Effect Of Intravenous Fluid Therapy Research Articles

Effect of intravenous fluid therapy for acute alcohol intoxication on length of time from arrival at the emergency department until awakening: A prospective observational cohort study.

To evaluate the association of intravenous fluid (IVF) therapy on the length of time from arrival at the emergency department (ED) until awakening in cases of acute alcohol intoxication. This single-center, prospective, observational study was conducted in the ED of the Self-Defense Forces Central Hospital during October 1, 2018 to July 31, 2019. Patients with 1,000 mL bolus of lactated Ringer's solution and those without bolus were compared. The primary outcome was the length of time until awakening. Secondary outcomes were the length of stay in the ED and occurrence of conditions requiring extra care. Predictors of the occurrence of any event requiring extra care were identified. We included 201 patients, of whom 109 received IVF and 92 did not. No significant difference existed in the baseline characteristics between the groups. The median length of time until awakening did not significantly differ between the groups (P = 0.77). Multivariable regression analysis adjusted by age, sex, hemoglobin, blood alcohol concentration, and initial Glasgow Coma Scale (GCS) score demonstrated that the regression coefficient of IVF for length of time until awakening was -9.55 (95% confidence interval [CI], -36.2 to 17.2). Hemoglobin (regression coefficient, 10.1; 95% CI, 0.38-19.9) and initial GCS score (regression coefficient, -7.51; 95% CI, -10.8 to -4.21) were significantly associated with length of time. IVF therapy was not associated with the length of time until awakening in patients with acute alcohol intoxication in the ED. Routine IVF administration was unnecessary.

Effect of Intravenous Fluid Therapy in Managing Acute Painful Crises in Sickle Cell Disease Patients

Background: Sickle cell disease (SCD), an autosomal recessive mutation leading to alterations in the shape of red blood cells, compromises their oxygen-carrying capacity, and is prevalent in Saudi Arabia. Individuals with SCD experience vaso-occlusive crises, leading to severe pain episodes. Although fluid administration is a common practice to deter the sickling process, limited data exist on its efficacy. Method: This substudy was preplanned within the published randomized control trial titled \"Ketamine Administration for Acute Painful Sickle Cell Crisis: A Randomized Controlled Trial,\" conducted at King Fahad University Hospital in Saudi Arabia in 2019. Results: The analysis included 139 patients. Both arms received equal amounts and types of analgesics, with 51.7% receiving up to 500 ml intravenous fluid and 48.3% receiving more than 500 ml. Of the participants, 23.7% were admitted to the hospital, while 76.3% were discharged. The average length of stay in the emergency department (ED) was 4.6 ± 2.1 hours. There was no significant difference in the average pain score between the arms at 30-120 minutes. However, patients who received more fluid (> 500 ml) exhibited a higher admission rate and a longer ED stay. Conclusions: The amount of fluid administered to SCD patients in the emergency department during a vaso-occlusive crisis did not show a significant difference in pain score improvement. Notably, patients receiving more fluid demonstrated longer ED stays and higher admission rates.

Statistical analysis plan for Better Evidence for Selecting Transplant Fluids (BEST-Fluids): a randomised controlled trial of the effect of intravenous fluid therapy with balanced crystalloid versus saline on the incidence of delayed graft function in deceased donor kidney transplantation

BackgroundDelayed graft function, or the requirement for dialysis due to poor kidney function, is a frequent complication of deceased donor kidney transplantation that is associated with inferior outcomes. Intravenous fluids with a high chloride content, such as isotonic sodium chloride (0.9% saline), are widely used in transplantation but may increase the risk of poor kidney function. The primary objective of the BEST-Fluids trial is to compare the effect of a balanced low-chloride crystalloid, Plasma-Lyte 148 (Plasmalyte), versus 0.9% saline on the incidence of DGF in deceased donor kidney transplant recipients. This article describes the statistical analysis plan for the trial.Methods and designBEST-Fluids is an investigator-initiated, pragmatic, registry-based, multi-centre, double-blind, randomised controlled trial. Eight hundred patients (adults and children) in Australia and New Zealand with end-stage kidney disease admitted for a deceased donor kidney transplant were randomised to intravenous fluid therapy with Plasmalyte or 0.9% saline in a 1:1 ratio using minimization. The primary outcome is delayed graft function (dialysis within seven days post-transplant), which will be modelled using a log-binomial generalised linear mixed model with fixed effects for treatment group, minimization variables, and ischaemic time and a random intercept for study centre. Secondary outcomes including early kidney transplant function (a ranked composite of dialysis duration and the rate of graft function recovery), treatment for hyperkalaemia, and graft survival and will be analysed using a similar modelling approach appropriate for the type of outcome.DiscussionBEST-Fluids will determine whether Plasmalyte reduces the incidence of DGF and has a beneficial effect on early kidney transplant outcomes relative to 0.9% saline and will inform clinical guidelines on intravenous fluids for deceased donor kidney transplantation. The statistical analysis plan describes the analyses to be undertaken and specified before completion of follow-up and locking the trial databases.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12617000358347. Prospectively registered on 8 March 2017ClinicalTrials.gov identifier NCT03829488. Registered on 4 February 2019

Study Protocol for Better Evidence for Selecting Transplant Fluids (BEST-Fluids): a pragmatic, registry-based, multi-center, double-blind, randomized controlled trial evaluating the effect of intravenous fluid therapy with Plasma-Lyte 148 versus 0.9% saline on delayed graft function in deceased donor kidney transplantation

BackgroundDelayed graft function, the requirement for dialysis due to poor kidney function post-transplant, is a frequent complication of deceased donor kidney transplantation and is associated with inferior outcomes and higher costs. Intravenous fluids given during and after transplantation may affect the risk of poor kidney function after transplant. The most commonly used fluid, isotonic sodium chloride (0.9% saline), contains a high chloride concentration, which may be associated with acute kidney injury, and could increase the risk of delayed graft function. Whether using a balanced, low-chloride fluid instead of 0.9% saline is safe and improves kidney function after deceased donor kidney transplantation is unknown.MethodsBEST-Fluids is an investigator-initiated, pragmatic, registry-based, multi-center, double-blind, randomized controlled trial. The primary objective is to compare the effect of intravenous Plasma-Lyte 148 (Plasmalyte), a balanced, low-chloride solution, with the effect of 0.9% saline on the incidence of delayed graft function in deceased donor kidney transplant recipients. From January 2018 onwards, 800 participants admitted for deceased donor kidney transplantation will be recruited over 3 years in Australia and New Zealand. Participants are randomized 1:1 to either intravenous Plasmalyte or 0.9% saline peri-operatively and until 48 h post-transplant, or until fluid is no longer required; whichever comes first. Follow up is for 1 year. The primary outcome is the incidence of delayed graft function, defined as dialysis in the first 7 days post-transplant. Secondary outcomes include early kidney transplant function (composite of dialysis duration and rate of improvement in graft function when dialysis is not required), hyperkalemia, mortality, graft survival, graft function, quality of life, healthcare resource use, and cost-effectiveness. Participants are enrolled, randomized, and followed up using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry.DiscussionIf using Plasmalyte instead of 0.9% saline is effective at reducing delayed graft function and improves other clinical outcomes in deceased donor kidney transplantation, this simple, inexpensive change to using a balanced low-chloride intravenous fluid at the time of transplantation could be easily implemented in the vast majority of transplant settings worldwide.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12617000358347. Registered on 8 March 2017. ClinicalTrials.gov: NCT03829488. Registered on 4 February 2019.

The Effect of Intravenous Fluid Therapy before Spinal Block on Postdural Headache in Women Undergoing Elective Cesarean Section: A Clinical Trial

The Effect of Intravenous Fluid Therapy before Spinal Block on Postdural Headache in Women Undergoing Elective Cesarean Section: A Clinical Trial

The Effect of Intravenous Fluid Therapy in Acute Migraine Attacks

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Intravenous Fluid Therapy Is Associated with a Reduced Incidence of Contrast-Induced Nephropathy but not with a Reduced Long-Term Incidence of Renal Dysfunction After Cardiac Catheterization.

Intravenous fluid (IVF) administration for the prevention of contrast-induced nephropathy (CIN) is considered standard of care, but the effect of IVF therapy on longer-term outcomes after radiocontrast dye administration is not well known. We studied 4367 patients undergoing coronary and peripheral angiography and intervention at a veterans' administration medical center. 2653 patients (61%) received IVF prior to the procedure and 1714 (39%) did not. Of the 4367 subjects 1962 (45%) had repeat creatinine values at 72 h and 3100 (70%) had repeat creatinine values at 3 months. CIN at 72 h occurred in 68 (6.7%) patients in the IVF group and in 87 patients (9.8%) in the group receiving no IVF (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.94-0.99; p = 0.004). At 3 months, renal dysfunction was seen in 224 (11.5%) patients of the IVF group versus 152 (13.1%) of the group receiving no IVF (OR 0.98, CI 0.96-1.01; p = 0.18). In adjusted analyses using a propensity score, IVF therapy was associated with a significant reduction in CIN occurrence at 72 h (OR = 0.97, (95% CI 0.94-0.99, p = 0.01) but was not associated with a change in the incidence of renal dysfunction at 3 months (OR 0.98, 95% CI 0.96-1.01. p = 0.18). In this cohort of US veterans, IVF administration was associated with a decreased incidence of CIN at 72 h but was not associated with a decreased incidence of renal dysfunction at 3 months.

A quantitative approach to intravenous fluid therapy in the syndrome of inappropriate antidiuretic hormone secretion

BackgroundA wide range of interesting mathematical models has been derived to predict the effect of intravenous fluid therapy on the serum sodium concentration (most notably the Adrogué–Madias equation), but unfortunately, these models cannot be applied to patients with disorders characterized by aberrant antidiuretic hormone (ADH) release, such as the syndrome of inappropriate ADH secretion (SIADH). The use of intravenous fluids in these patients should prompt caution, as the inability of the kidneys to properly dilute the urine can easily result in deterioration of hyponatremia.MethodsIn this report, a transparent and clinically applicable equation is derived that can be used to calculate the estimated effect of different types and volumes of crystalloid infusate on the serum sodium concentration in SIADH patients. As a “proof of concept”, we discuss five SIADH patient cases from our clinic. Alternatively, our mathematical model can be used to determine the infusate volume that is required to produce a certain desired change in the serum sodium concentration in SIADH patients.ConclusionThe presented model facilitates rational intravenous fluid therapy in SIADH patients, and provides a valuable addition to existing prediction models.

Intravenous Fluid for the Treatment of Emergency Department Patients With Migraine Headache: A Randomized Controlled Trial

The objective of this pilot study is to assess the feasibility and necessity of performing a large-scale trial to measure the effect of intravenous fluid therapy on migraine headache pain. This was a single-center, pilot randomized controlled trial. We randomized adult emergency department migraine headache patients to receive 1 L of normal saline solution during 1 hour (fluid group) or saline solution at 10 mL/hour for 1 hour (control group). All patients received intravenous prochlorperazine and diphenhydramine at the start of fluid administration. Participants and outcome assessors were blinded; nurses administering the intervention were not. Outcomes were assessed at 60 and 120 minutes, and 48hours. The primary outcome was the difference in the verbal pain rating (on a scale of 0 to 10) between 0 and 60 minutes. Key secondary outcomes included additional clinical endpoints, the rate of protocol completion, and the effectiveness of blinding. Fifty patients consented to participate; one withdrew, leaving 25 patients randomized to the fluid group and 24 in the no fluid group. The mean improvement in 0- to 60-minute pain score was 4.5 (95% confidence interval 3.7 to 5.3) in the fluid group and 4.9 (95% confidence interval 3.5 to 6.2) in the control group. Primary outcome data were collected for 49 of 50 enrolled patients, and only one participant correctly identified the group assignment. This pilot study showed no statistically significant treatment effect from fluid administration, but does not exclude the possibility of a clinically important treatment effect. The study protocol and approach to blinding are both feasible and effective.

The effect of intravenous fluid therapy in icteric neonates during phototherapy: A randomized clinical trial -

Jaundice is the most prevalent neonatal clinical complication. One of the causes of this disease is the insufficiency of mother's milk to feed the neonate. Therefore, fluid therapy is considered as one of the useful intervention to alleviate jaundice. This study was designed to examine the effect of intravenous fluid therapy on icteric neonates who are also treated by phototherapy. A clinical research was conducted on 100 icteric neonates hospitalized in the hospitals of the city of Kashan during the year 2014. They were randomly assigned into two equal groups of intervention and control groups. The case group was treated by photo plus fluid therapy whereas the control group was treated by the phototherapy only. The bilirubin level of neonates was measured at admission, 6, 12 and 24 hours after the start of the treatment in both groups. The rebound bilirubin level was measured 12 hours after the termination of the phototherapy. The results of analysis indicated that there was no significant difference in the bilirubin decrease between the photo plus fluid therapy and the phototherapy-only group after 6, 12 and 24 hours of treatment (p>0.05). However, when the bilirubin level of the treated group was very high there was a significant difference between the bilirubin decrease of the photo plus fluid therapy and the phototherapy group alone after 6, 12 and 24 hours of treatment (p<0.05). The level of bilirubin rebound in the photo plus fluid therapy was more than the control group and needed-phototherapy again; therefore, the time for the phototherapy in the photo plus fluid therapy was longer than the control group. Despite the fact that using fluid therapy in the group with very high level of bilirubin causes decrease of bilirubin level, it leads to the increase of bilirubin rebound and the need to use phototherapy again. Therefore, this treatment is useful for the cases of severe jaundice that require blood transfusion even though it results in longer periods of phototherapy and the length of hospitalization.

The effect of intravenous fluid therapy in icteric neonates during phototherapy: A randomized clinical trial

The effect of intravenous fluid therapy in icteric neonates during phototherapy: A randomized clinical trial

Are IV fluids useful for the treatment of large colon impactions?

Large colon impactions, defined as an accumulation of dehydrated ingesta (Plummer 2009), are a common cause of colic in the horse. The aetiology of colon impactions is not fully understood, although a dysfunction of intestinal motility has been suggested as have other management changes that lead to fluid shifts out of the large colon (Dabareiner and White 1995). Treatment of affected horses involves rehydration of ingesta whilst withholding feed and providing analgesia. Rehydration of ingesta is typically performed by administering fluids via nasogastric tube or intravenously; suggested to create a state of systemic overhydration and promote colonic secretion. Intravenous fluids are more expensive than oral fluids, require intravenous catheterisation and adequate facilities for fluid delivery, therefore it is important to critically evaluate the evidence pertaining to their use. Do intravenous fluids reduce treatment time when managing large colon impactions in the horse? Large colon impaction AND horse AND fluids Colonic hydration AND horse AND fluids Search one yielded 5 results of which 2 (Dabareiner and White 1995; Hallowell 2008) were relevant. Due to the relative paucity of clinical evidence, a further search was undertaken to include experimental studies of normal colon physiology, yielding 3 additional references (Lopes et al. 2002, 2004; Lester et al. 2013). Both Dabareiner and White (1995) and Hallowell (2008) are retrospective studies of hospital admissions, as such treatments were not randomly allocated and results are subject to selection bias and unblinded evaluation. Despite this Hallowell demonstrated no difference in admission data between treatment groups suggesting groups may be comparable. Treatment protocols were standardised in Hallowell's work with patients receiving one of 4 treatment protocols (IVFT or 3 different rates of nasogastric fluids), whereas treatments were not standardised by Dabareiner and White. See Table 1. Both Dabareiner and White (1995) and Hallowell (2008) included horses with naturally occurring large colon impactions, although cases were possibly more severe than encountered in first opinion practice given the referral population. In both studies fluids rates administered were comparable to those achievable in practice. Unfortunately the lack of an untreated control group means that it is not possible to determine if the use of intravenous fluids was beneficial. Three prospective cross-over studies investigating the effect of intravenous fluid therapy on hydration of colonic ingesta and faeces in clinically normal horses were identified (Lopes et al. 2002, 2004; Lester et al. 2013). In these studies each horse acted as its own control, treatment were standardised and order administered randomised, therefore the quality of evidence is higher. Although no untreated control group is present in 2 of these studies (Lopes et al. 2002; Lester et al. 2013) baseline levels of faecal hydration prior to interventions being performed are used to determine outcome. See Table 2. 1. IVFT + 1 g/kg bwt MgSO4 2. Oral fluids and MgSO4 10 l/h (16.8–22.8) ml/kg bwt/h for 6 h 1. IVFT 2. MgSO4 per os 3. NaSO4 per os 4. Water per os 5. Balanced electrolytes per os 6. No treatment The 2 studies by Lopes and co-workers were performed in clinically normal horses with right dorsal colon fistulation, without impactions of the large colon. How the results relate to the clinical case with a large colon impaction and disturbed gastrointestinal physiology is difficult to extrapolate. Lester et al. (2013) attempted to address this by withholding water for 24 h prior to comparing treatment effects, this resulted in an approximate 5–8% reduction in faecal water content. All 3 studies monitored change in faecal water content as their major outcome; however, the magnitude of change in faecal water content required to significantly contribute to the resolution of an impaction is unknown. The administration of 10 l/h (17–23 ml/kg bwt/h) of IVFT resulted in increases in faecal water content in healthy normovolaemic horses after 6 h, whilst this was not achieved at a lower dose of 5 l/h (9–11 ml/kg bwt/h) after 12 h. Increases in the faecal water content were observed in dehydrated horses treated with lower doses of IVFT (2, 4 and 6 ml/kg bwt/h). Intravenous fluids are beneficial in rehydrating the ingesta of the normal and dehydrated large colon, whether this translates to a clinical benefit in the treatment of the horse with a large colon impaction has not been established. A randomised prospective clinical trial to evaluate the use of different doses of i.v. fluids is required and study design would ideally include an untreated control group, although this may be ethically challenging to include. No conflicts of interests have been declared.

Effect of Intravenous Fluid Therapy on Postoperative Vomiting in Children Undergoing Tonsillectomy

Background Postoperative vomiting (POV) is one of the most frequent complications of tonsillectomy in children. The aim of this study was to evaluate the antiemetic effect of super-hydration with lactated Ringer's solution in children undergoing elective otorhinolaryngological surgery. Methods One hundred ASA I–II children, aged 1–12 yr, undergoing elective tonsillectomy, with or without adenoidectomy, under general anaesthesia were studied. Induction and maintenance of anaesthesia were standardized with fentanyl, mivacurium, and sevoflurane in N2O/O2. Subjects were assigned to one of the two groups: 10 ml kg−1 h−1 lactated Ringer's solution or 30 ml kg−1 h−1 lactated Ringer's solution. A multivariable logistic regression was used for assessing the effects of super-hydration on POV (defined as the presence of retching, vomiting, or both). A value of P Results During the first 24 h postoperative, the incidence of POV decreased from 82% to 62% (relative reduction of 24%, P=0.026). In the adjusted logistic regression model, subjects in the 10 ml kg−1 h−1 group had an odds ratio of POV that was 2.92 (95% confidence interval: 1.14, 7.51) for POV compared with subjects in the 30 ml kg−1 h−1 group. Conclusions Intraoperative administration of 30 ml kg−1 h−1 lactated Ringer's solution significantly reduced the incidence of POV during the first 24 h postoperative. Our results support the use of super-hydration during tonsillectomy, as an alternative way to decrease the risk of POV in children.

Effect of intravenous fluid therapy on postoperative vomiting in children undergoing tonsillectomy

Postoperative vomiting (POV) is one of the most frequent complications of tonsillectomy in children. The aim of this study was to evaluate the antiemetic effect of super-hydration with lactated Ringer's solution in children undergoing elective otorhinolaryngological surgery. One hundred ASA I-II children, aged 1-12 yr, undergoing elective tonsillectomy, with or without adenoidectomy, under general anaesthesia were studied. Induction and maintenance of anaesthesia were standardized with fentanyl, mivacurium, and sevoflurane in N(2)O/O(2). Subjects were assigned to one of the two groups: 10 ml kg(-1) h(-1) lactated Ringer's solution or 30 ml kg(-1) h(-1) lactated Ringer's solution. A multivariable logistic regression was used for assessing the effects of super-hydration on POV (defined as the presence of retching, vomiting, or both). A value of P<0.05 was considered statistically significant. During the first 24 h postoperative, the incidence of POV decreased from 82% to 62% (relative reduction of 24%, P=0.026). In the adjusted logistic regression model, subjects in the 10 ml kg(-1) h(-1) group had an odds ratio of POV that was 2.92 (95% confidence interval: 1.14, 7.51) for POV compared with subjects in the 30 ml kg(-1) h(-1) group. Intraoperative administration of 30 ml kg(-1) h(-1) lactated Ringer's solution significantly reduced the incidence of POV during the first 24 h postoperative. Our results support the use of super-hydration during tonsillectomy, as an alternative way to decrease the risk of POV in children.

A prospective randomized blinded study of the effect of intravenous fluid therapy on postoperative nausea and vomiting in children undergoing strabismus surgery

Nausea and vomiting is a common postoperative complication that often necessitates the use of antiemetic agents. In a prospective, randomized, double blind trial, the effect of perioperative fluid administration on postoperative adverse outcomes following anesthesia was studied. One hundred children undergoing strabismus repair were randomly assigned to receive 10 ml x kg(-1) x h(-1) (control group) or 30 ml x kg(-1) x h(-1) (superhydration group) of lactated Ringer's solution during the operation. During the first 24 h postoperatively, nausea and vomiting, thirst, pain, and fever were evaluated. Groups were similar with respect to demographic data, surgical procedures and baseline hemodynamic variables. In the first 24 h postoperatively, nausea and vomiting occurred in 27 patients (54%) of the control group and 11 (22%) of patients in the superhydration group (P = 0.001). Comparison of the superhydration group with the control group also showed a statistically significant benefit of superhydration on postoperative thirst (P = 0.0002) and fever (P = 0.02). The differences in nausea and vomiting, thirst, and fever remained significant after adjustment for age, gender, weight, and duration of surgery. There was no significant difference between the two groups in postoperative pain. Intravenous superhydration administration is an inexpensive and safe therapy for reducing postoperative nausea and vomiting and discomfort.

A Prospective Randomized Double-Blinded Study of the Effect of Intravenous Fluid Therapy on Adverse Outcomes on Outpatient Surgery

This study investigated the impact of perioperative fluid status on adverse clinical outcomes in ambulatory surgery.Two hundred ASA grade I-III ambulatory surgical patients were prospectively randomized into two groups to receive high (20 mL/kg) or low (2 mL/kg) infusions of isotonic electrolyte solution over 30 min preoperatively. A standardized balanced anesthetic was used. A minimal amount of fluid was given during the intraoperative and postoperative periods. Adverse outcomes were assessed by an investigator blinded to the fluid treatment group at 30 and 60 min after surgery, at discharge, and the first postoperative day. The incidence of thirst, drowsiness, and dizziness was significantly lower in the high-infusion group at all intervals. We recommend perioperative hydration of 20 mL/kg for patients undergoing general anesthesia for short ambulatory surgery. (Anesth Analg 1995;80:682-6)