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https://www.readbyqxmd.com/read/29779129/practical-impact-of-a-decision-support-for-goal-directed-fluid-therapy-on-protocol-adherence-a-clinical-implementation-study-in-patients-undergoing-major-abdominal-surgery
#1
Alexandre Joosten, Reda Hafiane, Marco Pustetto, Luc Van Obbergh, Thierry Quackels, Alexis Buggenhout, Jean-Louis Vincent, Brigitte Ickx, Joseph Rinehart
The purpose of this study was to assess the effects of using a real time clinical decision-support system, "Assisted Fluid Management" (AFM), to guide goal-directed fluid therapy (GDFT) during major abdominal surgery. We compared a group of patients managed using the AFM system with a historical cohort of patients (control group) who had been managed using a manual GDFT strategy. Adherence to the protocol was defined as the relative intraoperative time spent with a stroke volume variation (SVV) < 13%...
May 19, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29778750/our-modified-technique-of-combined-antegrade-vein-graft-cardioplegia-infusion-versus-conventional-antegrade-method-in-coronary-artery-bypass-grafting-a-randomized-clinical-trial
#2
Mehrzad Sharifi, Seyed Reza Mousavi, Mohammad Rafiei
BACKGROUND: To determine the efficacy of antegrade cardioplegia supplemented with venous graft perfusion in patients scheduled for coronary artery bypass grafting (CABG). METHODS: 223 consecutive patients scheduled for isolated CABG were randomized to receive either continuous crystalloid cardioplegia via vein grafts on completion of each distal anastomosis plus intermittent blood cardioplegia through aortic root (group 1, n = 110) or antegrade blood cardioplegia alone (group 2, n = 113)...
May 17, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29773240/perioperative-risk-factors-that-predict-complications-of-radial-forearm-free-flaps-in-oral-and-maxillofacial-reconstruction
#3
C Wang, G Fu, F Liu, L Liu, M Cao
The aim of the study was to find out what perioperative risk factors predicted complications in patients having reconstructions with radial forearm free flaps (RFFF). We organised a retrospective study of 169 patients (mean (range) age 54 (22-86) years, 100 of whom were female) who had oral and maxillofacial tumours resected, and reconstructed with RFFF, from January 2011-December 2016. We recorded predictive variables, subdivided into: personal and clinical (sex, age, weight, coexisting conditions, history of smoking, radiotherapy, and primary lesions); haemodynamic (perioperative concentrations of haemoglobin and albumin, blood loss, blood transfusion, urinary output (ml), and rate (ml/kg/hour), and infusion rates for crystalloids and colloids (ml/kg/hour, and volumes given intraoperatively and postoperatively for 24hours); and anaesthetic and surgical (American Society of Anesthesiologists(ASA) grade, visual analogue pain score (VAS), and duration of tourniquet and operation)...
May 14, 2018: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/29765455/ringer-s-lactate-solution-enhances-the-inflammatory-response-during-fluid-resuscitation-of-experimentally-induced-haemorrhagic-shock-in-rats
#4
Krzysztof Kusza, Mariusz Mielniczuk, Lukasz Krokowicz, Jacek B Cywiński, Maria Siemionow
Introduction: Hemorrhagic shock leads to systemic oxygen deficit (hypoxaemia) that results in systemic inflammatory response syndrome (SIRS), a recognised cause of late mortality in this case. The aim of this study was to analyse the impact of fluid resuscitation, using two Ringer solutions, on the microcirculation changes that take place during experimentally induced haemorrhagic shock. Material and methods: A model of the rat cremaster muscle was used to assess microcirculation in vivo ...
April 2018: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/29757400/predicting-the-ability-of-wounds-to-heal-given-any-burn-size-and-fluid-volume-an-analytical-approach
#5
Nehemiah T Liu, Julie A Rizzo, Beth A Shields, Maria L Serio-Melvin, Robert J Christy, José Salinas
Introduction: The intrinsic relationship between fluid volume and open wound size (%) has not been previously examined. Therefore, we conducted this study to 1) investigate whether open wound size can be predicted from fluid volume plus other significant factors over time and 2) evaluate how machine learning may perform in predicting open wound size. Methods: This retrospective study involved patients with at least 20% TBSA burned. Various predictive models were developed and compared using goodness-of-fit statistics (R2, error [MAE, RMSE])...
May 11, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/29753517/liberal-versus-restrictive-intravenous-fluid-therapy-for-early-septic-shock-rationale-for-a-randomized-trial
#6
Wesley H Self, Matthew W Semler, Rinaldo Bellomo, Samuel M Brown, Bennett P deBoisblanc, Matthew C Exline, Adit A Ginde, Colin K Grissom, David R Janz, Alan E Jones, Kathleen D Liu, Stephen P J Macdonald, Chadwick D Miller, Pauline K Park, Lora A Reineck, Todd W Rice, Jay S Steingrub, Daniel Talmor, Donald M Yealy, Ivor S Douglas, Nathan I Shapiro
Prompt intravenous fluid therapy is a fundamental treatment for patients with septic shock. However, the optimal approach for administering intravenous fluid in septic shock resuscitation is unknown. Two competing strategies are emerging: a liberal fluids approach, consisting of a larger volume of initial fluid (50 to 75 mL/kg [4 to 6 L in an 80-kg adult] during the first 6 hours) and later use of vasopressors, versus a restrictive fluids approach, consisting of a smaller volume of initial fluid (≤30 mL/kg [≤2 to 3 L]), with earlier reliance on vasopressor infusions to maintain blood pressure and perfusion...
May 9, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29752928/predicting-postoperative-day-1-hematocrit-levels-after-hysterectomy
#7
Sara H Rahman, Sarah Mayer, Katie Corcoran, Allan Mayer, Jonathan Shepherd
BACKGROUND: Swenson et al. developed a linear regression model to estimate postoperative day one (POD1) hematocrit (HCT) levels after benign hysterectomy. Predictive variables included pre-operative HCT, patient weight, estimated blood loss, intra-operative crystalloid volume, pre-operative platelet count, and hysterectomy route which predicted POD1 HCT ±5 for 100% of subjects using an internal validation set. OBJECTIVES: We aimed to externally validate the Swenson model using our hysterectomy population and to further validate the model in a cohort including robotic-assisted cases...
May 9, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29750699/implementation-of-closed-loop-assisted-intra-operative-goal-directed-fluid-therapy-during-major-abdominal-surgery-a-case-control-study-with-propensity-matching
#8
Alexandre Joosten, Sean Coeckelenbergh, Amelie Delaporte, Brigitte Ickx, Jean Closset, Thierry Roumeguere, Luc Barvais, Luc Van Obbergh, Maxime Cannesson, Joseph Rinehart, Philippe Van der Linden
BACKGROUND: Goal-directed fluid therapy (GDFT) has been associated with improved patient outcomes. However, implementation of GDFT protocols remains low despite growing published evidence and the recommendations of multiple regulatory bodies in Europe. We developed a closed-loop-assisted GDFT management system linked to a pulse contour monitor to assist anaesthesiologists in applying GDFT. OBJECTIVE: To assess the impact of our closed-loop system in patients undergoing major abdominal surgery in an academic hospital without a GDFT programme...
May 9, 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29745494/understanding-fluid-homoeostasis-in-infants-and-children-part-2
#9
Doreen Crawford
Part two of this article focuses on the care and management of infants and children who are seriously ill and who have lost so much fluid that they have entered a state of shock. The pathophysiology of shock is reviewed and the types and stages of shock are considered. The challenges of identifying shock are explored and the management of fluid resuscitation with colloids rather than crystalloids is analysed. An overview of the complex management of a young person in shock is provided using a case history format...
May 10, 2018: Nursing Children and Young People
https://www.readbyqxmd.com/read/29745073/hemodynamic-stability-achievement-by-application-of-goal-directed-fluid-therapy-with-different-infusion-solutions-in-colorectal-surgery
#10
Ana Cvetkovic, Nevena Kalezic, Biljana Milicic, Srdjan Nikolic, Milan Zegarac, Dejan Stojiljkovic, Merima Goran, Marina Stojanovic
PURPOSE: To determine whether there was a correlation between the type of administered infusion solutions intraoperatively with the quantity of administered infusion solutions, differences in values of cardiac output (CO) and cardiac index (CI) and need to use vasopressors and inotropes, between control and research groups. METHODS: This randomized prospective study included 55 patients with colorectal cancer. Subjects in the control group received only crystalloid solutions intraoperatively and postoperatively...
March 2018: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
https://www.readbyqxmd.com/read/29732686/ringer-s-lactate-vs-normal-saline-in-acute-pancreatitis-a-systematic-review-and-meta-analysis
#11
Umair Iqbal, Hafsa Anwar, Melissa Scribani
INTRODUCTION: Acute Pancreatitis (AP) is one of the most common causes of hospitalization in the United States. Aggressive intravenous hydration with crystalloids is the first step in management, and is associated with improved survival. Guidelines are unclear regarding the choice of crystalloids. Normal saline (NS) is most commonly used, but recent studies have shown Ringer's lactate (RL) to be associated with better outcomes. METHODS: A comprehensive literature review was conducted by searching the Embase, MEDLINE, Pubmed, and Google Scholar databases through December 2017 to identify all studies that compared the use of NS with RL for the management of acute pancreatitis...
May 7, 2018: Journal of Digestive Diseases
https://www.readbyqxmd.com/read/29728805/large-volume-crystalloid-fluid-is-associated-with-increased-hyaluronan-shedding-and-inflammation-in-a-canine-hemorrhagic-shock-model
#12
Lisa Smart, C J Boyd, M A Claus, E Bosio, G Hosgood, A Raisis
Shedding of the endothelial glycocalyx precedes leukocyte activation and adherence in acute inflammation. Rapid administration of crystalloid or colloid fluids for treating hemorrhagic shock may cause endothelial glycocalyx shedding, thereby increasing inflammation. This study aimed to compare the effect of different fluid treatments in a canine shock model on glycocalyx biomarker, hyaluronan, and inflammatory biomarkers. Greyhound dogs under general anesthesia subject to hemorrhage for 60 min were given 20 mL kg-1 of either fresh whole blood (FWB), hydroxyethyl starch (HES) 130/0...
May 4, 2018: Inflammation
https://www.readbyqxmd.com/read/29721496/the-role-of-plasma-transfusion-in-massive-bleeding-protecting-the-endothelial-glycocalyx
#13
REVIEW
Stefano Barelli, Lorenzo Alberio
Massive hemorrhage is a leading cause of death worldwide. During the last decade several retrospective and some prospective clinical studies have suggested a beneficial effect of early plasma-based resuscitation on survival in trauma patients. The underlying mechanisms are unknown but appear to involve the ability of plasma to preserve the endothelial glycocalyx. In this mini-review, we summarize current knowledge on glycocalyx structure and function, and present data describing the impact of hemorrhagic shock and resuscitation fluids on glycocalyx...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/29721013/changes-in-hepatic-blood-flow-and-liver-function-during-closed-abdominal-hyperthermic-intraperitoneal-chemotherapy-following-cytoreduction-surgery
#14
Stéphanie Dupont, Eduardo R C Schiffer, Marion J White, John R A Diaper, Marc-Joseph Licker, Philippe C Masouyé
Background: The increase in intra-abdominal pressure (IAP) during closed abdominal hyperthermic intraperitoneal chemotherapy (HIPEC) leads to major haemodynamic changes and potential organ dysfunction. We investigated these effects on hepatic blood flow (HBF) and liver function in patients undergoing HIPEC following cytoreductive surgery and fluid management guided by dynamic preload indices. Methods: In this prospective observational clinical study including 15 consecutive patients, we evaluated HBF by transesophageal echocardiography and liver function by determination of the indocyanine green plasma disappearance rate (ICG-PDR)...
2018: Gastroenterology Research and Practice
https://www.readbyqxmd.com/read/29719401/a-restrictive-dose-of-crystalloids-in-patients-during-laparoscopic-cholecystectomy-is-safe-and-cost-effective-prospective-two-arm-parallel-randomized-controlled-trial
#15
Matija Belavić, Vlatka Sotošek Tokmadžić, Antonija Brozović Krijan, Ines Kvaternik, Kristina Matijaš, Nedjeljko Strikić, Josip Žunić
Purpose: There are no evidence-based guidelines for volume replacement during surgical procedures such as laparoscopic cholecystectomy. However, the administration of a restrictive volume of crystalloids could be more cost-effective and safe. This trial aimed to determine the effectiveness and safety of a restrictive regimen of crystalloids in patients during laparoscopic cholecystectomy by analyzing its cost-effectiveness and 1-year morbidity rate. Patients and methods: In this randomized, prospective study, patients were assigned to one of three groups based on the volume of fluid administered: the restrictive group received 1 mL/kg/hr, the low liberal group received 5 mL/kg/hr, and the high liberal group received 15 mL/kg/hr of Ringer's solution intraoperatively...
2018: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29707319/perioperative-management-and-outcomes-of-minimally-invasive-esophagectomy-case-study-of-a-high-volume-tertiary-center-in-taiwan
#16
Tzu Chang, Po-Ni Hsiao, Man-Yin Tsai, Pei-Ming Huang, Ya-Jung Cheng
Background: Mortality and complication rates for surgical esophagectomy remain high despite progress in surgical techniques and perioperative care. Minimally invasive surgery and intraoperative goal-directed fluid management are gaining popularity in Taiwan; however, perioperative complications and short-term outcomes have been rarely reported. In this retrospective study, we analyzed the surgical procedures performed as well as the perioperative outcomes and treatments after esophagectomy in a high-volume medical center in Taiwan...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29707299/cold-crystalloid-versus-warm-blood-cardioplegia-in-patients-undergoing-aortic-valve-replacement
#17
Paolo Nardi, Sara R Vacirca, Marco Russo, Dionisio F Colella, Carlo Bassano, Antonio Scafuri, Antonio Pellegrino, Gerry Melino, Giovanni Ruvolo
Background: Myocardial protection techniques during cardiac arrest have been extensively investigated in the clinical setting of coronary revascularization. Fewer studies have been carried out of patients affected by left ventricular hypertrophy, where the choice of type and temperature of cardioplegia remain controversial. We have retrospectively investigated myocardial injury and short-term outcome in patients undergoing aortic valve replacement plus or minus coronary artery bypass grafting with using cold crystalloid cardioplegia (CCC) or warm blood cardioplegia (WBC)...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29706249/isolated-traumatic-brain-injury-results-in-significant-pre-hospital-derangement-of-cardiovascular-physiology
#18
M Gavrilovski, M El-Zanfaly, R M Lyon
INTRODUCTION: Major trauma can result in both life-threatening haemorrhage and traumatic brain injury (TBI). The pre-hospital management of these conditions, particularly in relation to the cardiovascular system, is very different. TBI can result in cardiovascular instability but the exact incidence remains poorly described. This study explores the incidence of cardiovascular instability in patients undergoing pre-hospital anaesthesia for suspected TBI. METHODS: Retrospective case series of all pre-hospital trauma patients attended by Kent, Surrey & Sussex Air Ambulance Trust (United Kingdom) trauma team during the period 1 January 2015-31 December 2016...
April 20, 2018: Injury
https://www.readbyqxmd.com/read/29704687/clinical-experience-of-autologous-blood-transfusion-in-neurosurgery-prospective-study-in-central-india
#19
Harshad Patil, Deepa Navakar, Laxmikant Banabokade, Nitin Garg
OBJECTIVE: The purpose of this study was to evaluate the benefits of intraoperative autologous blood transfusion in intracranial procedures and to conserve precious homologous blood due to shortage of donor and associated complications. METHODS: This was a prospective study performed at Bansal hospital, Bhopal. Predetermined autologous blood was collected in a well labelled bag containing citrate phosphate dextrose adenine (CPDA) solution after induction of general anaesthesia...
April 25, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29703051/balanced-10-hydroxyethyl-starch-compared-with-balanced-6-hydroxyethyl-starch-and-balanced-crystalloid-using-a-goal-directed-hemodynamic-algorithm-in-pancreatic-surgery-a-randomized-clinical-trial
#20
Julia Werner, Oliver Hunsicker, Anja Schneider, Henryk Stein, Christian von Heymann, Adrian Freitag, Aarne Feldheiser, Klaus-Dieter Wernecke, Claudia Spies
BACKGROUND: While hydroxyethyl starch (HES) solutions are not recommended any longer in critically ill patients, data on efficacy and safety during surgery are still limited. METHODS: In a randomized controlled trial 63 patients were assigned to receive 10% HES (130/0.42), 6% HES (130/0.42), or crystalloid within a goal-directed hemodynamic algorithm during pancreatic surgery. The primary endpoints were intraoperative volume of HES and time until fully on oral diet...
April 2018: Medicine (Baltimore)
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