Fluid Intake Research Articles

Conservative fluid resuscitation protocol does not reduce the incidence of reoperation for bleeding after emergency CABG

Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG.Trial registration: www.clinicaltrials.gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic.clinicaltrials.gov/ct2/show/NCT04533698

EP33 - Nil by mouth in GI surgery: are we starving our patients longer than we need to?

Abstract Aim Fluid intake preoperatively reduces postoperative nausea, vomiting and headache, and oral intake allows the patient to be metabolically active to respond better to surgery. However, a known risk to oral intake preoperatively is aspiration. Current guidelines state that a patient should be fasted from 6 hours preoperatively and should take clear fluids up to 2 hours preoperatively. We assessed how long GI patients admitted to the Surgical Assessment Unit (SAU) remained nil by mouth (NBM). Method Data was collected throughout November from SAU. Inclusion criteria was GI surgical patients and exclusion criteria was patients on home leave. We used electronic and paper notes to determine how long patients were kept NBM and their surgical outcome. We assumed that a patient was kept NBM from their admission (as per local protocol), until either noted to no longer be NBM, having surgery or being discharged. Results 50 patients were identified. We found that only 20% of patients kept nil by mouth went on to have surgery. Of the remaining 80%, 60% were kept nil by mouth for >6 hours, with no surgical procedures. Conclusions Many patients are kept NBM unnecessarily. We need to reduce this as well as the time patients are starved. Furthermore, clearer documentation is needed for commencing patients NBM, and when they can resume eating. We can move away from the culture of prolonged fasting in surgical patients by improving organisation and planning as well as increasing education on preoperative fasting.

International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis.

The aim of this study was to construct the sixth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the management of pediatric patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of literature in the PubMed database from January 1952 to December 2023. Each generated recommendation was graded using a modified GRADE methodology. Recommendations are agreed upon by Panel Members following review and discussion of the evidence. Guideline recommendations were developed that addressed the following topics: etiology, risk factors, clinical presentation and symptoms, diagnosis, conservative management, surgical interventions, prevention, and follow-up. Similarities in the treatment of primary stone episodes between children and adults, incorporating conservative management and advancements in technology for less invasive stone removal, are evident. Additionally, preventive strategies aiming to reduce recurrence rates, such as ensuring sufficient fluid intake, establishing well-planned dietary adjustments, and selective use pharmacologic therapies will also result in highly successful outcomes in pediatric stone patients. Depending on the severity of metabolic disorders and also anatomical abnormalities, a careful and close follow-up program should inevitably be planned in each pediatric patient to limit the risk of future recurrence rates.

Adjudication of Self-reported Symptomatic Stone Recurrence in the Prevention of Urinary Stones With Hydration Trial

ObjectiveTo assess accuracy of self-reported stone events in a large clinical trial by adjudication against the weight of documentation for spontaneous stone passage or surgical intervention. MethodsParticipants in the Prevention of Urinary Stones with Hydration (PUSH) trial were randomized to a multi-component behavioral intervention or control arm to increase and maintain high fluid intake. The primary endpoint was urinary stone events including symptomatic stone passage or procedural intervention. An independent adjudication committee blinded to randomization assignments reviewed all events. Confirmed clinical stone events required typical stone symptoms and documentation of stone passage (e.g., via photograph, clinical record) and/or surgical intervention. Events with typical symptoms and self-described stone passage but without objective documentation of passage were also considered as meeting the primary endpoint and classified separately as patient-reported passage. Non-events did not meet either criteria. ResultsAt time of this blinded analysis, a total of 1658 participants were randomized and had a median follow-up of 19 months. Self-reported stone events (n=217) were adjudicated by the committee as either confirmed clinical events (134; 61.8%), patient-reported passage (71; 32.7%), or non-events (12; 5.5%). Confirmed clinical events consisted of stone passage in 66/134 and procedural interventions in 68/134 (53 for symptoms and 15 without symptoms). ConclusionsRigorous adjudication revealed that self-reported stone events in the PUSH trial overwhelmingly represented clinically documented passage, surgical intervention, and patient-reported passage outside healthcare settings, with only 5.5% failing to satisfy adjudication criteria. Similar adjudication and classification processes warrant consideration for implementation in future stone trials. Clinical Trials RegistrationNCT03244189

Risk factors associated with early childhood diarrhea: a case-control study

Purpose This study aims to explore the link between prevalent risk factors for early childhood diarrhea, including hygiene, feeding, weaning practices and maternal education and the occurrence and severity of early childhood diarrhea in Saudi Arabia. Design/methodology/approach A case-control study was conducted, involving 98 mothers from the Eastern Region of Saudi Arabia (51 cases and 47 controls). Data were collected from both hospital and community sources. The collected data were statistically analyzed and depicted using descriptive statistics and frequency tables. Findings Demographic data revealed that 60% of mothers were housewives, 75% had normal deliveries and all babies were full term. In the study cohort, 44% of children aged one to two years. Four domains were compared: diarrheal management, hygiene, weaning and feeding practices. Diarrheal management was suboptimal in some cases: 29% increased fluid intake, 10% maintained adequate food intake, 50% sought medical advice, 58% were familiar with oral rehydration solutions and only 37% used them. Hygiene practices were deficient, with 35% using wipes or sanitizers, 64% handwashing before feeding and 52% adhering to the recommended 10-s duration. Controls exhibited better hygiene practices. Weaning practices were generally similar, with no significant differences between the two groups. Originality/value To the best of the authors’ knowledge, this is the first study to collectively report on the risk factors linked to early childhood diarrhea in Saudi Arabia. This study yields significant insights, highlighting the crucial role of managing diarrhea, educating mothers and implementing proper household practices in impacting the occurrence and severity of this perilous ailment.

Comparison of short-term clinical efficacy between modified Kamikawa anastomosis and double tract anastomosis after laparoscopic proximal gastrectomy.

This study aimed to explore the short-term clinical efficacy of modified Kamikawa anastomosis and double tract anastomosis after laparoscopic proximal gastrectomy. A retrospective analysis was carried out by collecting the clinical and pathological data of 42 patients who underwent laparoscopic proximal gastrectomy after admission in our centre from May 2020 to October 2022. Among the 42 enrolled patients, 22 underwent modified Kamikawa anastomosis (modified Kamikawa group), and the other 20 underwent double tract anastomosis (double tract group). Outcome measures included intraoperative condition, postoperative recovery, postoperative quality of life, postoperative nutritional status and gastroesophageal reflux. The patients were followed up using outpatient examination and telephone interviews to identify their nutritional status, reflux esophagitis and anastomotic status. (1) Intraoperative condition: Compared with the double tract group, the modified Kamikawa group had significantly prolonged time for operation and digestive tract reconstruction. However, no statistically significant difference in intraoperative blood loss was found between the two groups. (2) Postoperative recovery: Compared with the double tract group, the modified Kamikawa group had a significantly shorter time for the first postoperative intake of fluids, drainage tube placement and postoperative hospital stay. No statistically significant difference in the time to first postoperative anal exhaust and postoperative complications was found between the two groups. (3) Postoperative quality of life: Compared with the double tract group, the modified Kamikawa group showed better quality of life at 12 months after surgery. (4) Postoperative nutritional status and gastroesophageal reflux: No statistically significant difference in hemoglobin, total serum albumin, albumin, body mass index, MUST score, PG-SGA score, grading of reflux esophagitis using the Los Angeles classification system and GERD score was found between the two groups at 6 and 12 months after surgery. All patients did not experience anastomotic stenosis and tumour recurrence or metastasis. Modified Kamikawa anastomosis is a safe and feasible treatment in laparoscopic proximal gastrectomy, which can ensure good postoperative anti-reflux effect and nutritional status. It has the advantage of better postoperative recorvery and quality of life compared with double tract anastomosis.

Subdiaphragmatic activity-related artifacts in myocardial perfusion scintigraphy.

Myocardial perfusion imaging (MPI) with single photon emission computed tomography is an established non-invasive technique for assessing myocardial ischemia. This method involves the intravenous administration of a radiopharmaceutical that accumulates in the heart muscle proportional to regional blood flow. However, image quality and diagnostic accuracy can be compromised by various technical and patient-related factors, including high non-specific radiopharmaceutical uptake in abdominal organs such as the stomach, intestines, liver, and gall-bladder, leading to subdiaphragmatic artifacts. These artifacts are particularly problematic for evaluating inferior wall perfusion and often necessitate repeated imaging, which decreases gamma camera availability and prolongs imaging times. Despite numerous investigated techniques to reduce interfering gastrointestinal activity, results have been inconsistent, and current MPI guidelines provide scant information on effective procedures to mitigate this issue. Based on our experience, some possible approaches to reducing artifacts include choosing stress testing with an exercise stress test, when possible, late imaging, fluid intake, and consuming carbonated water immediately before imaging.

Nutritional habits of professional team sport athletes: An insight into the carbohydrate, fluid, and caffeine habits of English Premier League football players during match play

ABSTRACT To better understand the in-match fuelling practices of elite football players and compare against current guidelines, we quantified the carbohydrate, fluid, and caffeine intake of players from an English Premier League club (n = 22) during 90 min of competitive match-play. Mean carbohydrate intake across match-play was 17 ± 11 g.h−1 with players demonstrating a preference towards CHO-containing fluids (58%) when compared with semi-solids (38%) and solids (14%), respectively. CHO intake was significantly lower than reported by players (17 ± 11 vs 24.8 ± 11 g.h−1, p < 0.001) during initial consultation. Fluid was ingested at a rate of 0.45 ± 0.14 L.h−1, with 54, 40 and 6% of ingested fluid coming from water, carbohydrate, and electrolyte-only solutions, respectively. The majority of players (91%) met the UEFA guidelines for fluid consumption. Of the players who consumed caffeine across match-play (55%) the average dose was 233 ± 148 mg (2.8 ± 1.1 mg.kg−1 body mass [BM]), which meets the UEFA consensus guidelines for caffeine intake. Caffeine capsules (42%) and caffeine containing fluids (30%) were the preferred format prior to the warm-up whilst caffeine gum was exclusively used prior to kick-off and during the half-time period (100%). We conclude that 81% of the total playing squad failed to meet the current UEFA CHO intake recommendations of 30–60 g.h−1, which may be attributed to the preference towards fluid-based CHOs as the chosen format of delivery.

Daily and Weekly Urine Variations in Bacterial Growth Susceptibility in Postmenopausal Women With no History of Urinary Tract Infection: A Pilot Study

ObjectivesTo evaluate bacterial growth in the bladder as a major virulence factor during urinary tract infections (UTIs), we assessed the variability of uropathogenic bacterial growth in urine samples over multiple timepoints from three postmenopausal women with no history of UTI. MethodsFollowing IRB approval, postmenopausal women who never had a UTI provided mid-stream urine samples three times daily (8 a.m., 12 p.m. and 4 p.m.), twice a week over two weeks, as well as dietary intake logs. Each sample was studied for pH and bacterial growth using three uropathogenic Escherichia coli (E.coli) strains (LRPF007, KE40, UTI89), one uropathogenic Enterococcus faecalis strain (HRH40), and one non-pathogenic E. coli strain (W3110). ResultsSimilar mean growth yields were observed for the uropathogenic strains (mean ∆OD600 = 0.1 – 0.13) with high variability (standard deviation (SD) = 0.13 – 0.28) and lower mean growth for the non-pathogenic strain (mean ∆OD600 = 0.05). Urine from each individual at different collection times never had the same bacterial growth potential for any bacterial strain. There were significant associations between urine pH decrease with higher fat (p=0.017), vitamin D (p=0.02), magnesium (p=0.049), fluid (p=0.013), and ash (p=0.01) intake. ConclusionsMajor variations were observed in the bacterial growth response in the urine of the same individuals. These variations imply a requirement for a normalization procedure, e.g., growth in synthetic urine, for analysis of bacterial growth in urine. There were significant associations between decreased urine pH and several nutrients found in foods that are classified as highly acidic.

Functional Changes in the Expression of the Aqp4 Gene in the Hypothalamus Under the Influence of Drinking Regimen and Arterial Hypertension in Rats

Aquaporin-4 (AQP4) is the main water channel in the central nervous system. AQP4 is densely expressed in brain structures suggesting a crucial role in water transport in normal conditions and in disease. The effect of changes in drinking regime (water-deprivation and hyperhydration) and inherited arterial hypertension on the expression of the AQP4 water channel gene in the hypothalamus, the center of regulation of visceral functions, was studied. It was shown that the level of the Aqp4 mRNA in hyperhydrated animals more than 1.5 times lower than in animals with water-deprivation. This decrease in the Aqp4 gene expression in the hypothalamus may be associated with the ability to prevent cytotoxic edema during increased fluid intake. Rats with inherited stress induced arterial hypertension (ISIAH) are characterized by an increased level of Aqp4 mRNA in the hypothalamus, which suggests the involvement of this channel in processes associated with the regulation of brain water balance during arterial hypertension and the prevention of vasogenic cerebral edema. Thus, the presence of the AQP4 water channel in the brain, associated with the protection of brain cells, is functionally determined by the state of the body. This may be evidenced by bidirectional changes in the Aqp4 gene expression during hyperhydration and arterial hypertension.

Skimmed, Lactose-Free Milk Ingestion Postexercise: Rehydration Effectiveness and Gastrointestinal Disturbances Versus Water and a Sports Drink in Physically Active People.

Postexercise hydration is fundamental to replace fluid loss from sweat. This study evaluated rehydration and gastrointestinal (GI) symptoms for each of three beverages: water (W), sports drink (SD), and skimmed, lactose-free milk (SLM) after moderate-intensity cycling in the heat. Sixteen college students completed three exercise sessions each to lose ≈2% of their body mass. They drank 150% of body mass loss of the drink assigned in randomized order; net fluid balance, diuresis, and GI symptoms were measured and followed up for 3hr after completion of fluid intake. SLM showed higher fluid retention (∼69%) versus W (∼40%; p < .001); SD (∼56%) was not different from SLM or W (p > .05). Net fluid balance was higher for SLM (-0.26kg) and SD (-0.42kg) than W (-0.67kg) after 3hr (p < .001), resulting from a significantly lower diuresis with SLM. Reported GI disturbances were mild and showed no difference among drinks (p > .05) despite ingestion of W (1,992 ± 425ml), SD (1,999 ± 429ml), and SLM (1,993 ± 426ml) in 90min. In conclusion, SLM was more effective than W for postexercise rehydration, showing greater fluid retention for the 3-hr follow-up and presenting with low-intensity GI symptoms similar to those with W and SD. These results confirm that SLM is an effective option for hydration after exercise in the heat.

Dietary Needs, Barriers, and Facilitators Among Patients on Hemodialysis and Their Caregivers: The GoodRENal Project in Spain

ObjectiveDietary restrictions are common in patients undergoing hemodialysis (HD). These restrictions result in a complex diet that becomes difficult for patients to understand and to follow. Therefore, we aimed to identify dietary needs, and barriers and facilitators that influence the adherence to dietary recommendations as perceived by patients on HD and their caregivers. MethodsSeventy-two Spanish patients on HD and fifty-seven caregivers participated in this explorative study by replying a questionnaire consisting of 20 and 10 questions respectively. The responses were assessed using a Likert scale varying from 1 to 5 (strongly agree, agree, neither disagree or disagree, disagree, strongly disagree, respectively) to evaluate the perception of patients and caregivers regarding dietary needs, barriers and facilitators to adhere to the recommended diet. For analysis purposes, the responses were grouped in three categories (agree, neither agree or disagree, disagree). ResultsSeventy percent of the patients agreed that knowing the food sources of potassium, protein and phosphate was a need for them to know to be able to adhere to the dietary recommendations. Moreover, patients stated that not being able to eat what they liked, and feeling thirsty, were important barriers. For caregivers, the support of a renal dietitian was mentioned as an important facilitator to assist those they cared for to adhere to the diet. ConclusionsKnowing food sources of potassium, phosphate, and protein, exploring foods patients like to eat and adjusting fluid intake to avoid feeling thirsty were identified as important by the patients. These findings can be used to develop strategies and educational material to improve the dietary adherence in patients undergoing HD. Moreover, the presence of a renal dietitian was identified as an important resource by the caregivers.

Correlation Mineral Water Consumption and Hemoglobin Levels in Adolescent Girls

Anemia is a global health issue that affects people of all ages, particularly adolescent girls. Adolescent girls require nutritional intake, both from food and water. According to the balanced nutrition guidelines, people (particularly adolescents and adults) require 2000 liters (or eight glasses) of water daily. Most adolescent girls barely consider their water consumption. A lack of water in the body affects the balance of minerals (salt and sugar), disrupting regular metabolic processes such as hemoglobin (Hb) level regulation. This study investigates the correlation between adolescent girls' water consumption and hemoglobin levels. This quantitative study uses a cross-sectional design to collect variable data at a certain time. The study used blood with anti-coagulants EDTA from 30 adolescent girls from Universitas Muhammadiyah Semarang. The primary data for this study are water consumption and hemoglobin levels. Results of the research show that adolescent girls' water consumption was adequate (66.7%) and low (33.3%). The average Hb level among adolescent girls was 12.4 g/dL. Adequate water consumption resulted in 3 respondents with low Hb levels and 7 with normal Hb levels. In contrast, low water consumption resulted in 2 respondents with low Hb levels and 18 with normal Hb levels. The Rank-Spearman correlation test showed sig 0.177 (p&gt;0.05). The study concluded that there was no correlation between adolescent girl water consumption and hemoglobin levels. Food fluid intake can compensate for a lack of water consumption.

How hemodialysis patients manage dietary and fluid intake? A descriptive qualitative study

Background: Managing dietary and fluid intake for hemodialysis patients is crucial, but it is also challenging. Non-compliance to diet and fluid intake restriction may increase a patient’s morbidity and mortality. Exploring the experiences of hemodialysis patients who successfully manage those regimens may provide new insight to develop more effective strategies. Purpose: The study aimed to explore the experiences of hemodialysis patients who successfully manage the dietary and fluid intake restrictions. Methods: A descriptive qualitative study was applied. Semi–structured interviews were conducted with 15 hemodialysis patients purposively recruited from a hemodialysis unit of a public hospital in West Sumatera, Indonesia. Interviews were transcribed verbatim and thematically analyzed to describe the phenomenon of hemodialysis patients. The study was reported following the COREQ guidelines. Results: Most participants in this study are female, aged between 38 – 63 years and length of hemodialysis 4 months – 6 years. The finding of this study was that the essential themes that explained how hemodialysis patients adhere to fluid and dietary restrictions are 1) strategies for restricting fluid and dietary intake, 2) motivation to restrict fluid and dietary intake, 3) fear of the effects of non-adherence to fluid and dietary restrictions and 4) social support.

Early oral hydration on demand in postanesthesia care unit effectively relieves postoperative thirst in patients after gynecological laparoscopy: a prospective randomized controlled trial

BackgroundPostoperative thirst is one of the most intense, common and easily ignored subjective discomforts in patients after gynecological surgery. This study aimed to investigate whether early oral hydration on demand in the postanesthesia care unit (PACU) after gynecological laparoscopy under general anesthesia can appease postoperative thirst and increase patient comfort.MethodsParticipants were randomized into the intervention and control groups. Patients in the intervention group were allowed to achieve early oral hydration on demand in the PACU if they were evaluated as fully conscious, with stable vital signs, grade 5 muscle strength, and well-recovered cough and swallowing reflex. However, the total amount of water intake throughout the entire study should not exceed 0.5mL/kg. During the study, the frequency of water intake, the total amount of water intake and adverse events were accurately recorded. The control group was managed according to the routine procedures and began to drink water 2 h after anesthesia. The intensity of thirst and subjective comfort in patients were assessed using the visual analog scale (VAS) when they entered and left the PACU.ResultsNo statistically significant differences were identified in age, height, weight, body mass index, pre-operative fasting time, duration of surgery, intraoperative fluid intake, intraoperative blood loss, intraoperative urine volume, and thirst intensity and subjective comfort scores between the groups before intervention (P > 0.05). After intervention, the VAS score for thirst intensity in the intervention group significantly decreased (P < 0.05), and the VAS score for subjective comfort in the intervention group significantly increased (P < 0.05). No adverse events were detected in both groups during the entire study.ConclusionEarly oral hydration on demand in the PACU can safely and effectively relieve postoperative thirst in patients, and improve patient comfort after gynecological laparoscopy.Trial registrationThis single-center, prospective, randomized controlled trial was registered at the Chinese Clinical Trial Center on April 27, 2023. The registration number of this study is ChiCTR2300070985.

Resection of the extra vertebral portion of the filum terminale plus sphincterectomy. Case Report

Introduction: Constipation is a gastrointestinal disorder that causes less frequent bowel movements, difficult stools, pain, and stiffness. Acute constipation can cause intestinal obstruction and may even require surgery. The pathogenesis is multifactorial and focuses on genetic predisposition, socioeconomic status, low fiber consumption, lack of sufficient fluid intake, lack of mobility, changes in hormonal balance, side effects of medications or body anatomy. Chronic constipation is a complex condition in older people characterized by difficulty defecating. In this sense, this situation is closely related to the patient's quality of life and the consumption of health resources. Clinical Case: male patient who reports chronic constipation for a year, presents for 24 hours a clinical condition characterized by vomiting of food content on 4 occasions, reports abdominal distension accompanied by flatulence and dyspepsia, during hospitalization an episode of hematochezia versus rectal bleeding is evident. Evolution: Chronic Constipation is diagnosed and Resection Technique of the extravertebral portion of the filum terminalis plus posterior internal sphincterectomy is used. Conclusions: The Resection Technique of the extravertebral portion of the filum terminalis plus posterior internal sphincterectomy has demonstrated excellent benefits in the management of pediatric patients with chronic constipation.

Dietary Strategies in the Prevention and Treatment of Hypertension in Children and Adolescents: A Narrative Review.

This study aims to gather information on effective dietary strategies for the prevention and treatment of hypertension (HTN) in children and adolescents. It discusses specific nutritional models such as the Diet Approaches to Stop Hypertension (DASH diet), traditional Asian diets, plant-based diets, the Southern European traditional Atlantic diet, and the Mediterranean diet, highlighting the benefits of these approaches. The manuscript also addresses dehydration resulting from insufficient fluid intake among children, as well as the consumption of inappropriate beverages, like soft drinks and energy drinks, which contributes to the development of HTN. Additionally, it examines the role of oxidative stress in the pathomechanism of HTN in children, particularly in relation to the antioxidant potential of food components such as selenium, magnesium, and selected vitamins. The relationship between sodium and potassium intake from food and the development of HTN in children is also explored. Finally, this study discusses public health strategies for the prevention of HTN in children. A comprehensive search was performed across multiple databases, such as PubMed/MEDLINE, the Cochrane Library, Science Direct, and EBSCO. This search focused on locating English-language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from around the globe.

Neonatal nutrition and early childhood body composition in infants born extremely preterm

Previous studies have observed changes in fat and fat-free mass among preterm infants when compared to term-born infants. However, these studies have mainly focused on moderate or very preterm infants, with a scope limited to the first few years of life. We aimed to compare body composition in extremely preterm infants to term-born infants in early childhood. Additionally, we investigated whether early neonatal nutrition was associated with the distribution of fat- and fat-free mass in later life. The study used dual-energy x-ray absorptiometry to evaluate the body composition of 52 children aged 6-9-years, of whom 35 were born extremely preterm and 17 were born at term and was analyzed using multivariate linear regression. Nutritional intakes of fluids, energy, and macronutrients during the first eight postnatal weeks for 26 extremely preterm infants were investigated in relation to body composition at age 6-9 years using Bayesian regression analysis and Gradient Boosting Machine. Children born extremely preterm had smaller head circumference (confidence interval -8.7 to -1.7), shorter height (confidence interval -2.7 to -0.6), higher waist to height ratio (confidence interval 0.01-0.05) and lower fat-free mass (confidence interval -3.9 to -0.49), compared to children born at full-term. Children born extremely preterm had a differing response to amount of fluid and macronutrient intake for both fat mass index and fat-free mass index. A bimodal response showed high intake of fluid and macronutrients as associated with high fat mass index for some children, whereas others demonstrated an inverse association, suggesting analysis on cohort-level as problematic. Childhood body composition differs between extremely preterm infants and term-born infants. Extremely preterm infants display differing responses in their body composition to varying levels of fluids and macronutrient intake during the neonatal period.

Non-invasive technology to assess hydration status in advanced cancer to explore relationships between fluid status and symptoms: an observational study using bioelectrical impedance analysis

BackgroundOral fluid intake decreases in advanced cancer in the dying phase of illness. There is inadequate evidence to support the assessment, and management, of hydration in the dying. Bioelectrical impedance analysis (BIA) is a body composition assessment tool. BIA has the potential to inform clinal management in advanced cancer, by examining the relationships between hydration status and clinical variables.AimBIA was used to determine the association between hydration status, symptoms, clinical signs, quality-of-life and survival in advanced cancer, including those who are dying (i.e. in the last week of life).Materials and methodsWe conducted a prospective observational study of people with advanced cancer in three centres. Advance consent methodology was used to conduct hydration assessments in the dying. Total body water was estimated using the BIA Impedance index (Height – H (m)2 /Resistance – R (Ohms)). Backward regression was used to identify factors (physical signs, symptoms, quality of life) that predicted H2/R. Participants in the last 7 days of life were further assessed with BIA to assess hydration changes, and its relationship with clinical outcomes.ResultsOne hundred and twenty-five people participated (males n = 74 (59.2%), females, n = 51 (40.8%)). We used backward regression analysis to describe a statistical model to predict hydration status in advanced cancer. The model demonstrated that ‘less hydration’ (lower H2/R) was associated with female sex (Beta = -0.39, p < 0.001), increased appetite (Beta = -0.12, p = 0.09), increased dehydration assessment scale score (dry mouth, dry axilla, sunken eyes - Beta = -0.19, p = 0.006), and increased breathlessness (Beta = -0.15, p = 0.03). ‘More hydration’ (higher H2/R) was associated with oedema (Beta = 0.49, p < 0.001). In dying participants (n = 18, 14.4%), hydration status (H2/R) was not significantly different compared to their baseline measurements (n = 18, M = 49.6, SD = 16.0 vs. M = 51.0, SD = 12.1; t(17) = 0.64, p = 0.53) and was not significantly associated with agitation (rs = -0.85, p = 0.74), pain (rs = 0.31, p = 0.23) or respiratory tract secretions (rs = -0.34, p = 0.19).ConclusionsThis is the first study to use bioimpedance to report a model (using clinical factors) to predict hydration status in advanced cancer. Our data demonstrates the feasibility of using an advance consent method to conduct research in dying people. This method can potentially improve the evidence base (and hence, quality of care) for the dying. Future BIA research can involve hydration assessment of cancers (according to type and stage) and associated variables (e.g., stage of illness, ethnicity and gender). Further work can use BIA to identify clinically relevant outcomes for hydration studies and establish a core outcome set to evaluate how hydration affects symptoms and quality-of-life in cancer.

Fluid boluses and infusions in the early phase of resuscitation from septic shock and sepsis-induced hypotension: a retrospective report and outcome analysis from a tertiary hospital

BackgroundFluid administration is the first line treatment in intensive care unit (ICU) patients with sepsis and septic shock. While fluid boluses administration can be titrated by predicting preload dependency, the amount of other forms of fluids may be more complex to be evaluated. We conducted a retrospective analysis in a tertiary hospital, to assess the ratio between fluids given as boluses and total administered fluid intake during early phases of ICU stay, and to evaluate the impact of fluid strategy on ICU mortality. Data related to fluid administration during the first four days of ICU stay were exported from an electronic health records system (ICCA®, Philips Healthcare). Demographic data, severity score, norepinephrine dose at ICU admission, overall fluid balance and the percentage of different fluid components of the overall volume administered were included in a multivariable logistic regression model, evaluating the association with ICU survival.ResultsWe analyzed 220 patients admitted with septic shock and sepsis-induced hypotension from 1st July 2021 to 31st December 2023. Fluid boluses and maintenance represented 49.3% ± 22.8 of the overall fluid intake, being balanced solution the most represented (40.4% ± 22.0). The fluid volume for drug infusion represented 34.0% ± 2.9 of the total fluid intake, while oral or via nasogastric tube fluid intake represented 18.0% ± 15.7 of the total fluid intake. Fluid volume given as boluses represented 8.6% of the total fluid intake over the four days, with a reduction from 25.1% ± 24.0 on Day 1 to 4.8% ± 8.7 on Day 4. A positive fluid balance [OR 1.167 (1.029–1.341); p = 0.021] was the most important factor associated with ICU mortality. Non-survivors (n = 66; 30%) received a higher amount of overall inputs than survivors only on Day 1 [2493 mL vs. 1855 mL; p = 0.022].ConclusionsThis retrospective analysis of fluids given over the early phases of septic shock and sepsis-induced hypotension showed that the overall volume given by boluses ranges from about 25% on Day 1 to about 5% on Day 4 from ICU admission. Our data confirms that a positive fluid balance over the first 4 days of ICU is associated with mortality.