Fluid Therapy Research Articles

Application and control of intravenous fluids in German intensive care units : Anational survey among critical care physicians

The administration of intravenous fluids includes various indications, e.g., fluid replacement, nutritional therapy or as asolvent for drugs and is acommon routine in the intensive care unit (ICU); however, overuse of intravenous fluids can lead to fluid overload, which can be associated with a poorer outcome in critically ill patients. The aim of this survey was to find out the current status of the use and management of intravenous fluids as well as the interprofessional cooperation involving clinical pharmacists on German ICUs. An online survey with 33questions was developed. The answers of 62participants from the Scientific Working Group on Intensive Care Medicine of the German Society for Anesthesiology and Intensive Care Medicine were evaluated. Fluid overload occurs "frequently" in 62.9% (39/62) and "very frequently" in 9.7% (6/62) of the ICUs of respondents. An established standard for an infusion management system is unknown to 71.0% (44/62) of participants and 45.2% of the respondents stated that they did not have apatient data management system. In addition, the participants indicated how they define fluid overload. This was defined by the presence of edema by 50.9% (28/55) and by positive fluid balance by 30.9% (17/55). According to the participants septic patients (38/60; 63.3%) and cardiological/cardiac surgical patients (26/60; 43.3%) are most susceptible to the occurrence of fluid overload. Interprofessional collaboration among intensive care physicians, critical care nurses, and clinical pharmacists to optimize fluid therapy was described as "relevant" by 38.7% (24/62) and "very relevant" by 45.2% (28/62). Participants with clinical pharmacists on the wards (24/62; 38.7%) answered this question more often as "very relevant" with 62.5% (15/24). Fluid overload is afrequent and relevant problem in German intensive care units. Yet there are few established standards in this area. There is also alack of validated diagnostic parameters and aclear definition of fluid overload. These are required to ensure appropriate and effective treatment that is tailored to the patient and adapted to the respective situation. Intravenous fluids should be considered as drugs that may exert side effects or can be overdosed with severe adverse consequences for the patients. One approach to optimize fluid therapy could be achieved by afluid stewardship corresponding to comparable established procedures of the antibiotic stewardship. In particular, fluid stewardship will contribute to drug safety of intravenous fluids profiting from joined expertise in asetting of interprofessional collaboration. An important principle of fluid stewardship is to consider intravenous fluids in the same way as medication in terms of their importance. Furthermore, more in-depth studies are needed to investigate the effects of interprofessional fluid stewardship in aprospective and controlled manner.

Perioperative Fluid Management in Colorectal Surgery: Institutional Approach to Standardized Practice

The present review discusses restrictive perioperative fluid protocols within enhanced recovery after surgery (ERAS) pathways. Standardized definitions of a restrictive or liberal fluid regimen are lacking since they depend on conflicting evidence, institutional protocols, and personal preferences. Challenges related to restrictive fluid protocols are related to proper patient selection within standardized ERAS protocols. On the other hand, invasive goal-directed fluid therapy (GDFT) is reserved for more challenging disease presentations and polymorbid and frail patients. While the perfusion rate (mL/kg/h) appears less predictive for postoperative outcomes, the authors identified critical thresholds related to total intravenous fluids and weight gain. These thresholds are discussed within the available evidence. The authors aim to introduce their institutional approach to standardized practice.

Efficacy and safety of phospholipid nanoparticles (VBI-S) in reversing intractable hypotension in patients with septic shock: a multicentre, open-label, repeated measures, phase 2a clinical pilot trial

Since the 1990's attempts to favorably modulate nitric oxide (NO) have been unsuccessful. We hypothesized that because NO is lipophilic it would preferentially localize into intravascularly infused hydrophobic nanoparticles, thereby reducing its bioavailability and adverse effects without inhibiting its production. We aimed to determine the efficacy and safety of intravenous infusion of a fluid comprised of hydrophobic phospholipid nanoparticles (VBI-S) that reversibly absorb NO in the treatment of hypotension of patients in severe septic shock. This is a multicentre, open-label, repeated measures, phase 2a clinical pilot trial done at six hospital centers in the USA. Patients in severe septic shock were enrolled after intravenous fluid therapy had failed to raise mean arterial blood pressure (MAP) to at least the generally accepted level of 65mmHg, requiring the use of vasopressors. The primary endpoint of this study is the proportion of patients in whom MAP increased by at least 10mmHg. VBI-S was administered intravenously to patients as boluses of 100ml, 200ml, 400ml, and 800ml at 999ml/min until the blood pressure goal was reached after which the infusion was stopped, and the MAP was recorded. All patients who received any volume of VBI-S were included in the primary and safety analysis. The study is registered with ClinicalTrials.gov, NCT04257136. Between February 17, 2020 and January 3, 2023, 20 eligible patients were enrolled in the study. In all 20 (100%) patients, the goal of increasing MAP by at least 10mmHg using VBI-S was achieved (p=0.0087, effect size=0.654). Mean VBI-S volume required to meet the primary goal was 561.0±372.3ml. The goal of lowering vasopressor dose was also achieved (p=0.0017). Within 48h or less after VBI-S, there was a statistically significant improvement in oxygenation, serum creatinine, clotting variables, procalcitonin, lactic acid, and the sequential organ failure assessment (SOFA) score. At 24h and 48h following administration of VBI-S, 12/15 (80%) and 9/12 (75%) patients developed hyperlipidemia, respectively. No severe adverse events of VBI-S were observed, and there were no treatment-related deaths. These preliminary findings suggest the safety and efficacy of VBI-S in treating hypotension in patients with septic shock. However, a definitive mortality benefit cannot be demonstrated without a randomized controlled study. The Naval Medical Research Command-Naval Advanced Medical Development program via the Medical Technology Enterprise Consortium.

Assessing fluid responsiveness with ultrasound in the neonatal intensive care setting: the mini-fluid challenge.

The mini-fluid challenge (MFC) can guide individualised fluid therapy and prevent fluid overload and associated morbidity in adult intensive care patients. This ultrasound test is based on the Frank-Starling principles to assess dynamic fluid responsiveness, but limited MFC data exists for newborns.This brief report describes the feasibility of the MFC in 12 preterm infants with late onset sepsis and 5 newborns with other pathophysiology. Apical views were used to determine the changes in left ventricular stroke volume before and after a 3ml/kg fluid bolus was given over 5min. Four out of the 17 infants were fluid responsive, defined as a post-bolus increase in stroke volume of 15% or more. Conclusion: The MFC was feasible and followed the physiological principles of stroke volume and extravascular lung water changes and 24% were fluid responsive. The MFC could enable future studies to examine whether adding fluid responsiveness to guide fluid therapy in newborns can reduce the risk of fluid overload. What is Known: • Fluid overload is associated with morbidity and mortality. • The mini-fluid challenge (MFC) provides a personalised approach to fluid therapy. What is New: • The MFC is feasible in newborns. • The MFC followed the physiological principles of stroke volume and extravascular lung water changes.

Correlation of Ultrasound Guided Inferior Vena Cava Collapsibility Index with Central Venous Pressure to Assess the Volume Status in Postoperative Intensive Care Unit Patients: A Prospective Observational Study

Background: Accurate assessment of intravascular volume status is a vital aspect of management of intensive care unit (ICU) patients. Inferior vena cava (IVC) diameter and IVC collapsibility index have surfaced as promising methods to accurately predict hypovolemia. But no such study has evaluated it’s their utility in postoperative patients.
 Methods: The study aimed to assess the correlation between ultrasound guided IVC collapsibility index (IVC CI) and CVP for volume status in intensive care unit patients. Hundred spontaneously breathing patients receiving postoperative care in our surgical ICU between November 2019 to march 2021were enrolled into the study. Maximum IVC diameter (IVCdmax) at end-expiration, minimum IVC diameter at end-inspiration (IVCdmin) and IVC CI were measured. Simultaneous CVP recordings were obtained.
 Results: A positive correlation was noted between IVC maximum diameter and CVP (p = <0.001) and between IVC Minimum Diameter and CVP. (p = <0.001) A negative correlation between IVC CI and CVP was seen (p = <0.001). Mean IVC CI was highest in the hypovolemic group. The area under the ROC curve (AUROC) for IVC CI predicting hypovolemia was 0.943 (95% CI: 0.9 - 0.986), thus demonstrating excellent diagnostic performance. At a cut off of ≥58.416%, IVC CI predicts hypovolemia with a sensitivity of 93.8%, and a specificity of 84%.
 Conclusion: IVC CI can be used to guide fluid therapy due to its excellent diagnostic accuracy in predicting hypovolemia in postoperative patients in ICU.

Short anesthesia without intravenous fluid therapy in children: Results of a prospective non-interventional multicenter observational study.

The German guidelines recommend that intravenous fluid therapy should not be mandatorily performed in children with short fasting times undergoing short anesthesia, but there is a lack of clinical studies including a large number of pediatric patients. Therefore, we performed a prospective non-interventional multicenter observational study to evaluate the perioperative hemodynamic and metabolic stability of children undergoing short anesthesia without intravenous fluid therapy. The primary aim was to assess the incidence of hypotension and the secondary aim was to assess the real preoperative fasting times, the incidence of hypoglycemia and the impact on ketone bodies and acid-base balance. Children aged 1 month-18 years undergoing short anesthesia (<1 h) without intravenous fluid therapy were enrolled. Patient demographics, the surgical or diagnostic procedure performed, anesthesia, hemodynamic, laboratory data, and adverse events were documented using a standardized case report form. Four hundred and twenty seven children that were investigated at three pediatric centers from July 2021 to June 2022 (mean age 83.4 ± 58.9 months, body weight 27.9 ± 19.8 kg) were included in the analysis. The real preoperative fasting times were 14.2 ± 3.6 h for solids, 7.2 ± 3.5 h for milk and 5 ± 4.8 h for clear fluids. During the course of anesthesia, hypotension (<2.5th percentile) was detected in 3 of 427 cases (0.7%), hypoglycemia (glucose <3.0 mmol L-1) in 1 of 355 cases (0.3%), and ketosis (ketone bodies ≥0.6 mmol L-1) in 51 of 233 cases (21.9%). The occurrence of ketosis was associated with lower body weight (p <.001) and longer fasting times for solids or milk (p =.021), but not for clear fluids (p =.69). Our study supported the German guidelines recommendation that perioperative intravenous fluid therapy is not mandatory in children beyond the neonatal period with short pre- and postoperative fasting times undergoing short anesthesia (<1 h).

Assessing resuscitation in burn patients with varying degrees of liver disease

We find minimal literature and lack of consensus among burn practitioners over how to resuscitate thermally injured patients with pre-existing liver disease. Our objective was to assess burn severity in patients with a previous history of liver disease. We attempted to stratify resuscitation therapy utilised, using it as an indicator of burn shock severity. We hypothesized that as severity of liver disease increased, more fluid therapy is needed. We retrospectively studied adult patients with a total body surface area (TBSA) of burn greater than or equal to 20% (n = 314). We determined the severity of liver disease by calculating admission Model for End-Stage Liver Disease (MELD) scores and measured resuscitation adequacy via urine output within the first 24 h. We performed stepwise, multivariable linear regression with backward selection to test our hypothesis with α = 0.05 defined a priori. After controlling for important confounders including age, TBSA, baseline serum albumin, total crystalloids, colloids, blood products, diuretics, and steroids given in first 24 h, we found a statistically significant reduction in urine output as MELD score increased (p < 0.000). In our study, severity of liver disease correlated with declining urine output during first 24-hour resuscitation more so than burn size or burn depth. While resuscitation is standardized for all patients, lack of urine output with increased liver disease suggests a new strategy is of benefit. This may involve investigation of alternate markers of adequacy of resuscitation, or developing modified resuscitation protocols for use in patients with liver disease. More investigation is necessary into how resuscitation protocols may best be modified.

Post hospital admission blood lactate measurements are associated with mortality but not neurologic morbidity in children with cerebral malaria.

In children with cerebral malaria (CM) admission blood lactate has previously guided intravenous fluid therapy and been validated as a prognostic biomarker associated with death. The usefulness of post-admission measurements of blood lactate in children with CM is less clear. The strength of association between blood lactate and neurological sequelae in CM survivors, as well as the optimal duration of post-admission measurements of blood lactate to identify children at higher risk of adverse outcomes is unknown. A retrospective cohort study of 1674 Malawian children with CM hospitalized from 2000 to 2018 who had blood lactate measurements every 6h for the first 24h after admission was performed. The strength of association between admission lactate or values measured at any time point in the first 24h post-admission and outcomes (mortality and neurological morbidity in survivors) was estimated. The duration of time after admission that lactate remained a valid prognostic biomarker was assessed. When lactate is analysed as a continuous variable, children with CM who have higher values at admission have a 1.05-fold higher odds (95% CI 0.99-1.11) of death compared to those with lower lactate values. Children with higher blood lactate at 6h have 1.16-fold higher odds (95% CI 1.09-1.23) of death, compared to those with lower values. If lactate levels are dichotomized into hyperlactataemic (lactate > 5.0 mmol/L) or not, the strength of association between admission lactate and mortality increases (OR = 2.49, 95% CI 1.47-4.22). Blood lactate levels obtained after 18h post-admission are not associated with outcomes. Similarly, the change in lactate concentrations through time during the first 24h of hospital admission is not associated with outcomes. Blood lactate during hospitalization is not associated with adverse neurologic outcomes in CM survivors. In children with CM, blood lactate is associated with death but not neurologic morbidity in survivors. To comprehensively estimate prognosis, blood lactate in children with CM should be assessed at admission and for 18h afterwards.

Caecal dilatation and dislocation in 20 dairy cows. A retrospective study.

A total of 20 cows with caecal dilatation and dislocation were included in this retrospective study. The aim of the study was to describe the findings of the initial clinical examination, the haematological, biochemical and venous blood gas analysis as well as the therapeutic management and the surgical findings of these cases. A positive simultaneous percussion and auscultation in the right flank as well as rectal palpation of the distended caecum were the most common findings in 90% of the animals. Increased haematocrit, hyperlactateaemia and hyperglycaemia were the most often occurring laboratory findings. Conservative treatment using neostigmine s.c. (0.025mg/kg) was successful in three out of four cases. Surgical therapy including laparotomy in the right flank and typhlotomy was performed in 17 cases. Caecal dilatation (n=9), retroflexion (n=4) and torsion (n=4) were revealed intraoperatively. During surgery in three cows, the caecum had filled once again with fluid content and typhlotomyhad to be repeated. Typhlectomy was not necessary in any of these cows. A relaparotomy due to recurrence of the caecal disorder was not required in any of the cases during hospitalisation. The postsurgical treatment included antibiotics, neostigmine in all cows and fluid therapy in the majority of the animals. Laxative treatment using 250 g sodium sulphate twice daily per os was applied in 10 cases. All cows were discharged from the clinic and returned to the farm.

Infusion therapy in critical patients (state of problem). Part 2

With the development of clinical pathophysiology, the basic concepts of maintaining fluid homeostasis of the body in normal and critical conditions were revised, and the negative effects of infusion therapy at all stages of its use were studied. Therefore, in the intensive care of shock, the main clinical questions are: when to start fluid therapy, when to stop active fluid therapy, when to start fluid removal from the body, and when to stop fluid de-resuscitation. Thus, in order to implement the principle of personalized treatment, it is important to determine not only the ‘tolerance’ of infusion therapy, but also the ‘sensitivity’ to the infusion of a particular patient – the ability to maintain hemodynamics without the risk of fluid overload. Evaluation of routine clinical, instrumental and laboratory indicators of the state of macro- and microcirculation does not provide an opportunity to accurately answer these questions. Modern sonographic methods for monitoring central and peripheral cardiohemodynamics, ‘venous excess’ using Doppler and extended focus echocardiography allow us to assess the ‘tolerance of infusion therapy’. The implementation of this new direction will increase the efficiency and safety of infusion therapy and improve the outcomes of the critically ill patients’ treatment.

A balancing act: drifting away from the reflexive use of "ab"normal saline.

Maintenance intravenous fluids are the most frequently ordered medications for hospitalized children. Since the American Association of Pediatrics published national guidelines, there has been an increased reflexive use of isotonic solutions, especially 0.9% saline, as a prophylaxis against hyponatremia. In this educational review, we discuss the potential deleterious effects of using 0.9% saline, including the development of hyperchloremia, metabolic acidosis, acute kidney injury, hyperkalemia, and a proinflammatory state. Balanced solutions with anion buffers cause relatively minimal harm when used in most children. While the literature supporting one fluid choice over the other is variable, we highlight the benefits of balanced solutions over saline and the importance of prescribing fluid therapy that is individualized for each patient.

Postoperative fluid therapy in enhanced recovery after surgery for pancreaticoduodenectomy.

Optimal intravenous fluid management during the perioperative period for patients undergoing pancreaticoduodenectomy (PD) within the framework of enhanced recovery after surgery (ERAS) is unclear. Studies have indicated that excessive total body salt and water can contribute to the development of oedema, leading to increased morbidity and extended hospital stays. This study aimed to assess the effects of an intravenous therapy regimen during postoperative day (POD) 0 to 2 in PD patients within ERAS. A retrospective interventional cohort study was conducted, and it involved all PD patients before and after implementation of ERAS (2009-2017). In the ERAS group, a targeted maintenance fluid regimen of 20 mL/kg/day with a sodium requirement of 0.5 mmoL/kg/day was administered. Outcome measures included the mmol of sodium and chloride administered, length of stay, and morbidity (postoperative pancreatic fistula, POPF; acute kidney injury, AKI; ileus). The study included 169 patients, with a mean age of 64 ± 11.3 years. Following implementation of the intravenous fluid therapy protocol, there was a significant reduction in chloride and sodium loading. However, in the multivariable analysis, chloride administered (mmoL/kg) did not independently influence the length of stay; or rates of POPF, ileus, or AKI (p > 0.05). The findings suggested that a postoperative intravenous fluid therapy regimen did not significantly impact morbidity. Notably, there was a trend towards reduced length of stay within an increasingly comorbid patient cohort. This targeted fluid regimen appears to be safe for PD patients within the ERAS program. Further prospective research is needed to explore this area.

Frequency domain analysis of photoplethysmographic and arterial pressure waveforms for assessing hemodynamics in children with congenital heart surgery.

Time-domain parameters are less reliable in children due to increased arterial and chest wall compliance. We assessed the ability of indices derived from frequency analysis of photoplethysmography (PPG) and arterial blood pressure (ABP) waveforms to predict the hemodynamic state in children undergoing congenital heart surgery. We analyzed waveforms after cardiopulmonary bypass period in 76 children who underwent total repair of congenital heart disease. Amplitude density of baseline and amplitude modulation in PPG and ABP by respiratory frequency were obtained using fast Fourier transform analysis and normalized by cardiac pulse height (representing respiratory modulations in venous blood [PPG-DC%] and in amplitude [PPG-AC%] at respiratory frequency). The ratio of amplitude density of PPG at the cardiac frequency (CF) to ABP-CF was used to assess vascular compliance. We assessed volume replacement (ml/kg) and vasoactive inotropic score (VIS). Children requiring volume replacement > 10 ml/kg (15.8%) showed higher PPG-DC% than those not requiring it (median: 52.4%, 95% CI [24.8, 295.1] vs. 36.7% [10.7, 125.7], P = 0.017). In addition, children with a VIS > 7 (22.4%) showed higher PPG-CF/ABP-CF (3.6 [0.91, 10.8] vs. 1.2 [0.27, 5.5], P = 0.008). On receiver operating characteristic curve analysis, PPG-DC% predicted a higher fluid requirement (area under the curve: 0.71, 95% CI [0.604, 0.816], P = 0.009), while PPG-CF/ABP-CF predicted a higher VIS (0.714, [0.599, 0.812], P = 0.004). Frequency domain analysis of PPG and ABP may assess hemodynamic status requiring fluid or vasoactive inotropic therapy after congenital heart surgery.

Review on Canine Coronavirus Disease; Its Clinical Management and Zoonotic Spillover

Coronaviruses are a diverse group of viruses infecting many different animals, and they can cause mild to severe respiratory infections in humans, as with the recently emerged spillover caused by COVID-19 (SARS-CoV2), which broke out in China’s Wuhan seafood market. Human coronaviruses (HCoVs) often have animal origins. Canine coronavirus is a highly contagious viral disease which is a member of the broader coronavirus family with known pathogens in dogs. Both enteric and respiratory coronaviruses are the two common types of canine coronaviruses, and it often causes mild or hard-to-spot illness; however, it can be fatal under certain conditions, particularly in young puppies. Antibiotics are ineffective against coronavirus infection in dogs, but may be useful in controlling secondary bacterial infections and a dehydrated case requires adequate fluid therapy to maintain the fluid and electrolyte imbalances. Canine coronavirus is spread through contact with fecal material from infected dogs, so isolating infected dogs from healthy ones can help reduce disease distribution. The virus is susceptible to the household disinfectants, so cleaning virus contaminated areas and bedding enable to limit the spread of disease. Therefore, this literature review is designed to highlight about the canine coronavirus and its relation with other group of viruses including their public health importance.

Closed-loop anesthesia: foundations and applications in contemporary perioperative medicine.

A closed-loop automatically controls a variable using the principle of feedback. Automation within anesthesia typically aims to improve the stability of a controlled variable and reduce workload associated with simple repetitive tasks. This approach attempts to limit errors due to distractions or fatigue while simultaneously increasing compliance to evidence based perioperative protocols. The ultimate goal is to use these advantages over manual care to improve patient outcome. For more than twenty years, clinical studies in anesthesia have demonstrated the superiority of closed-loop systems compared to manual control for stabilizing a single variable, reducing practitioner workload, and safely administering therapies. This research has focused on various closed-loops that coupled inputs and outputs such as the processed electroencephalogram with propofol, blood pressure with vasopressors, and dynamic predictors of fluid responsiveness with fluid therapy. Recently, multiple simultaneous independent closed-loop systems have been tested in practice and one study has demonstrated a clinical benefit on postoperative cognitive dysfunction. Despite their advantages, these tools still require that a well-trained practitioner maintains situation awareness, understands how closed-loop systems react to each variable, and is ready to retake control if the closed-loop systems fail. In the future, multiple input multiple output closed-loop systems will control anesthetic, fluid and vasopressor titration and may perhaps integrate other key systems, such as the anesthesia machine. Human supervision will nonetheless always be indispensable as situation awareness, communication, and prediction of events remain irreplaceable human factors.

Early Autocalibrated Arterial Waveform Analysis for the Management of Burn Shock-A Cohort Study.

Adequate fluid therapy is crucial for resuscitation after major burns. To adapt this to individual patient demands, standard is adjustment of volume to laboratory parameters and values of enhanced hemodynamic monitoring. To implement calibrated parameters, patients must have reached the intensive care unit (ICU). The aim of this study was, to evaluate the use of an auto-calibrated enhanced hemodynamic monitoring device to improve fluid management before admission to ICU. We used PulsioflexProAqt® (Getinge) during initial treatment and burn shock resuscitation. Analysis was performed regarding time of measurement, volume management, organ dysfunction, and mortality. We conducted a monocentre, prospective cohort study of 20 severely burned patients, >20% total body surface area (TBSA), receiving monitoring immediately after admission. We compared to 57 patients, matched in terms of TBSA, age, sex, and existence of inhalation injury out of a retrospective control group, who received standard care. Hemodynamic measurement with autocalibrated monitoring started significantly earlier: 3.75(2.67-6.0) hours (h) after trauma in the study group versus 13.6(8.1-17.5) h in the control group (P < .001). Study group received less fluid after 6 h: 1.7(1.2-2.2) versus 2.3(1.6-2.8) ml/TBSA%/kg, P = .043 and 12 h: 3.0(2.5-4.0) versus 4.2(3.1-5.0) ml/TBSA%/kg, P = .047. Dosage of norepinephrine was higher after 18 h in the study group: 0.20(0.12-0.3) versus 0.08(0.02-0.18) µg/kg/min, P = .014. The study group showed no adult respiratory distress syndrome versus 21% in the control group, P = .031. There was no difference in other organ failures, organ replacement therapy, and mortality. The use of auto-calibrated enhanced hemodynamic monitoring is a fast and feasible way to guide early fluid therapy after burn trauma. It reduces the time to reach information about patient's volume capacity. Management of fluid application changed to a more restrictive fluid use in the early period of burn shock and led to a reduction of pulmonary complications.

Rehydration post-transport: duration of oral fluid therapy on behavior, biochemical measures of hydration, and health of neonatal dairy calves.

The objective of this study was to determine the impact of 0, 1, 2, or 3d of oral electrolyte solutions (OES) following transport on calf behavior, biochemical measures of hydration, and subsequent health. Two cohorts of 60 Holstein bull calves ~3 to 7d of age were included in this experiment. Calves (n = 30/treatment) were randomized to 1 of 4 treatments on arrival at a calf-raising facility: (1) 1-d OES, (2) 2-d OES, (3) 3-d OES, or (4) no OES (control). Calves were evaluated for signs of arthritis, depression, dehydration, diarrhea, fever, navel inflammation, and respiratory disease on arrival (day 0) and 1, 2, 3, and 7d after arrival. Blood was obtained following each examination to assess biochemical measures of hydration, including serum electrolytes, glucose, hematocrit, lactate, pH, and serum total protein (STP). Calves were fitted with 3D accelerometers attached to the right hind leg along the metatarsus bone to continuously measure lying time. Linear regression models with Gaussian or Poisson link functions were used to test differences between treatments in blood parameters, as well as disease frequency and behavior, respectively. Calves spent the most time lying immediately post-transport (day 0); however, there was no effect of OES treatment on lying time. On arrival, 90% (95% CI: 84.6% to 95.4%) of calves had mild to moderate dehydration, and there was no significant difference in hydration status across treatments. Mildly dehydrated calves that received 1- and 2-d OES had higher STP concentration compared to the control. Moderately dehydrated calves that received 3- vs. 1-d OES had higher (101.4 vs. 93.7mmol/L, respectively; P = 0.01) glucose concentration, and 3- vs. 2-d OES (101.4 vs. 96.2, respectively; P = 0.07) calves tended to have higher glucose concentration. The prevalence of failed transfer of passive immunity (STP < 5.1g/dL) and hypoglycemia (glucose < 4.95mmol/L) was 26.7% (18.6% to 34.7%) and 76.5% (68.7% to 84.2%), respectively. The frequency of moderate dehydration was lower for calves that received 2-d OES compared to the control (count ratio: 0.4; 0.2% to 0.8%; P = 0.009). These results underline the need for more research on rehydration strategies to help inform calf processing protocols. Future research should investigate preconditioning strategies to minimize the impact of marketing and transport on dairy calves. Continued nutritional-based research is also needed to better support calves' recovery post-transport.

Assessment of the activity of Trauma Centers for Children in Poland in 2021

Aim: Injuries are dominant causes of death and hospitalization among children and adolescents. In some countries, there are designated pediatric trauma centers (PTCs) that offer multiple levels of care for trauma patients. Our aim is to demonstrate that the criteria in Polish PTCs may not identify a large group of patients with life-threatening conditions, and they may be referred to centers with lower capabilities. Material and methods: We analyzed all trauma patients transported by ambulance to the Emergency Department in Pediatric Teaching Hospital of University Clinical Center of the Medical University of Warsaw in 2021. Results: Out of 981 pediatric trauma patients, 27 qualified for PTC. Key factors determining which children are more likely to qualify for PTC include the influence of alcohol, falls from heights, the need for analgesics, and fluid therapy. Physical examination abnormalities more likely found among patients qualified for PTC were: GCS≤13, abnormal pupillary reaction, abnormal pupil width, seizures, a decrease in systolic blood pressure, abnormal heart rate, and a decrease in oxygen saturation. There is a significant group of patients who do not meet PTC criteria but present a risk to life or health. Conclusions: Only a small number of admitted children met the qualification criteria for PTC. It seems that we should not assess a patient solely based on preestablished criteria, but the universality of this problem requires the creation of a segregation system that would allow access to patients more individually.

Clinical diagnosis and surgical management of chronic megacolon in a kitten

Chronic cases of megacolon are found frequently in older cats but are rarely reported in kittens below six months of age. Megacolon is the abnormal and persistent dilatation of the colon without mechanical obstruction, leading to severe constipation. A 5-month-old kitten was presented to a local vet hospital for investigation of a long-term bowel dysfunction followed by obstipation for nine days. Prior to the presentation, the kitten underwent medical treatments including oral laxatives/purgatives and enema, but these remained unsuccessful. Clinical examination revealed severe dehydration and dullness, alongside a distended abdomen in lateral recumbency. The diagnosis of chronic idiopathic megacolon was made based on radiographic imaging after meticulous physical examinations of the distended abdomen. Subtotal colectomy followed by end-to-end colo-colonic anastomosis was performed. Supportive medications and fluid therapies were provided subsequently. Unfortunately, the kitten did not survive beyond 54 h following the surgical intervention. The overall delay in presentation and poor preoperative status were considered to be the main contributors to the unfavorable outcome. In summary, chronic cases of megacolon can be deadly in kittens. Therefore, any cases of feline constipation must be considered with priority to ensure early treatment, otherwise, unresolved cases may lead to definite megacolon in later life.

Nurses’ Practices of Input and Output Monitoring of Patients on Intravenous Fluid Therapy within Fako Division

Background: Alternative routes of fluid administration such as intravenous access can deliver fluids directly to the vascular system for hospitalised patients who might have a reason for not tolerating oral intake. Too much or too little fluid can have a negative impact on patient outcomes; hence, careful titration of fluid administered is required. Previous studies have shown that majority of fluid balance records were incorrectly calculated or poorly documented. Aim: To investigate nurses’ practices of input/output monitoring of patients on intravenous fluid (IVF) therapy in the medical and surgical wards in hospitals within Fako Division, Cameroon. Methods: This study employed a retrospective and cross sectional design, data was collected using a structured questionnaire to assess nurses’ knowledge of fluid input/output monitoring from May to June 2021. In addition, a checklist was used to conduct an audit of 671 patients’ files and 76 nurses took part in the study. Data was analysed with the aid of SPSS 25. A multi-linear regression analysis was done for knowledge and practices using demographic variables and factors affecting monitoring of patients to test relationships between categorical variables. All statistics were set at 95% confidence interval with a 5% margin of error. Results were presented using frequency distribution, mean and standard deviation to describe different characteristics. Results: 77.63% nurses’ could identify methods of assessing patients on IVF therapy. However, they lacked knowledge on laboratory indications of fluid overload (5.26%), fluid loss (1.32), symptoms of fluid gain (3.9%) and fluid depletion (2.26). Their overall practice was 128(19.08%). Factors affecting monitoring of patients on intravenous fluid therapy were mainly workload 55(72.4%) and lack of measuring equipment 46(60.5%). Conclusion: Nurses’ in the medical and surgical wards in Fako Division lacked knowledge in certain areas of patients’ assessment about input/output monitoring of patients on IVF therapy and their practices were generally unsatisfactory. Qualification had a significant impact on nurses’ practices (P&lt;0.05).