Fluid Management Research Articles

An Unusual Case of Alarming Lactic Acidosis: Brain Metabolic Cross-Talk

AbstractA 39-year-old male with a BMI of 30.8 kg/m2 and a normal medical history underwent excision of a left orbito-cavernal hemangioma (4 × 2 × 2 cm) under general anesthesia. Balanced anesthesia and fluid management guided by pulse pressure variation (kept below 12%) were employed. Despite stable hemodynamics and normal blood sugar levels, arterial blood gas (ABG) analysis revealed a progressive rise in lactate levels, reaching 10.6 mmol/L, accompanied by acidemia. Systemic hypoperfusion was ruled out by maintaining mean arterial pressure between 70-80 mm Hg, ensuring a capillary refill time of less than 3 seconds, and confirming a central venous oxygen saturation of 72%. With a total blood loss of 800 mL, one unit of packed red blood cells was transfused due to concerns about decreased microcirculation and tissue hypoxia. After 10 hours of surgery, sodium bicarbonate (NaHCO3) was administered to mitigate metabolic acidosis and its potential impact on intracranial pressure. Postoperatively, lactate levels remained elevated (8-9 mmol/L), but with continued NaHCO3 infusion, lactate reduced to 6.4 mmol/L, allowing extubation. The patient's lactate normalized by the evening, and recovery was uneventful. This case highlights the significant metabolic disturbances, particularly lactic acidosis, that can arise during brain tumor surgery due to prolonged operative times, large tumor size, higher BMI, and stress-induced metabolic derangements. Awareness and prompt management of these disturbances are crucial for successful patient outcomes.

Role of copeptin as biomarker of volume overload in children with end-stage renal disease

Abstract Background Children who undergo dialysis may develop hypertension and cardiovascular morbidity as a result of fluid overload. The intravascular parameter is clinically relevant in children because it directly influences systemic blood pressure, cardiac output, and cardiovascular squeals. Optimum fluid management is still a chronic clinical challenge, despite recent advances in the care of children with end-stage renal disease (ESRD). The paraventricular and supraoptic nuclei of the hypothalamus emit arginine vasopressin (AVP), a nonapeptide. It is secreted into the bloodstream by the pituitary gland in response to both osmotic and nonosmotic stimuli. Copeptin and AVP are released at equimolar concentrations. The aim of the study is to determine if copeptin, a surrogate marker of AVP, may be used to predict unfavorable outcomes, including chronic volume overload and its impact on hypertension and cardiovascular diseases in children undergoing dialysis. Results A cross-sectional study including 65 children: The mean age of the investigated patients was 10.79 ± 2.857 years, with 53% being male. The patient group had significantly greater mean blood levels of AVP and copeptin compared to the control group (P value = 0.0001). 45% of patients experienced cardiac issues, specifically left ventricular hypertrophy. Hypertensive patients accounted for 57%. The mean blood levels of AVP and copeptin were considerably greater in individuals with cardiac problems and hypertension. Conclusions Hemodynamics have a significant influence on cardiac function and hypertension in children receiving hemodialysis. Copeptin is a more appropriate biomarker for evaluating the effects of AVP on hypertension and cardiac problems in children with ESRD.

Effects of nurse's knowledge and self-efficacy on nursing performance in pediatric intravenous fluid management in South Korea: a descriptive study.

This study aimed to identify the effects of nurse's knowledge and self-efficacy on nursing performance in pediatric intravenous fluid management and provide the primary data necessary for the efficient intravenous injection management of hospitalized children. This study was a descriptive study design with 141 nurses who perform pediatric intravenous therapy care at eight hospitals in the S, C, D, and S regions. Data were collected from September 1, 2023, to September 30, 2023. Nursing performance of pediatric intravenous injection management was significantly positively correlated with knowledge (r=.44, p<.001) and self-efficacy (r=.19, p=.022). Nurses' knowledge (β=.42, p<.001) and self-efficacy (β=.22, p=.004) of pediatric intravenous injection management and care were identified as significant predictors of nursing performance thereof, with these two factors explaining 21.9% of the variance. This study found that knowledge and self-efficacy of pediatric intravenous injection management are significant predictors of the practice of intravenous care among pediatric nurses. Therefore, considering these factors, education and intervention programs should be developed to enhance pediatric nurses' knowledge and self-efficacy regarding intravenous injection management.

Bioimpedance Analysis in CKD and HF Patients: A Critical Review of Benefits, Limitations, and Future Directions

Bioimpedance analysis (BIA) is a validated non-invasive technique already proven to be useful for the diagnosis, prognosis, and management of body fluids in subjects with heart failure (HF) and chronic kidney disease (CKD). Although BIA has been widely employed for research purposes, its clinical application is still not fully widespread. The aim of this review is to provide a comprehensive overview of the state of the art of BIA utilization by analyzing the clinical benefits, limitations, and potential future developments in this clinically unexplored field.

Hydraulic modeling and real-time optimization of drilling fluids: A future perspective

The evolution of drilling operations in the oil and gas industry has highlighted the need for more efficient and adaptive management of drilling fluids, particularly in complex well environments. This paper presents a comprehensive review of hydraulic modeling and real-time optimization of drilling fluids, focusing on future perspectives and industry implications. Hydraulic modeling plays a crucial role in predicting pressure, fluid flow, and wellbore stability, while real-time optimization, powered by advanced sensors, AI, and machine learning, enables dynamic fluid management. The integration of these technologies allows for continuous monitoring and adjustment of fluid properties, improving efficiency, reducing downtime, and preventing formation damage. Future technological advancements, including digital twins and enhanced downhole sensors, are expected to improve well performance and cost-efficiency further. Strategic recommendations for industry adoption include investment in advanced technologies and further research into hydraulic modeling and real-time optimization for complex wells.

AN ATYPICAL CASE OF INFECTIOUS MONONUCLEOSIS – CASE REPORT

Aims: Infectious mononucleosis, caused by the Epstein-Barr virus (EBV), typically presents with fever, exudative pharyngitis and lymphadenopathy. However, atypical presentations can complicate diagnosis and treatment. The objective of this paper is to illustrate the atypical progression of infectious mononucleosis and to delineate the differential diagnosis that should be considered. Additionally, it outlines the therapeutic approaches for managing symptoms associated with the disease. Case Description: A 25-year-old woman presented at a GP's office with eyelid edema, fever, and significant weight loss. Initial tests and treatments were inconclusive, leading to further investigations. Despite typical treatment for viral infections, the patient’s condition worsened, displaying dyspnoea, acute hepatitis, rash, significantly elevated ESR, hemolytic anemia, leukopenia, and thrombocytopenia. Hospitalization was required for comprehensive care, including steroid therapy and fluid management. Conclusions: This case highlights the diagnostic challenges posed by atypical presentations of infectious mononucleosis and underscores the importance of considering EBV infection in the differential diagnosis. Early recognition and appropriate management are crucial for optimal patient outcomes.

Anesthetic Management of a Child with Frontonasal Encephalocele and Hemifacial Microstomia Syndrome for Repair of Encephalocele and Microstomia Correction

AbstractAnesthetic management of a child with hemifacial microstomia and frontonasal encephalocele can be challenging due to factors such as a difficult airway, associated systemic conditions, young age, and prolonged operating time. Hereby, we outline the intraoperative management of a 3-year-old child undergoing repair of multiple defects requiring multidisciplinary involvement of neurosurgery, plastic surgery, and anesthesia team. In our case, a size 0 mask and hyper-angulated D-blade video laryngoscopy were used to prevent sac compression and facilitate intubation. Blood conservation strategies included tranexamic acid, precise fluid management, and maintenance of normothermia. Extubation was carefully planned, considering blood loss and airway edema, and performed when the child was fully awake, ensuring a stable postoperative period and successful recovery. This report emphasizes the importance of meticulous preoperative assessment, readiness for a challenging airway, efficient management of intraoperative blood loss, and the value of teamwork.

Multiparametric assessment of decongestion in patients admitted with acute heart failure: dynamic changes and correlation with natriuresis

Abstract Background Heart Failure (HF) is a major public health problem, expected to increase in the next few decades. The vast majority of acute HF (AHF) episodes are precipitated by congestion with volume overload and/or fluid redistribution. Current Guidelines stress on the importance of relieving congestion before discharge, recommending anyway only daily assessment of signs and symptoms. Lung ultrasound (LUS) B-lines and other ultrasound markers of congestion has emerged as valuable tools to improve diagnostic accuracy and help clinicians in fluid management. Purpose To assess the dynamic changes of B-lines and other markers of congestion and their relationship with the clinical evaluation, chest X-ray (CXR) and natriuretic peptides in patients admitted for AHF. Methods Fifty-eight patients (age 72±11 ys, 35% women) admitted with acute HF were enrolled. Patients underwent clinical evaluation (Clinical Congestion Score, CCS, including rales, pathological S3 heart sound, pedal oedema, jugular vein distension; range 0-4), and CXR (CXR score, including enlargement and loss of definition of hilar structures, peribronchial and perivascular cuffing, cardiomegaly, pleural effusion; range 0-4). An integrated multiorgan ultrasound exam including LUS B-lines, echocardiography, and venous excess ultrasound (VExUS) score was performed at admission (T0), between 24 and 48 hours from T0 (T1), and at discharge (T2). Follow-up data at 30 days were collected. Results Mean CCS was 1.52±0.99 at T0, with a reduction at T1 (0.86±0.66; p&amp;lt;0.01), and at T2 (0.34±0.66; p&amp;lt;0.01). Sixteen percent of patients with a CCS=0 at T0 showed, however, persistent B-lines on LUS (mean B-lines 19±6). The mean number of B-lines was 26±12 at T0 with a reduction at T1 (17±11; p&amp;lt;0.001), and at T2 (13±11; p&amp;lt;0.001). Other echocardiographic non-invasive hemodynamic parameters, such as pulmonary artery systolic pressure (PASP) and E/e’ showed a reduction only at T2, but not at T1 (figure). The number of B-lines correlated at all time points with CCS, CXR score, VExUS score, and NT-proBNP values (all p&amp;lt;0.05). We divided patients into two groups: "responders" (with ≥15 reduction of B-lines between T0 and T2) and "non-responders" (with &amp;lt;15 reduction of B-lines between T0 and T2). Responders had higher chlorine and sodium urinary excretion at T1 compared to non-responders. The number of B-lines at all time points was associated to 30-days cardiovascular mortality at univariable analysis. Neither CCS nor CXR score were associated with 30-day events. Conclusions In patients with acute HF, B-lines quantification is related to standard congestion assessment based on clinical evaluation, CXR and NT-proBNP, showing, however, a more dynamic behaviour in the assessment of decongestion. B-lines variations are also related to diuresis and chlorine urinary output, a recognized predictor of diuretic response. Persistent congestion is related to an increased risk of hospitalization and death.

Unraveling anesthetic challenges of a patient with dilated cardiomyopathy posted for lower limb amputation surgery -A case report

This case report details the anesthetic management of a 64-year-old male with dilated cardiomyopathy (DCM) and a significantly reduced ejection fraction, undergoing lower limb amputation for peripheral arterial disease. Managing anesthesia in such patients poses considerable challenges due to the complexities associated with congestive heart failure. The successful administration of general anesthesia in this case can be attributed to a rigorous preoperative assessment and a meticulously devised anesthetic plan. The systematic approach included careful monitoring, fluid management, and the use of specific anesthetic agents that minimize cardiovascular stress, thereby ensuring an uneventful anesthetic course. This report emphasizes the importance of strategic planning and expert execution in the anesthesia management of patients with severe cardiomyopathy undergoing major surgical procedures.

Management and outcomes in pulmonary arterial hypertension patients with sepsis

BackgroundSepsis is a common cause of death in patients with pulmonary arterial hypertension (PAH). Treatment requires careful fluid management and hemodynamic support. This study compares patients with or without PAH presenting with sepsis with a focus on initial fluid resuscitation.MethodsThis retrospective analysis compared adults with and without PAH admitted for sepsis at two academic hospitals between 2013 and 2022. Prior PAH diagnosis was verified by review of right heart catheterization data and sepsis present on admission was verified by chart review. Demographics, vital signs, laboratory values, imaging results, treatment approaches, and all-cause mortality data were obtained. Controls were propensity score weighted by age, sex, and Charlson Comorbidity index. Logistic regression models controlling for age and Charlson comorbidity indices were used to examine factors associated with survival.ResultsThirty patients admitted for sepsis with pre-existing PAH were compared to 96 matched controls. Controls received significantly more fluids at 24 h compared to PAH patients (median 0 mL v. 1216 mL, p < 0.001), while PAH patients were more likely to receive vasoactive medications (23.3% vs. 8.3%, p = 0.037). At 30 days, 7 PAH patients (23.3%) and 13 control patients (13.5%) had died (p = 0.376). PAH patients that received more fluids had decreased mortality (OR 0.31, 95% CI 0.11–0.92, p = 0.03) and patients who received fluids had shorter mean time to antibiotics (2.3 h v. 6.5 h, p = 0.04), although decreased time to antibiotics was not associated with mortality. Patients who received no fluids more often had previously identified right ventricular systolic dysfunction (62.5% v. 28.6%, p = 0.136).ConclusionPatients with PAH and sepsis have high mortality and receive different treatments than controls, with more reliance on vasopressors and less on fluid resuscitation. PAH patients who received less fluids had higher mortality and those who received no fluids had a longer time to receiving antibiotics, indicating a potential delay in recognizing sepsis. Timely recognition of sepsis and dynamic decision-making around fluid resuscitation remains critical in this high-risk population.

Fluid deresuscitation in critically ill children: comparing perspectives of intensivists and nephrologists

IntroductionFluid accumulation, presently defined as a pathologic state of overhydration/volume overload associated with clinical impact, is common and associated with worse outcomes. At times, deresuscitation, the active removal of fluid via diuretics or ultrafiltration, is necessary. There is no consensus regarding deresuscitation in children admitted to the pediatric intensive care unit. Little is known regarding perceptions and practices among pediatric intensivists and nephrologists regarding fluid provision and deresuscitation.MethodsCross-sectional electronic survey of pediatric nephrologists and intensivists from academic societies in the United States designed to better understand fluid management between disciplines. A clinical vignette was used to characterize the perceptions of optimal timing and method of deresuscitation initiation at four timepoints that correspond to different stages of shock.ResultsIn total, 179 respondents (140 intensivists, 39 nephrologists) completed the survey. Most 75.4% (135/179) providers believe discussing fluid balance and initiating fluid deresuscitation in pediatric intensive care unit (PICU) patients is “very important”. The first clinical vignette time point (corresponding to resuscitation phase of early shock) had the most dissimilarity between intensivists and nephrologists (p = 0.01) with regards to initiation of deresuscitation. However, providers demonstrated increasing agreement in their responses to initiate deresuscitation as the clinical vignette progressed. Compared to intensivists, nephrologists were more likely to choose “dialysis or ultrafiltration” as a deresuscitation method during the optimization [10.3 vs. 2.9% (p = 0.07)], stabilization [18.0% vs. 3.6% (p &amp;lt; 0.01)], and evacuation [48.7% vs. 23.6% (p &amp;lt; 0.01)] phases of shock. Conversely, intensivists were more likely to utilize scheduled diuretics than nephrologists [47.1% vs. 28.2% (p = 0.04)] later on in the patient course.DiscussionMost physicians believe that discussing fluid balance and deresuscitation is important. Nevertheless, when to initiate deresuscitation and how to accomplish it differed between nephrologist and intensivists. Widely understood and operationalizable definitions, further research, and eventually evidence-based guidelines are needed to help guide care.

Efficacy of acetazolamide as adjunct therapy in improving fluid management in patients with acute congestive heart failure: a systematic review and meta-analysis of randomized controlled trials

Abstract Introduction Persistent congestion in acute congestive heart failure despite conventional treatments highlights the need for innovative therapeutic approaches. Evaluating acetazolamide as adjunctive therapy for reducing volume overload is significant. Our meta-analysis examines randomized clinical trials to assess acetazolamide's efficacy in improving fluid management in acute congestive heart failure. Methods We systematically searched Embase, PubMed, and the Cochrane Library in January 2024 for randomized controlled trials comparing the addition of acetazolamide to diuretic therapy versus standard diuretic therapy in patients with acute congestive heart failure. Article selection was conducted independently by two authors. Statistical analyses, including the weighted mean differences (MD) and assessment of heterogeneity using the I² statistic, were performed using R software version 5.4.1. Results Three studies comprising 596 patients were included. Of these, 297 (50%) received acetazolamide as adjunctive diuretic therapy, while 299 (50%) received standard diuretic therapy with a loop diuretic. Among participants, 385 (65%) were male, with a mean age of 72.76 years (±11.13). Acetazolamide adjunctive therapy led to an increase in natriuresis at day 2, expressed in milimoles (mmol), (MD 80.30; 95% CI [45.10-115.51]; p&amp;lt;0.00001; I2=29%), and a trend towards higher natriuresis volume, expressed in liters (L), at day 2 (MD 0.56; 95% CI [-0.37-1.48]; p=0.24; I2=87%), although the latter lacked statistical significance. Conclusions Our findings suggest that acetazolamide adjunctive therapy may have potential benefits in improving fluid management and possibly enhancing clinical outcomes in patients with acute congestive heart failure. Further research is warranted to validate these findings and explore the long-term effects of acetazolamide therapy.

Uncovering the Evidence for Sustainability in Urology: A Scoping Review.

This article focuses on the environmental impact of urology devices and procedures in hospitals and identifies practices that can reduce greenhouse gas emissions associated with urology services. A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted using MEDLINE, EMBASE, and Google Scholar to find studies on the carbon footprint of urologic procedures and sustainable practices. We identified 14 studies, 6 of which used life cycle assessments to compare the environmental impact of single-use and reusable urology devices. Three studies favored single-use devices, 2 favored reusable ones, and 1 found no significant difference, with the sterilization of reusable devices being a major carbon contributor. To enhance sustainability in urology, 8 articles suggested measures including day-case procedures, minimizing low-value care, drapeless cystoscopy, fluid management systems, using quick response (QR) codes in documentation, telehealth initiatives, and low-emission anesthetics. Promoting sustainability in healthcare requires more than just using reusable equipment; it necessitates a comprehensive approach from manufacturing to disposal, including the carbon footprint of sterilization. Encouraging low-emission anesthetics, QR codes, and telemedicine can significantly reduce emissions in urology.

Impact of a kidney-adjusted ERAS® protocol on postoperative outcomes in patients undergoing partial nephrectomy

PurposeEvaluation of a kidney-adjusted enhanced recovery after surgery (ERAS®) protocol (kERAS) in patients undergoing nephron-sparing surgery (PN).MethodsThe kERAS protocol is a multidimensional protocol focusing on optimized perioperative fluid and nutrition management as well as strict intraoperative and postoperative blood pressure limits. It was applied in a prospective cohort (n = 147) of patients undergoing open or robotic PN. Patients were analyzed for the development of acute postoperative renal failure (AKI), achievement of TRIFECTA criteria, upstaging or new onset of chronic kidney disease (CKD) and length of hospital stay (LOS) and compared to a retrospective cohort (n = 162) without application of the protocol.ResultsCox regression analyses could not confirm a protective effect of kERAS on the development of AKI post-surgery. A positive effect was observed on TRIFECTA achievement (OR 2.2, 95% CI 1.0-4.5, p = 0.0374). Patients treated with the kERAS protocol showed less long-term CKD upstaging compared to those treated with the standard protocol (p = 0.0033). There was no significant effect on LOS and new onset of CKD.ConclusionThe implementation of a kERAS protocol can have a positive influence on long-term renal function in patients undergoing PN. It can be used safely without promoting AKI. Furthermore, it can be realized with a manageable amount of additional effort.

IMPACT OF ADVANCED HEMODYNAMIC MONITORING ON MYOCARDIAL REVASCULARIZATION SURGERY IN HIGH-RISK PATIENTS

Coronary artery bypass grafting is a critical procedure for patients with advanced coronary disease, especially those classified as high risk due to comorbidities such as heart failure, hypertension and diabetes. Advanced hemodynamic monitoring has proved essential in this context, allowing continuous and accurate surveillance of cardiac and vascular parameters, which can reduce intra- and post-operative complications. This abstract aims to assess the impact of advanced hemodynamic monitoring during coronary artery bypass graft surgery in high-risk patients. The aim is to explore the advantages of this type of monitoring, the technologies used and the benefits in terms of clinical outcomes and reduction of complications. This is a literature review with a qualitative approach, carried out in the PubMed, SciELO, LILACS, BVS and Google Scholar databases. In order to optimize the search, descriptors such as Hemodynamic Monitoring, Cardiac Surgery, High Risk Patients and Fluid Management were used. For time delimitation, the research considered publications between the years 2019 and 2022, a period that reflects the latest advances in hemodynamic monitoring technologies in high-risk cardiac surgeries. Advanced hemodynamic monitoring includes the use of devices such as the pulmonary artery catheter and non-invasive bioimpedance systems, which provide real-time data on cardiac output, blood pressure, oxygen saturation and systemic vascular resistance. In high-risk patients, these devices allow for precise adjustments in the administration of fluids and vasoactive drugs, promoting better hemodynamic stability. Studies indicate that this approach reduces the incidence of serious complications, such as cardiogenic shock and arrhythmias, optimizing post-operative recovery. Therefore, advanced hemodynamic monitoring is a crucial tool in CABG surgeries, especially for high-risk patients. Its implementation improves intraoperative management, reducing the risk of complications and promoting better clinical outcomes. Therefore, its use should be considered an integral part of strategies for complex cardiac surgeries.

Incidence, predictability, and outcomes of systemic venous congestion following a fluid challenge in initially fluid-tolerant preload-responders after cardiac surgery: a pilot trial

BackgroundFluid administration has traditionally focused on preload responsiveness (PR). However, preventing fluid intolerance, particularly due to systemic venous congestion (VC), is equally important. This study evaluated the incidence and predictability of VC following a 7 ml/kg crystalloid infusion in fluid-tolerant preload-responders and its association with adverse outcomes.MethodsThis single-center, prospective, observational study (May 2023–July 2024) included 40 consecutive patients who were mechanically ventilated within 6 h of intensive care unit (ICU) admission after elective open-heart surgery and had acute circulatory failure. Patients were eligible if they were both fluid-tolerant and preload-responsive. PR was defined as a ≥ 12% increase in left-ventricular outflow tract velocity time integral (LVOT-VTI) 1 min after a passive leg raising (PLR) test. VC was defined by a portal vein pulsatility index (PVPI) ≥ 50%. Patients received a 7 ml/kg Ringer’s Lactate infusion over 10 min. The primary outcome was the incidence of VC 2 min post-infusion (early-VC). Secondary outcomes included VC at 20 min, the incidence of acute kidney injury (AKI) and severe AKI at 7 days, and ICU length of stay (LOS).Results45% of patients developed early-VC, with VC persisting in only 5% at 20 min. One-third of patients developed AKI, with 17.5% progressing to severe AKI. The median ICU LOS was 4 days. Patients with early-VC had significantly higher central venous pressure, lower mean perfusion pressure, worse baseline right ventricular function, and a higher incidence of severe AKI. While LVOT-VTI returned to baseline by 20 min in both groups, PVPI remained elevated in early-VC patients (p < 0.001). The LVOT-VTI versus PVPI regression line showed similar slopes (p = 0.755) but different intercepts (p < 0.001), indicating that, despite fluid tolerance and PR at baseline, early-VC patients had reduced right ventricular diastolic reserve (RVDR). Post-PLR PVPI predicted early-VC with an area under the curve of 0.998, using a threshold of 44.3% (p < 0.001).ConclusionPost-PLR PVPI effectively predicts fluid-induced early-VC in fluid-tolerant preload-responders, identifying those with poor RVDR. Its use can guide fluid management in cardiac surgery patients, helping to prevent unnecessary fluid administration and associated complications.Trial Registration: NCT06440772. Registered 30 May 2024. Retrospectively registered.

Impact of an Educational Workshop on Dietitians’ and Dietetics Students’ Self-Efficacy, Knowledge, and Assessment Skills in Fluid and Electrolyte Management

Hydration plays a crucial role in maintaining health and physiological functions, yet dehydration contributes to morbidity in chronic diseases. Despite the importance of hydration management, research indicates that healthcare professionals, including dietitians, lack sufficient training and confidence in this area. This study aimed to assess the impact of an educational workshop on dietitians' and dietetic students' self-efficacy, knowledge, and assessment skills related to hydration and electrolyte management. A non-randomized, pre-post observational study was conducted among 191 dietitians and dietetic students attending a half-day continuing education program in Ghana. Participants completed pre- and post-surveys assessing self-efficacy, knowledge, and assessment skills. The Wilcoxon signed-rank test was used to evaluate changes in scores. Data were analyzed using IBM SPSS Statistics Version 29, with significance set at p &lt; 0.05. Out of 191 participants, 141 completed both pre- and post-surveys. Significant improvements were observed in self-efficacy (hydration: Z = 8.64, p &lt; 0.001; electrolytes: Z = 8.66, p &lt; 0.001), assessment skills (Z = 7.57, p &lt; 0.001), and knowledge (Z = 7.45, p &lt; 0.001). Both dietitians and students showed similar improvements across all variables. The workshop significantly enhanced participants' confidence, knowledge, and assessment skills in hydration and electrolyte management, addressing critical gaps in their professional training. The findings underscore the need for ongoing, interprofessional education in hydration care. Targeted educational interventions can effectively improve healthcare professionals’ abilities to manage hydration, with implications for better patient care outcomes. Further research is needed to expand these findings across diverse settings.

Identifying septic shock subgroups to tailor fluid strategies through multi-omics integration

Fluid management remains a critical challenge in the treatment of septic shock, with individualized approaches lacking. This study aims to develop a statistical model based on transcriptomics to identify subgroups of septic shock patients with varied responses to fluid strategy. The study encompasses 494 septic shock patients. A benefit score is derived from the transcriptome space, with higher values indicating greater benefits from restrictive fluid strategy. Adherence to the recommended strategy is associated with a hazard ratio of 0.82 (95% confidence interval: 0.64–0.92). When applied to the baseline hospital mortality rate of 16%, adherence to the recommended fluid strategy could potentially lower this rate to 13%. A proteomic signature comprising six proteins is developed to predict the benefit score, yielding an area under the curve of 0.802 (95% confidence interval: 0.752–0.846) in classifying patients who may benefit from a restrictive strategy. In this work, we develop a proteomic signature with potential utility in guiding fluid strategy for septic shock patients.

Acute Adrenal Insufficiency in Childhood: Etiopathogenesis, Clinical Picture, and Intensive Care

Introduction. Acute adrenal insufficiency (AAI) is a severe endocrinopathy whose victims include children and adolescents and which can be life-threatening despite its low incidence. Analysis of issues associated with intensive care of children with this pathology is of vital interest for pediatric anesthesiology and critical care medicine. The aim of this work was to assess current views on the etiopathogenesis, clinical pathology and intensive treatment of pediatric AAI.Materials and methods. The topic was researched by analyzing publications found in the Cochrane Library, PubMed and Medscape using the following search terms: “acute adrenal insufficiency, children and adolescents, intensive therapy, fluid management”, with 65 published sources chosen.Results and discussion. In AAI, caused by a sharp deficiency of cortisol (and mineralocorticoids), which triggers an inflammatory reaction, electrolyte imbalance and hemodynamic disorders. AAI presents with dehydration, nausea and vomiting, feelings of pain, hypotension, tachycardia, seizures and impaired consciousness up to coma. Laboratory tests in children often reveal hyperkalemia, hyponatremia, hypoglycemia and hypercalcemia. Intensive management of AAI in the ICU relies on parenteral corticosteroids (preferably intravenous hydrocortisone). Two or three days later, when the child is stable, they are switched to oral hormones. Meanwhile, fluid management is performed over 2 to 3 days to increase the circulating blood volume and relieve dehydration with crystalloid fluids.Conclusion. A clearer understanding of the etiopathogenesis, clinical manifestations and diagnostic features of AAI, along with knowledge of emergency care algorithms, will improve the quality of intensive therapy of pediatric patients with this condition.

A Review of Published Cases Regarding the Amphotericin B Deoxycholate Overdose in the Pediatric Population and a Case Report.

Considering the fact that two available and commonly used formulations of amphotericin B could be used instead of each other by mistake. Also, an updated and comprehensive data regarding management of this medication error was not available; the current review was conducted to gather available data among the pediatric population and discuss management and outcome of patients in case such an error occurs. We review all the cases of amphotericin B overdose which reported in PubMed and google scholar so far then discuss an 8-years-old girl diagnosed with Ewing sarcoma who inadvertently received five times more than therapeutic dose of amphotericin B deoxycholate (5mg/kg/day).In total, ten of the cases were exactly matched to our purpose of the study. In our case, fluid and electrolyte management was aggressively undertaken and she was put under cardiac monitoring for 7 days following detection of the medication error. Finally, she was discharged from hospital with stable condition. Reviewed data in this manuscript showed that amphotericin B deoxycholate overdose could cause severe complications and lead to cardio toxicity, electrolyte imbalance and death. Aggressive cardiac, fluid and electrolyte monitoring and management of any problem as soon as they were detected was the pathway followed by the authors of this review and others who faced this medication error. The role of NAC and hydrocortisone in the managing amphotericin B deoxycholate overdose requires further investigation.