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goal directed fluid

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https://www.readbyqxmd.com/read/28330460/sepsis-recognition-in-the-emergency-department-impact-on-quality-of-care-and-outcome
#1
Marius Morr, Alexander Lukasz, Eva Rübig, Hermann Pavenstädt, Philipp Kümpers
BACKGROUND: Appropriate and timely recognition of sepsis is a prerequisite for starting goal-directed therapy bundles. We analyzed the appropriateness of sepsis recognition and documentation with regard to adequacy of therapy and outcome in an internal medicine emergency department (ED). METHODS: This study included 487 consecutive patients ≥18 years of age who presented to a university hospital ED during a 4-week period. Clinical, laboratory, and follow-up data were acquired independently from documentation by ED physicians...
March 23, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28321811/interleukin-2-old-and-new-approaches-to-enhance-immune-therapeutic-efficacy
#2
Pooja Dhupkar, Nancy Gordon
Interleukin-2 (IL-2) is a very well-known cytokine that has been studied for the past 35 years. It plays a major role in the growth and proliferation of many immune cells such NK and T cells. It is an important immunotherapy cytokine for the treatment of various diseases including cancer. Systemic delivery of IL-2 has shown clinical benefit in renal cell carcinoma and melanoma patients. However, its use has been limited by the numerous toxicities encountered with the systemic delivery. Intravenous IL-2 causes the well-known "capillary leak syndrome," or the leakage of fluid from the circulatory system to the interstitial space resulting in hypotension (low blood pressure), edema, and dyspnea that can lead to circulatory shock and eventually cardiopulmonary collapse and multiple organ failure...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28320242/early-goal-directed-therapy-for-septic-shock-a-patient-level-meta-analysis
#3
(no author information available yet)
Background After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of individual patient data from the three recent trials was designed prospectively to improve statistical power and explore heterogeneity of treatment effect of EGDT. Methods We harmonized entry criteria, intervention protocols, outcomes, resource-use measures, and data collection across the trials and specified all analyses before unblinding...
March 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28288059/effects-of-intraoperative-fluid-management-on-postoperative-outcomes-a-hospital-registry-study
#4
Christina H Shin, Dustin R Long, Duncan McLean, Stephanie D Grabitz, Karim Ladha, Fanny P Timm, Tharusan Thevathasan, Alberto Pieretti, Cristina Ferrone, Andreas Hoeft, Thomas W L Scheeren, Boyd Taylor Thompson, Tobias Kurth, Matthias Eikermann
OBJECTIVE: Evaluate the dose-response relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of surgical patients. BACKGROUND: Healthy humans may live in a state of fluid responsiveness without the need for fluid supplementation. Goal-directed protocols driven by such measures are limited in their ability to define the optimal fluid state during surgery. METHODS: This analysis of data on file included 92,094 adult patients undergoing noncardiac surgery with endotracheal intubation between 2007 and 2014 at an academic tertiary care hospital and two affiliated community hospitals...
March 10, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28253353/effect-of-goal-directed-therapy-on-outcome-after-esophageal-surgery-a-quality-improvement-study
#5
Denise P Veelo, Mark I van Berge Henegouwen, Kirsten S Ouwehand, Bart F Geerts, Maarten C J Anderegg, Susan van Dieren, Benedikt Preckel, Jan M Binnekade, Suzanne S Gisbertz, Markus W Hollmann
BACKGROUND: Goal-directed therapy (GDT) can reduce postoperative complications in high-risk surgery patients. It is uncertain whether GDT has the same benefits in patients undergoing esophageal surgery. Goal of this Quality Improvement study was to evaluate the effects of a stroke volume guided GDT on post-operative outcome. METHODS AND FINDINGS: We compared the postoperative outcome of patients undergoing esophagectomy before (99 patients) and after (100 patients) implementation of GDT...
2017: PloS One
https://www.readbyqxmd.com/read/28211020/goal-directed-fluid-restriction-during-brain-surgery-a-prospective-randomized-controlled-trial
#6
Jinfeng Luo, Jing Xue, Jin Liu, Bin Liu, Li Liu, Guo Chen
BACKGROUND: The value of goal-directed fluid therapy in neurosurgical patients, where brain swelling is a major concern, is unknown. The aim of our study was to evaluate the effect of an intraoperative goal-directed fluid restriction (GDFR) strategy on the postoperative outcome of high-risk patients undergoing brain surgery. METHODS: High-risk patients undergoing brain surgery were randomly assigned to a usual care group (control group) or a GDFR group. In the GDFR group, (1) fluid maintenance was restricted to 3 ml/kg/h of a crystalloid solution and (2) colloid boluses were allowed only in case of hypotension associated with a low cardiac index and a high stroke volume variation...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28187752/targeting-urine-output-and-30-day-mortality-in-goal-directed-therapy-a-systematic-review-with-meta-analysis-and-meta-regression
#7
Esther N van der Zee, Mohamud Egal, Diederik Gommers, A B Johan Groeneveld
BACKGROUND: Oliguria is associated with a decreased kidney- and organ perfusion, leading to organ damage and increased mortality. While the effects of correcting oliguria on renal outcome have been investigated frequently, whether urine output is a modifiable risk factor for mortality or simply an epiphenomenon remains unclear. We investigated whether targeting urine output, defined as achieving and maintaining urine output above a predefined threshold, in hemodynamic management protocols affects 30-day mortality in perioperative and critical care...
February 10, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28152987/trends-and-causes-of-maternal-mortality-in-ethiopia-during-1990-2013-findings-from-the-global-burden-of-diseases-study-2013
#8
Gizachew Assefa Tessema, Caroline O Laurence, Yohannes Adama Melaku, Awoke Misganaw, Sintayehu A Woldie, Abiye Hiruye, Azmeraw T Amare, Yihunie Lakew, Berihun M Zeleke, Amare Deribew
BACKGROUND: Maternal mortality is noticeably high in sub-Saharan African countries including Ethiopia. Continuous nationwide systematic evaluation and assessment of the problem helps to design appropriate policy and strategy in Ethiopia. This study aimed to investigate the trends and causes of maternal mortality in Ethiopia between 1990 and 2013. METHODS: We used the Global Burden of Diseases and Risk factors (GBD) Study 2013 data that was collected from multiple sources at national and subnational levels...
February 2, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28126672/goal-directed-fluid-therapy-for-reducing-risk-of-surgical-site-infections-following-abdominal-surgery-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#9
REVIEW
Jianhu Yuan, Yanxia Sun, Chuxiong Pan, Tianzuo Li
BACKGROUND AND OBJECTIVE: Surgical site infections (SSIs) become a key indicator of quality of care. This meta-analysis aimed to determine the effect of goal-directed fluid therapy (GDFT) on the risk of SSIs after abdominal surgery. METHODS: MEDLINE, Embase, CINAHL, Scopus, the Cochrane Controlled Trials Register, and Cochrane Database of Systematic Reviews were searched for randomized controlled trials (RCTs), from inception to May 2016 that compared the incidence of SSIs in abdominal surgical patients with or without GDFT treatment...
January 23, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28124862/fluid-management-in-thoracic-anesthesia
#10
Mert Şentürk, Mukadder Orhan Sungur, Zerrin Sungur
Fluid management during thoracic anesthesia remains as a challenge for the anesthesiologists. The "safe zone" between volume overload (risk of pulmonary edema) and hypovolemia (potential risk of renal failure) is hard to determine and narrow. Relationship between peroperative fluid administration and postoperative lung injury has been clearly demonstrated but lung injury can even occur after the most restrictive management. Multiple hit hypothesis and endothelial glycocalyx in addition to revised Starling equation can help us understand this dilemma...
January 25, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28094478/fluid-management-in-cardiac-surgery-patients-pitfalls-challenges-and-solutions
#11
Elena Bignami, Marcello Guarnieri, Marco Gemma
Fluid administration is a powerful tool for hemodynamic stabilization as it increases preload and improves cardiac function in fluid-responsive patients. However, there are various types of fluid to choose from. The use of colloids and crystalloids in non-cardiac Intensive Care Units (ICU) has been reported, showing controversial results. Many trials on sepsis in a non-cardiac ICU setting show that colloids, in particular hydroxyethyl starches and gelatins, might have a detrimental effect on kidney function, and on major outcomes such as mortality...
January 17, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28092334/is-enhanced-recovery-the-new-standard-of-care-in-microsurgical-breast-reconstruction
#12
Anoushka Afonso, Sabine Oskar, Kay See Tan, Joseph J Disa, Babak J Mehrara, Jihan Ceyhan, Joseph H Dayan
BACKGROUND: Enhanced recovery pathways (ERPs) have been shown to aid in patient recovery and improve outcomes in many surgical settings. At present, there is limited data available regarding the use and feasibility of ERPs for patients undergoing microsurgical breast reconstruction. We sought to assess patient outcomes before and after the introduction of an ERP that was adopted by multiple surgeons at a single cancer center. METHODS: A multidisciplinary ERP was developed for patients undergoing deep inferior epigastric perforator (DIEP) or muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction...
January 12, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28077530/impact-of-balanced-tetrastarch-raw-material-on-perioperative-blood-loss-a-randomized-double-blind-controlled-trial
#13
A Joosten, R Tircoveanu, S Arend, P Wauthy, P Gottignies, P Van der Linden
BACKGROUND: As 6% hydroxyethyl starch (HES) 130/0.40 or 130/0.42 can originate from different vegetable sources, they might have different clinical effects. The purpose of this prospective, randomized, double-blind controlled trial was to compare two balanced tetrastarch solutions, one maize-derived and one potato-derived, on perioperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). METHODS: We randomly assigned 118 patients undergoing elective cardiac surgery into two groups, to receive either a maize- or a potato-derived HES solution...
October 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28067711/early-goal-directed-therapy-for-sepsis-a-novel-solution-for-discordant-survival-outcomes-in-clinical-trials
#14
Andre C Kalil, Daniel W Johnson, Steven J Lisco, Junfeng Sun
OBJECTIVES: Early goal-directed therapy has shown discordant survival outcomes in sepsis studies. We aim to find the reasons for this discordance. DESIGN: Random-effects and Bayesian hierarchical analyses. SETTING: Studies that evaluated early goal-directed therapy. SUBJECTS: Patients with severe sepsis and/or septic shock. INTERVENTIONS: Early goal-directed therapy. MEASUREMENTS AND MAIN RESULTS: A total of 19,998 patients were included in the main analysis: 31 observational (n = 15,656) and six randomized (n = 4,342) studies...
April 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/27999663/implementation-of-goal-directed-fluid-therapy-during-hip-revision-arthroplasty-a-matched-cohort-study
#15
Marit Habicher, Felix Balzer, Viktor Mezger, Jennifer Niclas, Michael Müller, Carsten Perka, Michael Krämer, Michael Sander
BACKGROUND: Several randomized controlled trials (RCTs) have demonstrated that intraoperative goal-directed fluid therapy (GDFT) can decrease postsurgical complications in patients undergoing major abdominal surgery. However, very few studies have demonstrated the value of goal-directed therapy (GDT) in patients undergoing orthopaedic surgery and confirmed it is as useful in real-life conditions. Therefore, we initiated a GDFT implementation programme in patients undergoing hip revision arthroplasty in order to assess its effects on postoperative complications (e...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27968811/a-review-of-central-venous-pressure-and-its-reliability-as-a-hemodynamic-monitoring-tool-in-veterinary-medicine
#16
REVIEW
Kristen M Hutchinson, Scott P Shaw
OBJECTIVE: To review the current literature regarding central venous pressure (CVP) in veterinary patients pertaining to placement (of central line), measurement, interpretation, use in veterinary medicine, limitations, and controversies in human medicine. ETIOLOGY: CVP use in human medicine is a widely debated topic, as numerous sources have shown poor correlation of CVP measurements to the volume status of a patient. Owing to the ease of placement and monitoring in veterinary medicine, CVP remains a widely used modality for evaluating the hemodynamic status of a patient...
September 2016: Topics in Companion Animal Medicine
https://www.readbyqxmd.com/read/27958191/wet-or-dry-a-review-of-intravenous-fluid-administration-in-anesthesia-practice
#17
Matthew D'Angelo, R Kyle Hodgen
Fluid therapy has dramatically changed since its early inception nearly 200 years ago. Administration of intravenous fluid (IVF) has evolved from a "drip" technique to the algorithmic approach of the anesthetic fluid plan, and is now moving toward Goal-Directed Fluid Therapy. As the science and culture of fluid management evolves, anesthetists must remain focused on "why" anesthetic fluid matters. The purpose of IVF administration is to support tissue perfusion and maintain euvolemia. As the evidence underlying perioperative practice matures and the science of anesthesia races to meet the evolving demands of surgery, anesthetists must align knowledge generation with the individualized needs of the patient...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27940452/perioperative-goal-directed-haemodynamic-therapy-based-on-flow-parameters-a-concept-in-evolution
#18
L Meng, P M Heerdt
Haemodynamic management incorporating direct or surrogate stroke volume monitoring has experienced a rapid evolution, because of emergence of the "goal-directed therapy" concept and technological developments aimed at providing a parameter leading to the goal. Nonetheless, consensus on both definitions of the ideal "goal" and strategies for achieving it remain elusive. For this review, we first consider basic physiological and patient monitoring factors relevant to the concept of "fluid responsiveness", and then focus upon randomized controlled trials and meta-analyses involving goal-directed haemodynamic therapy based on various flow parameters...
December 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27935782/wet-or-dry-a-review-of-intravenous-fluid-administration-in-anesthesia-practice
#19
Matthew D'Angelo, R Kyle Hodgen
Fluid therapy has dramatically changed since its early inception nearly 200 years ago. Administration of intravenous fluid (IVF) has evolved from a "drip" technique to the algorithmic approach of the anesthetic fluid plan, and is now moving toward Goal-Directed Fluid Therapy. As the science and culture of fluid management evolves, anesthetists must remain focused on "why" anesthetic fluid matters. The purpose of IVF administration is to support tissue perfusion and maintain euvolemia. As the evidence underlying perioperative practice matures and the science of anesthesia races to meet the evolving demands of surgery, anesthetists must align knowledge generation with the individualized needs of the patient...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27929582/liquid-biopsy-on-chip-a-paradigm-shift-towards-the-understanding-of-cancer-metastasis
#20
REVIEW
Amogha Tadimety, Abeer Syed, Yuan Nie, Christina R Long, Kasia M Kready, John X J Zhang
This comprehensive review serves as a guide for developing scalable and robust liquid biopsies on chip for capture, detection, and analysis of circulating tumor cells (CTCs). Liquid biopsy, the detection of biomarkers from body fluids, has proven challenging because of CTC rarity and the heterogeneity of CTCs shed from tumors. The review starts with the underlying biological mechanisms that make liquid biopsy a challenge before moving into an evaluation of current technological progress. Then, a framework for evaluation of the technologies is presented with special attention to throughput, capture rate, and cell viability for analysis...
December 8, 2016: Integrative Biology: Quantitative Biosciences From Nano to Macro
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