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goal directed fluid

Davy Guillarme, Vincent Desfontaine, Sabine Heinisch, Jean-Luc Veuthey
Mass spectrometry (MS) is considered today as one of the most popular detection methods, due to its high selectivity and sensitivity. In particular, this detector has become the gold standard for the analysis of complex mixtures such as biological samples. The first successful SFC-MS hyphenation was reported in the 80's, and since then, several ionization sources, mass analyzers and interfacing technologies have been combined. Due to the specific physicochemical properties and compressibility of the SFC mobile phase, directing the column effluent into the ionization source is more challenging than in LC...
March 7, 2018: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
Charles N Melton, Sheida T Riahinasab, Amir Keshavarz, Benjamin J Stokes, Linda S Hirst
When nanoparticle self-assembly takes place in an anisotropic liquid crystal environment, fascinating new effects can arise. The presence of elastic anisotropy and topological defects can direct spatial organization. An important goal in nanoscience is to direct the assembly of nanoparticles over large length scales to produce macroscopic composite materials; however, limitations on spatial ordering exist due to the inherent disorder of fluid-based methods. In this paper we demonstrate the formation of quantum dot clusters and spherical capsules suspended within spherical liquid crystal droplets as a method to position nanoparticle clusters at defined locations...
March 7, 2018: Nanomaterials
Farid Froghi, Rahul Koti, Kurinchi Gurusamy, Susan Mallett, Douglas Thorburn, Linda Selves, Sarah James, Jeshika Singh, Manuel Pinto, Christine Eastgate, Margaret McNeil, Helder Filipe, Fatima Jichi, Nick Schofield, Daniel Martin, Brian Davidson
BACKGROUND: Patients with liver cirrhosis undergoing liver transplantation have a hyperdynamic circulation which persists into the early postoperative period making accurate assessment of fluid requirements challenging. Goal-directed fluid therapy (GDFT) has been shown to reduce morbidity and mortality in a number of surgery settings. The impact of GDFT in patients undergoing liver transplantation is unknown. A feasibility trial was designed to determine patient and clinician support for recruitment into a randomised controlled trial of GDFT following liver transplantation, adherence to a GDFT protocol, participant withdrawal, and to determine appropriate endpoints for a subsequent larger trial to evaluate the efficacy of GDFT in patients undergoing liver transplantation...
March 7, 2018: Trials
Hoan T Ngo, Elizabeth Freedman, Ren Abelard Odion, Pietro Strobbia, Agampodi Swarnapali De Silva Indrasekara, Priya Vohra, Steve M Taylor, Tuan Vo-Dinh
Direct detection of genetic biomarkers in body fluid lysate without target amplification will revolutionize nucleic acid-based diagnostics. However, the low concentration of target sequences makes this goal challenging. We report a method for direct detection of pathogen RNA in blood lysate using a bioassay using surface-enhanced Raman spectroscopy (SERS)-based detection integrated in a "lab-in-a-stick" portable device. Two levels of signal enhancement were employed to achieve the sensitivity required for direct detection...
March 6, 2018: Scientific Reports
Drayton A Hammond, Laura Baumgartner, Craig Cooper, Elisabeth Donahey, Serena A Harris, Jessica M Mercer, Mandy Morris, Mona K Patel, Angela M Plewa-Rusiecki, Alia A Poore, Ryan Szaniawski, Deanna Horner
PURPOSE: To summarize selected meta-analyses and trials related to critical care pharmacotherapy published in 2017. The Critical Care Pharmacotherapy Literature Update (CCPLU) Group screened 32 journals monthly for impactful articles and reviewed 115 during 2017. Two meta-analyses and eight original research trials were reviewed here from those included in the monthly CCPLU. Meta-analyses on early, goal-directed therapy for septic shock and statin therapy for acute respiratory distress syndrome were summarized...
February 26, 2018: Journal of Critical Care
María Lema Tome, Francisco Andrés De la Gala, Patricia Piñeiro, Luis Olmedilla, Ignacio Garutti
INTRODUCTION: In last few years, emphasis was placed in goal-directed therapy in order to optimize patient's hemodynamic status and improve their prognosis. Parameters based on the interaction between heart and lungs have been questioned in situations like low tidal volume and open chest surgery. The goal of the study was to analyze the changes that one-lung ventilation can produce over stroke volume variation and to assess the possible impact of airway pressures and lung compliance over stroke volume variation...
February 21, 2018: Revista Brasileira de Anestesiologia
Derek M Culnan, Kelley Farner, Genevieve H Bitz, Karel D Capek, Yiji Tu, Carlos Jimenez, William C Lineaweaver
Volume resuscitation of patients with high-voltage electrical injuries (>1000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae dependent on percentage of cutaneous burn. Myonecrosis occurring from direct electrical injury and secondary compartment syndromes can result in rhabdomyolysis, compromising renal function and urine output. Urine output is the primary end point, with a goal of 1 mL/kg/h for adult patients with high-voltage electrical injuries...
March 2018: Annals of Plastic Surgery
Hideki Taniguchi, Toshio Sasaki, Hisae Fujita, Hiroko Kobayashi, Rieko Kawasaki, Takashi Ogata, Haruhiko Cho, Takaki Yoshikawa, Keiko Ushigome, Akemi Tanaka, Osami Takano
BACKGROUND AND AIMS: The Enhanced Recovery after Surgery (ERAS) program has been proposed as a postoperative recovery-enhancing strategy. We frequently apply the Modified-ERAS program following oesophagectomy. This study aims to elucidate the impact of goal-directed fluid therapy (GDT) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy. METHODS: This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre, Japan...
February 2018: Clinical Nutrition ESPEN
Satoshi Ishihara, Takeshi Yokoyama, Katsuyuki Katayama
Background: Goal-directed therapy (GDT) is beneficial for surgical patients, especially for those undergoing high-risk surgery. However, little has been reported on the hemodynamic effects of GDT in extensive surgery. We conducted a study to determine the impact of GDT on intraoperative management of extensive surgery. Findings: We retrospectively collected data from 90 patients who underwent pancreaticoduodenectomy: 44 who received intraoperative GDT (GDT group) and 46 who received conventional hemodynamic management (control group)...
2018: JA Clin Rep
Mathieu Jozwiak, Olfa Hamzaoui, Xavier Monnet, Jean-Louis Teboul
The prognosis of septic shock is tightly linked to the earliness of both appropriate antibiotic therapy and early hemodynamic resuscitation. This latter is essentially based on fluid and vasopressors administration. The step-by-step strategy, called "early goal-directed therapy" (EGDT) developed in 2001 and endorsed by the Surviving Sepsis Campaign (SSC) between 2004 and 2016 is no longer recommended. Indeed, recent multicenter randomized clinical trials showed no reduction in all-cause mortality, duration of organ support and in-hospital length of stay with EGDT in comparison with standard care...
February 14, 2018: Minerva Anestesiologica
Bernd Saugel, Daniel A Reuter
"Perioperative goal-directed therapy" (PGDT) aims at an optimization of basic and advanced global hemodynamic variables to maintain adequate oxygen delivery to the end-organs. PGDT protocols help to titrate fluids, vasopressors, or inotropes to hemodynamic target values. There is considerable evidence that PGDT can improve patient outcome in high-risk patients if both fluids and inotropes are administered to target hemodynamic variables reflecting blood flow. Despite this evidence, PGDT strategies aiming at an optimization of blood flow seem to be not well implemented in routine clinical care...
2018: Frontiers in Medicine
L R Soenksen, T Kassis, M Noh, L G Griffith, D L Trumper
Precise fluid height sensing in open-channel microfluidics has long been a desirable feature for a wide range of applications. However, performing accurate measurements of the fluid level in small-scale reservoirs (<1 mL) has proven to be an elusive goal, especially if direct fluid-sensor contact needs to be avoided. In particular, gravity-driven systems used in several microfluidic applications to establish pressure gradients and impose flow remain open-loop and largely unmonitored due to these sensing limitations...
February 13, 2018: Lab on a Chip
Filiz Ateş, Brenda L Davies, Swati Chopra, Krista Coleman-Wood, William J Litchy, Kenton R Kaufman
Intramuscular pressure (IMP) is the hydrostatic fluid pressure that is directly related to muscle force production. Electromechanical delay (EMD) provides a link between mechanical and electrophysiological quantities and IMP has potential to detect local electromechanical changes. The goal of this study was to assess the relationship of IMP with the mechanical and electrical characteristics of the tibialis anterior muscle (TA) activity at different ankle positions. We hypothesized that (1) the TA IMP and the surface EMG (sEMG) and fine-wire EMG (fwEMG) correlate to ankle joint torque, (2) the isometric force of TA increases at increased muscle lengths, which were imposed by a change in ankle angle and IMP follows the length-tension relationship characteristics, and (3) the electromechanical delay (EMD) is greater than the EMD of IMP during isometric contractions...
2018: Frontiers in Physiology
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
C A Pfortmueller, G-C Funk, C Reiterer, A Schrott, O Zotti, B Kabon, E Fleischmann, G Lindner
BACKGROUND: This double-blind randomised controlled trial investigated whether normal saline or a balanced crystalloid has distinct effects on vasopressor use in patients undergoing major abdominal surgery. METHODS: Patients received either normal saline 0.9% or an acetate-buffered crystalloid for intraoperative volume replacement in a goal-directed fashion. The primary outcome was need for vasopressors; the secondary outcomes were the total dose of catecholamines, total perioperative fluid, and unplanned intensive care admissions...
February 2018: British Journal of Anaesthesia
Yogen Singh, Anup C Katheria, Farha Vora
Shock in newborn infants has unique etiopathologic origins that require careful assessment to direct specific interventions. Early diagnosis is key to successful management. Unlike adults and pediatric patients, shock in newborn infants is often recognized in the uncompensated phase by the presence of hypotension, which may be too late. The routine methods of evaluation used in the adult and pediatric population are often invasive and less feasible. We aim to discuss the pathophysiology in shock in newborn infants, including the transitional changes at birth and unique features that contribute to the challenges in early identification...
2018: Frontiers in Pediatrics
Rizwan Sultan, Hasnain Zafar
OBJECTIVE: To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA). STUDY DESIGN: An audit. PLACE AND DURATION OF STUDY: Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014. METHODOLOGY: Patients undergone emergency bowel surgery during the review period were included...
February 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Xian Zhao, Yuhong Li, Hai-Ying Kong, Lin Zhang, Xiao-Hong Wen
RATIONALE: Survey data show approximately 10% patients with lung cancer may present concomitant coronary heart disease. Simultaneous surgery is a challenge for anesthetist. We review our experience in the anesthesia with 5 patients who required simultaneous off-pump coronary artery bypass grafting (OPCABG) and pulmonary resection for lung cancer. PATIENT CONCERNS: Between 2014 and 2016, 5 patients with ASA (American Society of Anesthesiologists) grade II or III, underwent combined OPCABG and lung resection in the first Affiliated Hospital, Zhejiang University School of Medicine...
December 2017: Medicine (Baltimore)
Hao-Yu Chiao, Chang-Yi Chou, Yuan-Sheng Tzeng, Chih-Hsin Wang, Shyi-Gen Chen, Niann-Tzyy Dai
BACKGROUND: Adequate fluid titration during the initial resuscitation period of major burn patients is crucial. This study aimed to evaluate the feasibility and efficacy of a goal-directed fluid resuscitation protocol that used hourly urine output plus the arterial waveform analysis FloTrac (Edwards LifeSciences, Irvine, Calif) system for major burns to avoid fluid overload. METHODS: We conducted a retrospective cohort study of 43 major burn patients at the Tri-Service General Hospital after the Formosa Fun Coast Dust Explosion on June 27, 2015...
February 2018: Annals of Plastic Surgery
Drew Taylor Louden, Lori Ellen Rutman
Sepsis, severe sepsis, and septic shock represent a dynamic clinical syndrome involving a systemic inflammatory response, circulatory changes, and end-organ dysfunction from an infection. Early aggressive management to restore perfusion and/or improve hypotension is critical to improving outcomes. Although the basic management principles of early goal-directed therapy for sepsis have not undergone significant changes, there has been a recent shift in recommendations related to the timing and type of inotropic support...
February 2018: Pediatric Emergency Care
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