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volume resuscitation

Bijan S Kheirabadi, Nahir Miranda, Irasema B Terrazas, Mary D Gonzales, Rose C Grimm, Michael A Dubick
INTRODUCTION: Prehospital, small-volume resuscitation of combat casualties with a synthetic colloid [6% hydroxyethyl starch (HES) 670/0.75] has been recommended when blood or blood components are unavailable. We studied hemostatic effects of a newer synthetic colloid (6% HES 130/0.4,) compared to either a natural colloid (albumin) or to crystalloids in an uncontrolled hemorrhage model. METHODS: Spontaneously breathing NZW rabbits (3.4±0.1 kg) were anesthetized, instrumented and subjected to a splenic injury with uncontrolled bleeding...
October 25, 2016: Journal of Trauma and Acute Care Surgery
Louis J Imbriano, Joseph Mattana, James Drakakis, John K Maesaka
BACKGROUND: There is controversy over the prevalence of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral or renal salt wasting (RSW), 2 syndromes with identical common clinical and laboratory parameters but different therapies. The traditional approach to the hyponatremic patient relies on volume assessment, but there are limitations to this method. METHODS: We used an algorithm that relies on fractional excretion of urate (FEurate) to evaluate patients with hyponatremia and present 4 illustrative cases...
October 2016: American Journal of the Medical Sciences
Jiangquan Yu, Ruiqiang Zheng, Hua Lin, Qihong Chen, Jun Shao, Daxin Wang
PURPOSE: This study aimed to investigate the clinical effects of early goal-directed therapy according to the global end-diastolic volume index (GEDI) on chronic obstructive pulmonary disease (COPD) patients with septic shock. METHODS: A total of 71 COPD patients with septic shock were randomly assigned to 2 groups. In the control group (n = 37), fluid resuscitation was performed based on the central venous pressure. In the study group (n = 34), fluid resuscitation was performed until GEDI reached 800 mL/m(2)...
October 8, 2016: American Journal of Emergency Medicine
Nehemiah T Liu, José Salinas, Craig A Fenrich, Maria L Serio-Melvin, George C Kramer, Ian R Driscoll, Martin A Schreiber, Leopoldo C Cancio, Kevin K Chung
INTRODUCTION: The depth of burn has been an important factor often overlooked when estimating the total resuscitation fluid needed for early burn care. The goal of this study was to determine the degree to which full-thickness (FT) involvement affected overall 24-hour burn resuscitation volumes. METHODS: We performed a retrospective review of patients admitted to our burn intensive care unit from December 2007 to April 2013, with significant burns that required resuscitation using our computerized decision support system for burn fluid resuscitation...
November 2016: Journal of Trauma and Acute Care Surgery
Jie Zhao, Guolin Wang
BACKGROUND This study aimed to investigate the relationship between the inferior vena cava respirophasic variation (IVC collapsibility index [IVCCI]) and the general heart end-diastolic volume index (GEDVI). By determining the above relationship, we could evaluate the utility of IVCCI as an indicator. MATERIAL AND METHODS Forty-two septic patients were finally enrolled in this study. The inferior vena cava's diameter was measured with the largest at the end of expiration (IVC3) and with the smallest at the end of inspiration (IVCi) on the ultrasound (IVCCI=[(IVCD e - IVCD i)/IVCD e] ×100%)...
October 20, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Lukasz Szarpak, Zenon Truszewski, Lukasz Czyzewski, Michael Frass, Oliver Robak
INTRODUCTION: European Resuscitation Council as well as American Heart Association guidelines for cardiopulmonary resuscitation (CPR) stress the importance of uninterrupted and effective chest compressions (CCs). Manual CPR decreases in quality of CCs over time because of fatigue which impacts outcome. We report the first study with the Lifeline ARM automated CC device for providing uninterrupted CCs. METHODS: Seventy-eight paramedics participated in this randomized, crossover, manikin trial...
October 7, 2016: American Journal of Emergency Medicine
Anuj B Mehta, Colin R Cooke, Ivor S Douglas, Peter K Lindenauer, Renda Soylemez Wiener, Allan J Walkey
RATIONALE: In the United States, approximately 20% of patients hospitalized with pneumonia are readmitted to a hospital within 30 days. Given the significant costs and healthcare system utilization due to unplanned readmissions, pneumonia readmission rates are a target of national quality measures. Patient do-not-resuscitate (DNR) status strongly influences hospital pneumonia mortality measures; however, associations between DNR status and 30-day readmissions following pneumonia are unclear...
October 18, 2016: Annals of the American Thoracic Society
Mun Ki Min, Seok Ran Yeom, Ji Ho Ryu, Yong In Kim, Maeng Real Park, Sang Kyoon Han, Seong Hwa Lee, Sung Wook Park, Soon Chang Park
OBJECTIVE: We compared training using a voice advisory manikin (VAM) with an instructor-led (IL) course in terms of acquisition of initial cardiopulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and distributed them randomly into two groups: the IL group (n=41) and the VAM group (n=37)...
September 2016: Clin Exp Emerg Med
Scott C Watkins, Andrew D Shaw
PURPOSE OF REVIEW: The past decade has seen more advances in our understanding of fluid therapy than the preceding decades combined. What was once thought to be a relatively benign panacea is increasingly being recognized as a potent pharmacological and physiological intervention that may pose as much harm as benefit. RECENT FINDINGS: Recent studies have clearly indicated that the amount, type, and timing of fluid administration have profound effects on patient morbidity and outcomes...
September 29, 2016: Current Opinion in Critical Care
Alexander K Leung, Shawn D Whatley, Dechang Gao, Marko Duic
OBJECTIVE: To study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures. METHODS: This was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage...
October 17, 2016: CJEM
Lori A Stolz, Uwe Stolz, J Matthew Fields, Turandot Saul, Michael Secko, Matthew J Flannigan, Johnathan M Sheele, Robert P Rifenburg, Anthony J Weekes, Elaine B Josephson, John Bedolla, Dana M Resop, Jonathan Dela Cruz, Megan Boysen-Osborn, Terrell Caffery, Charlotte Derr, Rimon Bengiamin, Gerardo Chiricolo, Brandon Backlund, Jagdipak Heer, Robert J Hyde, Srikar Adhikari
OBJECTIVES: Emergency ultrasound (EUS) has been recognized as integral to the training and practice of emergency medicine (EM). The Council of Emergency Medicine Residency-Academy of Emergency Ultrasound (CORD-AEUS) consensus document provides guidelines for resident assessment and progression. The Accredited Council for Graduate Medical Education (ACGME) has adopted the EM Milestones for assessment of residents' progress during their residency training which includes demonstration of procedural competency in bedside ultrasound...
October 14, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Kambiz Masoumi, Arash Forouzan, Ali Asgari Darian, Alireza Rafaty Navaii
BACKGROUND: Appropriate fluid therapy affects morbidity and mortality rates. A conclusion is yet to be reached on the role of crystalloids and colloids in immediate fluid therapy. This study was done to determine the suitable solution in immediate resuscitation of patients with hemorrhagic shock caused by tissue trauma. METHODS: One hundred trauma patients with hemorrhagic shock, who underwent fluid therapy in the emergency unit, were assigned randomly to two groups of hydroxyethyl starch (Voluven) and normal saline...
November 2016: Journal of Clinical Medicine Research
Camila Chaves Viana, Carla Marques Nicolau, Regina Celia Turola Passos Juliani, Werther Brunow de Carvalho, Vera Lucia Jornada Krebs
OBJECTIVE: To assess the effects of manual hyperinflation, performed with a manual resuscitator with and without the positive end-expiratory pressure valve, on the respiratory function of preterm newborns under mechanical ventilation. METHODS: Cross-sectional study of hemodynamically stable preterm newborns with gestational age of less than 32 weeks, under mechanical ventilation and dependent on it at 28 days of life. Manual hyperinflation was applied randomly, alternating the use or not of the positive end-expiratory pressure valve, followed by tracheal aspiration for ending the maneuver...
September 2016: Revista Brasileira de Terapia Intensiva
J N Seheult, D J Triulzi, L H Alarcon, J L Sperry, A Murdock, M H Yazer
BACKGROUND/OBJECTIVES: The safety of administering uncrossmatched, group O, cold-stored, whole blood (cWB) during civilian trauma resuscitation was evaluated. METHODS/MATERIALS: Male trauma patients with haemorrhage-induced hypotension who received leuko-reduced uncrossmatched group O+, low titer (<50) anti-A and -B, platelet-replete cWB during initial resuscitation were included. The biochemical markers of haemolysis (lactate dehydrogenase, total bilirubin, haptoglobin, creatinine, serum potassium) were measured on the day of cWB receipt (day 0), and over the next 2 days, reports of transfusion reactions and total blood product administration in first 24 h of admission were recorded...
October 12, 2016: Transfusion Medicine
Da-Xiong Zeng
We read the article by Chung and colleagues with great interest [1]. The authors showed that elevated mean platelets volume (MPV) at admission was associated with poor neurological outcomes and mortality at 30 days. MPV levels might be a critical prognostic marker among resuscitated patients. It is an attractive result, but we have some minor criticisms about the study. This article is protected by copyright. All rights reserved.
October 11, 2016: Journal of Thrombosis and Haemostasis: JTH
Dawid L Staudacher, Wolfgang Gold, Paul M Biever, Christoph Bode, Tobias Wengenmayer
PURPOSE: For circulatory support, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is dependent on sufficient venous drainage ensured by fluid therapy. Volume overload however is linked to poor prognosis. This study therefore evaluates volume therapy in VA-ECMO. MATERIAL AND METHODS: We report data of a single center registry of all patients after VA-ECMO implantation treated between 2010 and 2015. RESULTS: A total of 195 patients were included in this registry with a medium age of 58...
September 27, 2016: Journal of Critical Care
Takeshi Umegaki, Takeo Uba, Chisato Sumi, Sachiyo Sakamoto, Sachiko Jomura, Kiichi Hirota, Koh Shingu
BACKGROUND: Previous studies reported a higher mortality risk and a greater need for renal replacement therapy in patients administered hydroxyethyl starch (HES) rather than other fluid resuscitation preparations. In this study, we investigated the association between 6% HES 70/0.5 use and postoperative acute kidney injury (AKI) in gastroenterological surgery patients. METHODS: We conducted retrospective full-cohort and propensity-score-based analyses of patients who underwent gastroenterological surgery between June 2011 and August 2013 in a Japanese university hospital...
October 2016: Korean Journal of Anesthesiology
Peter B Hjortrup, Nicolai Haase, Helle Bundgaard, Simon L Thomsen, Robert Winding, Ville Pettilä, Anne Aaen, David Lodahl, Rasmus E Berthelsen, Henrik Christensen, Martin B Madsen, Per Winkel, Jørn Wetterslev, Anders Perner
PURPOSE: We assessed the effects of a protocol restricting resuscitation fluid vs. a standard care protocol after initial resuscitation in intensive care unit (ICU) patients with septic shock. METHODS: We randomised 151 adult patients with septic shock who had received initial fluid resuscitation in nine Scandinavian ICUs. In the fluid restriction group fluid boluses were permitted only if signs of severe hypoperfusion occurred, while in the standard care group fluid boluses were permitted as long as circulation continued to improve...
September 30, 2016: Intensive Care Medicine
Hendry Robert Sawe, Cathryn Haeffele, Juma A Mfinanga, Victor G Mwafongo, Teri A Reynolds
BACKGROUND: Bedside inferior vena cava (IVC) ultrasound has been proposed as a non-invasive measure of volume status. We compared ultrasound measurements of the caval index (CI) and physician gestalt to predict blood pressure response in patients requiring intravenous fluid resuscitation. METHODS: This was a prospective study of adult emergency department patients requiring fluid resuscitation. A structured data sheet was used to record serial vital signs and the treating clinician's impression of patient volume status and cause of hypotension...
2016: PloS One
Bulent Ergin, Philippe Guerci, Lara Zafrani, Frank Nocken, Asli Kandil, Ebru Gurel-Gurevin, Cihan Demirci-Tansel, Can Ince
BACKGROUND: Modulation of inflammation and oxidative stress appears to limit sepsis-induced damage in experimental models. The kidney is one of the most sensitive organs to injury during septic shock. In this study, we evaluated the effect of N-acetylcysteine (NAC) administration in conjunction with fluid resuscitation on renal oxygenation and function. We hypothesized that reducing inflammation would improve the microcirculatory oxygenation in the kidney and limit the onset of acute kidney injury (AKI)...
December 2016: Intensive Care Medicine Experimental
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