Fluid Balance Research Articles

Associations Between Daily-Use Products and Urinary Biomarkers of Endocrine-Disrupting Chemicals in Adults of Reproductive Age

Background: Daily-use products, including personal care products, household products, and dietary supplements, often contain ingredients that raise concerns regarding harmful chemical exposure. Endocrine-disrupting chemicals (EDCs) found in daily-use products are associated with numerous adverse health effects. Methods: This pilot study explores the relationship between concentrations of EDCs in urine samples and products used 24 h prior to sample collection, and ingredients of concern in those products, in 140 adults of reproductive age in Northern Nevada. Results: Having higher numbers of products and ingredients of concern, especially in the personal care category, was associated with higher levels of mono-(-ethyl-5-carboxypentyl) phthalate (MECPP). Similarly, taking more supplements was associated with higher levels of methylparaben (MePB). In contrast, using household products with more ingredients of concern was associated with lower levels of monobutyl phthalate (MBP). Generally, women used more products, were exposed to more ingredients of concern and had higher urinary metabolites than men. Participants who rated themselves as being in poor/fair health were exposed to more personal care and supplement ingredients of concern than those in better health. Interestingly, those in excellent health also took supplements with more ingredients of concern. Conclusions: Greater product use and more ingredients of concern are associated with urinary metabolites of known EDCs and self-ratings of poor health. Women and people who take supplements are at greater risk, and even people who consider themselves to be healthy can be highly exposed. More education among the general public is needed to make people aware of the presence of these chemicals in their everyday products so they can make efforts to avoid them.

Electroactive Asymmetric Dressing for Spatiotemporal Deep Burn Scarless Healing and Management.

Burn care and treatment differ markedly from other types of wounds, as they are significantly more prone to infections and struggle to maintain fluid balance post-burn. Moreover, the limited self-healing abilities exacerbate the likelihood of scar formation, further complicating the recovery process. To tackle these issues, an asymmetric wound dressing comprising a quercetin-loaded poly(3-hydroxybutyrate-co-4-hydroxybutyrate) (P34HB@Qu) hydrophilic layer and a zinc oxide nanoparticle-loaded, thermally treated polyvinylidene fluoride (HPVDF@ZnO) hydrophobic layer is designed. This dressing provided antibacterial property and exudate management in the early stages of burn treatment, preventing infection and maintaining moisture balance at the wound site. As healing progresses, the electroactive properties of HPVDF@ZnO and quercetin from P34HB@Qu synergistically regulate cell migration and differentiation, accelerating wound healing and facilitating scar-free regeneration. Furthermore, the wound dressing assisted in the regeneration of skin appendages. This study underscores the full-cycle strategy of versatile wound dressings for spatiotemporal burn wound management from injury to scarless healing.

Understanding the Current Practice in Chest Tube Management Following Lung Resection–A Canadian National Survey

AIM: Timing of chest tube removal post lung resection is variable in practice and often based on personal experience rather than evidence. The current practice in chest tube management among thoracic surgeons across Canada is so far unknown. Our primary aim was to assess the current status of chest tube removal in Canada in order to uncover potential shortcomings. METHODS: An online anonymous survey was emailed to members of Canadian Association of Thoracic Surgeons in order to better understand the status quo of the chest tubes' removal policy in the different departments preparing the grounds for suggesting a future uniformity. Data were collected and analysed with descriptive statistics. A linear regression analysis was performed in order to understand the factors related to chest tube removal. RESULTS: Sixty responses were received (44.4% response rate). Most surgeons place a single chest tube in both open (75%, 45/60) and minimally invasive lobectomies (93.3%, 56/60). Digital drainage systems are used by half of the surgeons surveyed. A quarter of the respondents report removing chest tubes regardless of drainage output. This practice was independent of the surgeons' number of years in practice (p = 0.127), number of lobectomies performed annually (p = 0.877), proportion of lobectomies performed minimally invasively (p = 0.259), whether digital drainage system is used (p = 0.141) and whether the surgeon is aware of the Enhanced Recovery after Surgery (ERAS) guideline (p = 0.374). Of those who remove chest tubes based on fluid output, thresholds vary widely; a significant proportion (86%, 37/43) uses a volume lower than the 450 mL/24 h threshold set out ERAS. Most respondents (77%) were interested in a clinical trial studying chest tube removal independent of drainage volume. CONCLUSIONS: This study demonstrated ongoing diverse practice amongst thoracic surgeons in Canada with regards to post-operative chest tube management, indicating a much-needed area of research.

Real World Testing of a Clinical Strategy to Start Early Peritoneal Dialysis for High-Risk Newborns Following Cardiac Surgery.

The beneficial impact of peritoneal dialysis (PD) catheter placement following cardiopulmonary bypass in young infants has been demonstrated. But the indications to start early peritoneal dialysis are not agreed upon. This retrospective single center study was conducted to evaluate the performance of a clinical strategy for early PD start. PD catheters were placed in the operating room (OR) following cardiopulmonary bypass (CPB). Those with prolonged CPB times (>180 minutes), post-operative (post-op) oligo-anuria and/or inability to achieve negative fluid balance in post-op 24 hours were evaluated as high-risk and selected for early PD start (PD +). All PD + were started within the first post-op 24 hours. Primary outcomes were 5% fluid accumulation at post-op 48 hours and severe acute kidney injury (AKI) at post-op day 5. There were forty-nine newborns. Twenty-nine subjects were early PD (PD +) starts and twenty used the PD catheter as an abdominal drain (PD -). Baseline demographic data were similar. Both groups were oliguric during post-op first 8 hours (p= 0.906). The Early PD (+) group produced significantly less urine output during post-op day 1 (0.98 vs 3.02 ml/kg/hour; p= 0.001). At post-op 48 hours, early PD (+) group had similar prevalence of 5% fluid accumulation as early PD (-), 5 (16.7%) vs. 2 (7.41%), respectively (p= 0.427). Severe AKI incidence at post-op day 5 was similar between the groups (17.3% vs 5.0%; p=0.204). Time to extubation was longer for early PD (+) group compared to PD (-) group, 10.0 days [7.0;16.0] vs. 4.0 days [4.0;10.0] (p=0.017). Persistent oliguria and inability to achieve negative fluid balance during initial post-op 24 hours may identify those newborns who will benefit from early PD. The first post-operative 8 hours was indiscriminative for this strategy. PD start may ameliorate the disadvantage for the designated group.

Left ventricular diastolic dysfunction is prevalent but not associated with mortality in patients with septic shock.

Prognostic impact of left ventricular diastolic dysfunction (LVDD) in septic shock patients has not been determined using current diagnostic guidelines. We assessed the relation between LVDD during the first 3days following intensive care unit (ICU) admission for septic shock and Day-28 mortality. This prospective, multicenter, observational study enrolled 402 patients (age: 63 ± 13year; 59% male; SAPS II: 59 ± 20; SOFA: 9.4 ± 3.6; mechanical ventilation: 74%) with septic shock (Sepsis-3 definition). Patients were echocardiographically assessed within 12h after admission (Day 1), on Day 2, Day 3, at ICU and at hospital discharge (or Day 28 whichever occurred first), using 2016 American-European guidelines. LVDD was present at least once between Day 1 and 3 in 304 patients (76%), and in 56% and 44% of patients at ICU discharge and on Day 28 (or hospital discharge), respectively (43% of patients with follow-up). Seventy-eight of 172 patients (45%) exhibited similar LV diastolic properties throughout the study period while 58 patients (34%) improved their LVDD at follow-up (lower grade: n = 9, regression: n = 49). Day-28 mortality was not statistically different between patients with and without LVDD (80/304 [26%] vs. 25/88 [28%]; OR: 0.900 [0.530-1.527]; p = 0.696). Similar results were obtained when adjusting the multivariate model on SAPSII or SOFA score on admission, together with fluid balance during the first three days of ICU stay (OR: 0.838 [0.471-1.491]: p = 0.547 and OR: 0.887 [0.513-1.534]: p = 0.668, respectively). LVDD was highly prevalent in patients with septic shock but not associated with mortality. It appeared improving in one-third of survivors. PRODIASYS study registered on ClinicalTrials (September 27, 2016, number NCT02918214).

Capillary Filtration of Plasma is Accelerated During General Anesthesia: A Secondary Population Volume Kinetic Analysis.

How infusion fluids are distributed and eliminated is of importance to how much and how fast they should be administered. This manuscript applies population pharmacokinetic modeling to intravenous infusions of crystalloid fluid, which is a common therapy in hospital care and mandatory during surgery. The analysis was based on the hemodilution and urine output measured during and after 262 infusions of 1647 ± 461 mL (mean ± SD) of fluid over 30 min in adults. The result shows that distribution of fluid from the plasma to the interstitial fluid space occurred twice as fast during general anesthesia as compared to the conscious state. The increased rate ensures adequate nutritional flow to the cells despite decreased flow in the macrocirculation, which is a characteristic of general anesthesia. This increased capillary leakage of fluid was coupled with an even greater reduction of the urinary output and accumulation of fluid in both the fast-exchange interstitial fluid space and a remote "third fluid space," the latter of which apparently serves as an overflow reservoir. During the first hour of the experiments, 88% more fluid resided extravascularly in the presence of general anesthesia than in the awake state. General anesthesia increased the half-life from 1.8 to 16.6 h, showing marked impairment in the handling of infused crystalloid fluid.

Aldose Reductase: A Promising Therapeutic Target for High-Altitude Pulmonary Edema.

The Qinghai-Tibet Plateau, famously known as the "Roof of the World", has witnessed a surge in individuals traveling or working there. However, a considerable percentage of these individuals may suffer from acute mountain sickness (AMS), with high-altitude pulmonary edema (HAPE) being a severe and potentially life-threatening manifestation. HAPE disrupts the balance of intrapulmonary tissue fluid, resulting in severe lung function impairment. Current therapeutic interventions for HAPE have limitations and are accompanied by significant side effects. Aldose reductase (AR), a crucial enzyme in the polyol metabolic pathway, has been implicated in various diseases. In this study, we sought to explore the role of AR in HAPE. Utilizing both in vivo and in vitro models, we investigated the impact of AR on hypoxia-induced pulmonary edema, vascular pressure, inflammatory factors, and oxidative stress. Our findings revealed that AR knockdown mitigated hypoxia-induced pulmonary edema, decreased the expression of vascular pressure and inflammatory factors, and enhanced the expression related to oxidative stress. These results indicate that AR may serve as a potential therapeutic target for HAPE, offering a plausible pathological basis and novel drug targets for the prevention and treatment of this condition.

Relevance of perioperative fluid dynamics in liver transplantation to acute kidney injury and patient outcomes: a cross-sectional survey.

Fluid administration is a critical component of perioperative management for liver transplant recipients, and excessive fluid infusion can lead to acute kidney injury (AKI) and poor patient outcomes. We conducted a cross-sectional survey on the fluid intake and output of adult liver transplant recipients over a 7-day period. The patients were divided into AKI and non-AKI groups. Multivariate logistic regression analyses were used to evaluate the association between fluid balance (FB) and AKI. A Kaplan-Meier survival analysis was performed to determine the survival of the recipient survival at 180 days. A total of 210 liver transplant recipients were included. The peak FB occurred on the second day after transplantation, which was higher than on the seventh day (0.3 [IQR, -0.2 to 0.8] L vs. -0.4 [IQR, -1.0 to 0.3] L, p < 0.001). The highest incidence of AKI was observed on the second day after transplantation and the lowest on the seventh day (52.4% vs. 15.4%, p < 0.001). Multivariate analysis showed that a cumulative FB > 1 L within the first 2 days postoperatively was an independent risk factor for AKI on the second day after liver transplantation (LT) (OR = 2.66, 95% CI, 1.31-5.41, p = 0.007). Survival analysis indicated significant differences in 180-day survival rates among patients with different grades of AKI [94.0% (grade 1) vs. 91.4% (grade 2) vs. 77.8% (grade 3), χ 2 = 12.93, p < 0.001]. There is a significant correlation between post-LT AKI and perioperative FB. Cumulative FB > 1 L in the first 2 days postoperatively is an independent risk factor for AKI on the second day after LT. AKI after LT is associated with a lower 180-day survival rate in patients.

Development and validation of a multicompound LLE–LC–MS/MS method for biomonitoring of hazardous medicinal products in urine of exposed workers

Antineoplastic drugs are carcinogens, mutagens, or teratogenic substances, which can pose serious risks to professionals. Concerns about chronic exposure to these hazardous medicinal products (HMPs) have led to their prominence in the EU strategic framework on health and safety at work 2021-2027. To estimate and mitigate human exposure to HMPs, regular monitoring programs and, consequently, reliable, sensitive, multicomponent methods are crucial. In this study, an unconventional liquid-liquid extraction coupled with liquid chromatography–tandem mass spectrometry analysis is proposed to simultaneously identify and quantify seven HMPs of high concern in urine: cyclophosphamide, etoposide, ifosfamide, paclitaxel, megestrol, mycophenolate mofetil, and tamoxifen, the last three for the first time. Recoveries of all drugs from urine samples were close to 100%, and method detection limits (0.6–4.1ng/L) were noticeably lower than most previously reported. This novel, non-invasive method for biomonitoring is thus suitable to unequivocally identify the target drugs at the expected trace levels in urine and to infer about workers' exposure. The method contributes to the conception of regular monitoring programs for antineoplastic drugs, in line with recommendations under EU Directive 2004/37/EC. This is especially relevant in Portugal, where neither analytical methods nor exposure data exist due to lack of formal surveillance.

Effect of acetate- and lactate-containing intravenous fluid on acid-base status, electrolytes and plasma lactate concentration in dehydrated cats.

Acetate (ACE) and lactate (LAC)-containing balanced resuscitation fluids are commonly used for fluid therapy in cats. These fluids can influence acid-base and electrolyte status. This prospective randomised study compared two balanced crystalloid solutions regarding their effect on acid-base status, electrolytes and LAC concentrations in dehydrated cats after intravenous fluid therapy. A total of 100 client-owned cats presenting to the emergency service with dehydration ⩾5% due to diarrhoea, vomiting or anorexia were included in this study. They were randomised to receive either ACE- (Sterofundin ISO; B Braun Vet Care) or LAC-containing (Ringer-Laktat nach Hartmann; B. Braun Vet Care) fluids for rehydration. Exclusion criteria were age <6 months, severe electrolyte abnormalities, severely increased creatinine or bolus therapy, and decompensated heart disease and liver diseases. Vital parameters were assessed and venous blood gas analysis was performed before and after fluid therapy. Data were analysed using the Mann-Whitney U-test and the Wilcoxon matched-pairs signed-rank test. The significance level was set at P ⩽0.05. Post-rehydration pH normalised, and bicarbonate and base excess increased in both groups. Anion gap and LAC and potassium concentrations decreased in both groups. No difference in electrolyte, acid-base status and LAC was observed between cats receiving ACE and cats receiving LAC. Both fluids have similar effects on dehydrated cats' acid-base status and electrolyte and LAC concentrations. No significant differences in values were found between ACE- and LAC-containing resuscitation fluids. Blood LAC concentration decreased in both groups.

Piezoelectric hydrogels for accelerating healing of diverse wound types.

The skin, as the body's largest organ, plays a crucial role in protecting against mechanical forces and infections, maintaining fluid balance, and regulating body temperature. Therefore, skin wounds can significantly threaten human health and cause a heavy economic burden on society. Recently, bioelectric fields and electrical stimulation (ES) have been recognized as a promising pathway for modulating tissue engineering and regeneration of wounded skin. However, conventional hydrogel dressing lacks electrical generation capabilities and usually requires external stimuli to initiate the cell regeneration process, and the role of ES in different stages of healing is not fully understood. Therefore, to endow hydrogel-based wound dressings with piezoelectric properties, which can accelerate wound healing and potentially suppress infection via introducing ES, piezoelectric hydrogels (PHs) have emerged recently, combining the advantages of both piezoelectric nanomaterials and hydrogels beneficial for wound healing. Given the scarcity of systematic literature on the application of PHs in wound healing, this paper systematically discusses the principles of the piezoelectric effects, the design and fabrication of PHs, their piezoelectric properties, the way PHs trigger ES and the mechanisms by which they promote wound healing. Additionally, it summarizes the recent applications of PHs in various types of wounds, including traumatic wounds, pressure injuries, diabetic wounds, and infected wounds. Finally, the paper proposes future directions and challenges for the development of PH wound dressings for wound healing.

Rapid Pleurodesis in Patients With Chronic Noninfectious Pleural Effusion: Twenty Years of Real-world Performance Data.

Small cohort studies have shown rapid pleurodesis protocol's (RPP) effectiveness and capacity to expedite pleurodesis for malignant pleural effusion (MPE). This study intends to evaluate the effectiveness of the RPP in inducing pleurodesis in patients with pleural effusions from either malignant or benign etiologies. In this single-center, retrospective cohort study spanning 2 decades, we assessed patients with recurrent symptomatic chronic noninfectious pleural effusion, both benign and malignant. Post-RPP, chest tubes were removed when fluid output dropped below 150mL/d, and patients were discharged with daily indwelling pleural catheter (IPC) drainage. Exclusion criteria included nonexpandable lung and active pleural infection. Treatment success was defined as IPC removal on reduced output (<50mL) on 3 consecutive drainages and radiologic effusion resolution. Recurrence was defined as the occurrence of pleural effusion requiring additional pleural procedures postsuccess. Duration outcome was expressed as median with IPC placement as time zero. Of the 210 patients studied, 72% had MPE, and 28% had benign effusions. The median hospital stay was 4 days post-RPP. Treatment was successful in 177 (84%) patients within a median of 12 days, with no significant differences between MPE and benign cases. Nine patients (5%) experienced recurrence within a median of 152 days. Complications included hemothorax in 4 (1.9%) and empyema in 2 (1%). The thirty-day mortality rate was 9%, with a median survival time of 245 days postprocedure. The RPP combines the benefit of chemical pleurodesis and IPC and appears to be a reasonable option for patients with recurrent and symptomatic pleural effusion.

Dextrose 5% versus normal saline as maintenance fluid therapy in patients with septic shock (DEMANDS): a randomized controlled trial

ABSTRACT Objective To determine the effects of Dextrose 5% for maintenance and creep fluids on cumulative fluid balance (CFB) for septic shock concerning adult people. Design An open-label randomized clinical trial with a single center and parallel groups. Setting ICUs of a tertiary care academic medical center. Patients Adult individuals who have developed septic shock as described by the Sepsis 3 criteria. Interventions Dextrose 5% (n = 50) versus Saline 0.9% (n = 50) for maintenance and creep fluid for 72 hours. Main variables of interest The primary outcome measured was the CFB at 72 hours. Secondary outcomes assessed included mortality within 28 days, the number of days patients were free from (coma and delirium, ICU, mechanical ventilation, vasopressors), the occurrence of acute kidney injury, and disturbances in electrolyte levels. Results The CFB was significantly lower in Dextrose group vs Saline group (4.46 versus 6.75 L, median difference; −2.06 L; 95% CI, −2.63 to −1.35; p = P < 0.001). No significant difference mortality within 28 days (32% in the Dextrose vs 42% in the saline group; hazard ratio, 0.7; 95% CI, 0.36 to 1.34, p = 0.28). The proportions of patients with hyponatremia were higher in the Dextrose than the Saline group (31% versus 0%, p < 0.001). Conclusions Particularly in cases of septic shock, maintenance and creep fluids with Dextrose 5% as compared to Saline 0.9% resulted in a significantly lower CFB at 72 hours.

The role of bioimpedancemetry in optimizing antihypertensive therapy in patients with high peripheral resistance

Background: Hypertension remains a leading global health concern, particularly in patients with high peripheral resistance, where therapeutic optimization poses a significant challenge. Bioimpedancemetry offers a novel approach to individualize antihypertensive therapy by providing insights into vascular resistance and fluid distribution. This study aimed to evaluate the role of bioimpedancemetry in optimizing antihypertensive therapy in patients with high peripheral resistance. Methods: A total of 62 patients with hypertension (29–60 years, mean age 48.75 ± 1.6 years; 30 women) were included in the study. Bioimpedancemetry was employed to assess vascular resistance and fluid balance at baseline and during therapy. Based on the findings, antihypertensive therapy was tailored to individual needs. Blood pressure control, peripheral resistance, and clinical outcomes were evaluated over six months. Results: Bioimpedancemetry-guided therapy resulted in a significant reduction in mean arterial blood pressure (p &lt; 0.05) and peripheral resistance (p &lt; 0.01) compared to standard therapy. Women demonstrated greater improvement in vascular resistance parameters (p &lt; 0.05) than men. Additionally, therapy adjustments based on bioimpedance data improved patient adherence and overall therapeutic efficacy. No adverse effects related to therapy adjustments were reported. Conclusion: The integration of bioimpedancemetry in managing patients with hypertension and high peripheral resistance significantly enhances therapeutic outcomes by enabling personalized treatment strategies. This method holds promise for broader clinical application in hypertension management.

The Impact of Tranexamic Acid Administration in Reduction Mammaplasty: A Systematic Review.

Previous studies demonstrated the effectiveness and safety of tranexamic acid (TXA) in several surgical specialties. Recent publications suggested that TXA may also be beneficial in plastic surgery, including breast procedures. The aim of this study is to evaluate the impact of TXA in reduction mammaplasty by assessing several intraoperative and postoperative outcomes and the safety of its administration. A systematic search was conducted according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines on several online databases. Studies evaluating the outcomes of TXA administration in patients undergoing reduction mammaplasty, regardless of TXA dose and administration route were eligible for inclusion. Only studies with a control group were included. Risk-of-bias assessment was conducted using Cochrane and MINORS (Methodological Index for Non-Randomized Studies) tools. Our systematic review included 7 studies: 3 randomized controlled trials and 4 retrospective cohorts involving 1234 female patients (2232 breasts), 741 of whom received TXA (60%). Four studies used topical TXA, 2 used intravenous (IV) TXA, one used locally infiltrated TXA, and another combined locally infiltrated TXA with IV TXA. Four studies demonstrated benefits from TXA administration, whereas 3 studies did not. Topical TXA used just before wound closure resulted in a 42% reduction in drain fluid output and a 10-times reduction in major hematoma. The administration of IV TXA during induction resulted in a 12-times reduction in major and minor hematoma. The combined use of IV and locally infiltrated TXA reduced intraoperative blood loss. No adverse effects were reported. There is scientific evidence suggesting TXA may be effective and safe in reduction mammaplasty.

Comparison of the Thrombolytic Effects of Urokinase Delivered by Normothermic Machine Perfusion or Hypothermic Machine Perfusion in a Pair of Human Kidneys With Microthrombus

ABSTRACTExtensive glomerular thrombosis can be a reason for the non‐use of donor kidneys, which exacerbates donor shortage. Pre‐transplantation intervention with thrombolytic drugs delivered via hypothermic machine perfusion (HMP) can dissolve thrombi in kidneys with thrombosis. However, this method requires a long intervention time to fully eliminate all thrombi. This increases the period of ischemia and limits the improvement of the kidney. We compared the effect of short‐term thrombolysis by urokinase combined with normothermic machine perfusion (NMP) versus HMP in a pair of clinically discarded and pathologically confirmed thrombotic human donor kidneys. During perfusion with urokinase for 1 h, improvement of kidney appearance, perfusion flow, urine production, thrombus break‐down, and plasminogen consumption were all greater with NMP than with HMP. The renal glomerular thrombosis rate in the NMP‐treated kidney decreased from 13.3% (2 in 15) to 8.3% (1 in 12) after 30 min of urokinase administration, accompanied by decreased levels of plasminogen in the renal tubular cells (the positive area decreased from 13.1% to 7.5%). In contrast, both the renal glomerular thrombosis rate and plasminogen level were unchanged during HMP. Furthermore, D‐dimer in the NMP perfusate increased rapidly from 1.55 to 7.33 µg/mL, compared with from 0.33 µg/mL to 0.86 µg/mL in HMP perfusate. Our findings indicate that the effect of urokinase to facilitate rapid thrombolysis before transplantation is greater when administered by NMP than by HMP. NMP can, therefore, improve donor kidney quality more efficiently than HMP.

Difficulties in the differential diagnosis of comorbid fluid and electrolyte balance disorders: description of a clinical case

Difficulties in the differential diagnosis of comorbid fluid and electrolyte balance disorders: description of a clinical case

Part II. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?

Creatine monohydrate supplementation (CrM) is a safe and effective intervention for improving certain aspects of sport, exercise performance, and health across the lifespan. Despite its evidence-based pedigree, several questions and misconceptions about CrM remain. To initially address some of these concerns, our group published a narrative review in 2021 discussing the scientific evidence as to whether CrM leads to water retention and fat accumulation, is a steroid, causes hair loss, dehydration or muscle cramping, adversely affects renal and liver function, and if CrM is safe and/or effective for children, adolescents, biological females, and older adults. As a follow-up, the purpose of this paper is to evaluate additional questions and misconceptions about CrM. These include but are not limited to: 1. Can CrM provide muscle benefits without exercise? 2. Does the timing of CrM really matter? 3. Does the addition of other compounds with CrM enhance its effectiveness? 4. Does CrM and caffeine oppose each other? 5. Does CrM increase the rates of muscle protein synthesis or breakdown? 6. Is CrM an anti-inflammatory intervention? 7. Can CrM increase recovery following injury, surgery, and/or immobilization? 8. Does CrM cause cancer? 9. Will CrM increase urine production? 10. Does CrM influence blood pressure? 11. Is CrM safe to consume during pregnancy? 12. Does CrM enhance performance in adolescents? 13. Does CrM adversely affect male fertility? 14. Does the brain require a higher dose of CrM than skeletal muscle? 15. Can CrM attenuate symptoms of sleep deprivation? 16. Will CrM reduce the severity of and/or improve recovery from traumatic brain injury? Similar to our 2021 paper, an international team of creatine research experts was formed to perform a narrative review of the literature regarding CrM to formulate evidence-based responses to the aforementioned misconceptions involving CrM.

Early Albumin Administration in Veno-Arterial Extracorporeal Membrane Oxygenation.

The clinical outcome and fluid balance of patients with veno-arterial extracorporeal membrane oxygenation (VA ECMO) or after extracorporeal cardiopulmonary resuscitation (eCPR) may be improved by addressing the high fluid demand with an early albumin administration. In this prospective observational study, patients supported with VA ECMO or eCPR received early albumin administration (25 g/L) to prime the VA ECMO system. These patients were compared to patients who received a regimen based solely on balanced crystalloids (crystalloid group) or a regimen based on a 1:4 volume mixture of albumin (10 g/L) and balanced crystalloids (albumin group). 660 VA ECMO patients (66.4% eCPR) treated between January 2017 and June 2021 were analyzed, whereby 265 patients received crystalloid fluid therapy, 269 patients received albumin therapy, and 126 patients received early albumin therapy. When compared to the albumin and crystalloid groups, patients in the early albumin treatment group had significantly lower cumulative fluid balances (p < 0.05). However, this effect was only observed in the group of eCPR patients and not in patients with cardiogenic shock. Logistic regression revealed albumin administration as an independent predictor of increased survival (Odds ratio 1.66 (1.11-2.47) [95%-CI], p = 0.013). Yet, only eCPR patients showed a survival benefit from albumin administration compared to the crystalloid group (survival of 29.4% vs. 18.8%, p = 0.024). Early albumin administration in eCPR patients was linked to a significant decline in fluid balance. Moreover, volume therapy with albumin application was an independent predictor for improved survival in eCPR patients.

Impact on fluid balance of an optimized restrictive strategy targeting non-resuscitative fluids in intensive care patients with septic shock: a single-blind, multicenter, randomized, controlled, pilot study

BackgroundIn septic shock, the classic fluid resuscitation strategy can lead to a potentially harmful positive fluid balance. This multicenter, randomized, single-blind, parallel, controlled pilot study assessed the effectiveness of a restrictive fluid strategy aiming to limit daily volume.MethodsPatients 18–85 years’ old admitted to the ICU department of three French hospitals were eligible for inclusion if they had septic shock and were in the first 24 h of vasopressor infusion. Exclusion criteria were acute kidney injury requiring renal replacement therapy, end stage chronic kidney disease, and severe malnutrition. Patients were electronically randomized 1:1 to either an optimized fluid restriction (reducing fluid intake as much as possible in terms of maintenance fluids and fluids for drug dilution during the first 7 days) or standard fluid strategy. The primary outcome was cumulative fluid balance (ml/kg) in the first 5 days. Patients and statisticians were blinded to group arm, but not clinicians.ResultsBetween September 2021 and February 2023, 1201 patients were screened and 50 included, with two in the control group withdrawing, thus 48 patients were analyzed (24 in each group). In the first 5 days, the optimized restrictive strategy and control groups received 89.7 (IQR 35; 128.9) and 114.3 (IQR 78.8; 168.5) ml/kg of fluid, respectively (mean difference: 35.9 ml/kg [0.0; 71.8], p = 0.0506). After 5 days, the median cumulative fluid balance was 6.9 (IQR − 13.7; 52.1) and 35.0 (IQR − 7.9; 40.2) ml/kg in the optimized restrictive strategy and control groups, respectively (absolute difference 13.2 [95%CI − 15.2; 41.6], p = 0.42). After 28 days, mortality and the numbers of days alive without life support were similar between groups. The main adverse events were severe hypernatremia in 1 and 2 patients in the fluid restriction strategy and control groups, respectively, and acute kidney injury KDIGO 3 in 4 and 7 patients in the fluid restriction strategy and control groups, respectively.ConclusionsIn ICU patients with septic shock, an optimized restrictive fluid strategy targeting hidden fluid intakes did not reduce the overall fluid balance at day 5.Trial registration ClinicalTrials.gov identifier NCT04947904, registered on 1 July 2021.Graphical