: Shock
David A Ferenbach, Joseph V Bonventre
PURPOSE OF REVIEW: The kidney mediates the excretion or conservation of water and electrolytes in the face of changing fluid and salt intake and losses. To ultrafilter and reabsorb the exact quantities of free water and salts to maintain euvolemia a range of endocrine, paracrine, and hormonal signaling systems have evolved linking the tubules, capillaries, glomeruli, arterioles, and other intrinsic cells of the kidney. Our understanding of these systems remains incomplete. RECENT FINDINGS: Recent work has provided new insights into the workings of the communication pathways between tubular segments and the glomeruli and vasculature, with novel therapeutic agents in development...
May 2016: Current Opinion in Nephrology and Hypertension
Jose I Suarez
PURPOSE OF REVIEW: The purpose of this article is to present the epidemiology, clinical presentation, and management of patients with subarachnoid hemorrhage (SAH). SAH is a neurologic emergency that carries high morbidity and mortality. Patients with SAH are at risk for several significant neurologic complications, including hydrocephalus, cerebral edema, delayed cerebral ischemia, rebleeding, seizures, and neuroendocrine abnormalities that lead to impaired body regulation of sodium, water, and glucose...
October 2015: Continuum: Lifelong Learning in Neurology
Iva Bačak Kocman, Nikolina Bašić Jukić, Marija Topalović Grković, Mladen Perić
Anesthesia in patients with chronic kidney disease (CKD) represents a challenge for anesthesiologists and other specialists in the perioperative team. There is a high incidence of CKD among patients preoperatively, especially in elderly population. For anesthesiologists, it is an imperative to understand the pathophysiology of CKD, prevention of further kidney damage and its complications. This requires experienced anesthesiologist, careful preoperative patient assessment, recognition and modification of the potential risk factors in order to improve patient outcome...
April 2014: Acta Medica Croatica: C̆asopis Hravatske Akademije Medicinskih Znanosti
Aydin Unal, Feridun Kavuncuoglu, Mustafa Duran, Fatih Oguz, Ismail Kocyigit, Murat Hayri Sipahioglu, Bulent Tokgoz, Oktay Oymak
AIM: The aim of this study is to investigate whether there is a relationship between inflammation and volume status in patients underwent peritoneal dialysis (PD). PATIENTS AND METHOD: This cross-sectional study included 159 PD patients. The median duration of PD was 17 (range, 1-151) months. All patients were examined using bioelectrical impedance analysis to estimate the ratio of extracellular water to total body water (ECW/TBW), which was used to assess their volume status...
July 2015: Renal Failure
Jade E Basaraba, Arden R Barry
Heart failure with preserved ejection fraction (HFpEF) constitutes ~50% of all heart failure diagnoses and is associated with considerable morbidity and mortality. The treatment of HFpEF can be challenging due to a lack of evidence supporting the benefit of various drug therapies. In practice, treatment can be divided into acute and chronic management. Acute therapy for decompensated heart failure is similar for both HFpEF and heart failure with reduced ejection fraction. The mainstay of treatment is diuretics to reduce volume overload and improve dyspnea...
April 2015: Pharmacotherapy
Michael M Braun, Craig H Barstow, Natasha J Pyzocha
Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Sodium disorders are associated with an increased risk of morbidity and mortality. Plasma osmolality plays a critical role in the pathophysiology and treatment of sodium disorders. Hyponatremia and hypernatremia are classified based on volume status (hypovolemia, euvolemia, and hypervolemia). Sodium disorders are diagnosed by findings from the history, physical examination, laboratory studies, and evaluation of volume status...
March 1, 2015: American Family Physician
Joseph C Serrone, Hidetsugu Maekawa, Mardjono Tjahjadi, Juha Hernesniemi
Aneurysmal subarachnoid hemorrhage is the most devastating form of stroke. Many pathological mechanisms ensue after cerebral aneurysm rupture, including hydrocephalus, apoptosis of endothelial cells and neurons, cerebral edema, loss of blood-brain barrier, abnormal cerebral autoregulation, microthrombosis, cortical spreading depolarization and macrovascular vasospasm. Although studied extensively through experimental and clinical trials, current treatment guidelines to prevent delayed cerebral ischemia is limited to oral nimodipine, maintenance of euvolemia, induction of hypertension if ischemic signs occur and endovascular therapy for patients with continued ischemia after induced hypertension...
April 2015: Expert Review of Neurotherapeutics
Balaji Krishnan, Margarita Patarroyo-Aponte, Daniel Duprez, Marc Pritzker, Emil Missov, David G Benditt
BACKGROUND: The pathophysiology of orthostatic hypotension (OH) is multifactorial, with the most frequent causes being adverse effects of cardioactive drugs. In 20%-40% of cases, the etiology is unknown. In recent reports, altered levels of endogenous neuropeptides have been observed in noncardiac syncope, but B-type natriuretic peptide (BNP) and its amino-terminal cleavage fragment (NT-proBNP) have not been studied. OBJECTIVE: The purpose of this study was to assess the possibility that BNP with its diuretic and vasorelaxant properties could contribute to OH...
June 2015: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Debasish Ghosh, Kenneth M Williams, Garry G Graham, Priya Nair, Hergen Buscher, Richard O Day
INTRODUCTION: Aspirin overdose, though now infrequently encountered, nevertheless continues to contribute to significant morbidity and mortality. The patient described in this case report intentionally ingested overdoses of aspirin on repeated occasions. The case provided an unusual and possibly one-of-a-kind opportunity to focus on the variability in the time course of plasma salicylate concentrations with current treatment modalities of aspirin overdose in an individual patient. CASE PRESENTATION: A 75-year-old Caucasian man who weighed 45 kg and had an extensive history of various drug overdoses and stage 3 chronic kidney disease presented to a tertiary university hospital on three occasions within 2 months after successive overdoses of aspirin...
2014: Journal of Medical Case Reports
Timothy E Miller, Anthony M Roche, Michael Mythen
Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state...
February 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
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