Infusion Volume Research Articles

1 The Battle of the Titans: Comparing Resuscitation Between 5 Centers Using the Burn Navigator

IntroductionThe goal of burn resuscitation is to provide the least amount of fluid necessary to maintain end-organ perfusion and prevent burn shock. The objective of this analysis was to examine how the Burn Navigator (BN), a clinical decision support tool in burn resuscitation, was utilized across 5 major burn centers in the United States.MethodsA non-interventional, observational trial of 300 adult patients with embedded prospective and retrospective components was undertaken to examine the effectiveness of the BN in burn resuscitation. 5 ABA-verified burn centers enrolled patients. Data examining patient demographics, burn characteristics, fluid volumes, and resuscitation-related complications were examined. Statistical analysis compared the 5 sites in terms of these variables.ResultsA total of 285 patients were eligible for analysis. There was no difference among the centers in terms of average age (45.5 + 16.8 years), BMI (29.2 + 6.9), ISS (21.2 + 12.8), or median TBSA (34 [25.8, 47]). Primary crystalloid infusion volumes at 24 hours differed significantly when measured in ml/kg/TBSA (median 3.7 [2.9, 8.8], range 1.3 to 12.3). Similarly, total fluids, which includes colloid adjuncts, drip medications and enteral fluids, differed between groups when measured in both ml/kg (median 149.8 [106.5, 224.1], range 38.4 to 536.2) and ml/kg/TBSA (4.2 [3.3, 5.5], 1.7 to 15.3) at 24 hours. Post-hoc adjustment for pairwise comparisons resulted in a loss of significance between most of the sites. There was a total of 156 resuscitation-related complications reported across the 5 sites with an average incidence of 44.4 % incidence.ConclusionsThe Burn Navigator appeared to standardize fluid resuscitations across 5 major US burn centers. With primary fluid volumes near the Parkland formula, the device can be utilized effectively in burn centers, and further study should exam the utility of this device in facilities that do not commonly treat burn injuries, as well as the battlefield.

A mini-whole lung lavage to treat autoimmune pulmonary alveolar proteinosis (PAP)

BackgroundPAP is an ultra-rare respiratory syndrome characterized by the accumulation of surfactant within the alveoli. Whole lung lavage (WLL) is the current standard of care of PAP, however it is not a standardized procedure and the total amount of fluid used to wash each lung is still debated. Considering ICU hospitalization associated risks, a “mini-WLL” with anticipated manual clapping and reduced total infusion volume and has been proposed in our center.The aim of the study is to retrospectively analyze the efficacy of mini-WLL compared to standard WLL at the Pavia center.Methods13 autoimmune PAP patients eligible for WLL were included: 7 patients were admitted to mini-WLL (9 L total infusion volume for each lung) and 6 patients underwent standard WLL (14 L of infusion volume). Functional data (VC%, FVC%, TLC%, DLCO%) and alveolar-arterial gradient values (A-aO2) were collected at the baseline and 1, 3, 6, 12, 18 months after the procedure.ResultsA statistically significant improvement of VC% (p = 0.013, 95%CI 3.49–30.19), FVC% (p = 0.016, 95%CI 3.37–32.09), TLC% (p = 0.001, 95%CI 7.38–30.34) was observed in the mini-WLL group in comparison with the standard WLL group, while no significant difference in DLCO% and A-aO2 mean values were reported.ConclusionMini-WLL has demonstrated higher efficacy in ameliorating lung volumes, suggesting that a lower infusion volume is sufficient to remove the surfactant accumulation and possibly allows a reduced mechanical insult of the bronchi walls and the alveoli. However, no statistically significant differences were found in terms of DLCO% and Aa-O2.

Comparison between dexmedetomidine versus magnesium sulfate infusions for mitigating emergence agitation in obese adults undergoing nasal surgery

BackgroundEmergence agitation is a potentially serious post-anesthetic event occurring in the early phase of recovery from general anesthesia, characterized by anxiety, disorientation, violent, and irrational behavior. Many agents have been used as prophylaxis with varying degrees of success. The purpose of this study was to compare the efficacy and safety of dexmedetomidine to magnesium sulfate in mitigating emergence agitation. Patients were randomly allocated to one of three groups of 35 each. Dexmedetomidine group (D group) received intraoperative Dex 0.7 μg/kg/h infusion (no loading dose). The magnesium sulfate group (M group) received intraoperative magnesium sulfate 20 mg/kg/h infusion (no loading dose). The control group (C group) received equal volume of saline infusion as placebo.ResultsThe total incidence of emergence agitation was significantly lower in group D, 5.6% and group M, 8.5% compared to control group, 54.2%. The median time to extubation was significantly longer in group D than C and M groups (13, 7, and 8, respectively) and was not significantly different between group C and M. During recovery, the number of patients who experience pain was significantly lower in D and M groups compared to patients in control group (P < 0.002). The total dose of rescue analgesic was also significantly lower in D and M group versus control group (P < 0.001).ConclusionsDexmedetomidine and magnesium sulfate infusion are both equally effective in reducing the incidence of emergency agitation in obese adults undergoing nasal surgery. Extubation time and post-operative anesthesia care time were rather longer in dexmedetomidine than other groups.Trial registrationRegistered with ClinicalTrials.gov Identifier: NCT04531371

Difference between delayed anastomosis and early anastomosis in damage control laparotomy affecting the infusion volume and NPWT output volume: is infusion restriction necessary in delayed anastomosis? A single-center retrospective analysis

ObjectivesDuring temporary abdominal closure (TAC) with damage control laparotomy (DCL), infusion volume and negative-pressure wound therapy (NPWT) output volume are associated with the success and prognosis of primary fascial closure....

The impact of acid-base disorders in patients with chronic pancreatitis comorbid with type 2 diabetes on long-term quality of life and possible improvement with small volume infusion therapy

Summary. The article presents the results of the study of metabolic endogenous intoxication indexes (MEI) reflecting intoxication by organic compounds influencing the change of physiological pH balance and their correlation with the presence and severity of chronic pain syndrome and quality of life criteria. The dynamics of these indexes and improvement of QOL on the background of the suggested scheme of small volume infusion detoxification therapy (SWIDT) by hyperosmolar balanced crystalloid (HSC) containing components with reserve alkalinity in the section of 30-day period were researched. The aim of the study – to evaluate the therapeutic effect of SWIT on the severity of pH abnormalities as well as the effect of SWIT on the severity of chronic pain syndrome and related aspects of quality of life in patients with CP in comorbidity with T2DM. Materials and Methods. 115 patients divided into 5 groups were examined: Group 1 – 20 patients without complaints on the gastrointestinal tract, Group 2 – 30 patients with CP, Group 3 – 20 CP patients with concomitant T2DM received protocol treatment (PT), Group 4 and 5 – CP patients with concomitant T2DM, including 21 patients received PT with a course of SWIT for 3 days, and 24 patients – SWIT course for 5 days. The concentration of lactate and pyruvate in blood plasma was determined, the lactate/pyruvate ratio was calculated, the concentration of bicarbonates in blood plasma was determined, pain was determined by the QLQ-C30 and PAN28 questionnaires, pain syndrome severity was determined by the visual analogue scale (VAS). Statistical processing of the obtained data was performed using Microsoft Excel 2016 and Statistica 13.0. Results. A positive therapeutic effect on the dynamics of the level of mEI markers and COPD disorders in patients with CP with concomitant T2DM has been proved, which indicates the positive effect of the SWIT scheme in the program of complex treatment. A clear dependence of the rate of normalization of these parameters on the duration of the SWIT course was revealed. Conclusions. 1 Statistically significant increase of objective markers of COS impairment due to MEI (lactate, lactate/pyruvate ratio) in CP patients with concomitant T2DM in comparison with the same in isolated CP was revealed (p&lt;0.05). Strong correlations between markers of mEI and pH disturbance towards metabolic acidosis mediated by lactate/pyruvate ratio and bicarbonate content were found. A higher level of efficiency of SWIT-5 application in complex therapy in comparison with MOIT-3 program has been established. It is proved that normalization of the specified indexes directly correlates with duration of the MOIT course.

Peripheral IV Administration of Hypertonic Saline: Single-Center Retrospective PICU Study.

To determine the frequency and characteristics of complications of peripherally administered hypertonic saline (HTS) through assessment of infiltration and extravasation. Retrospective cross-sectional study. Freestanding tertiary care pediatric hospital. Children who received HTS through a peripheral IV catheter (PIVC). None. We conducted a single-center retrospective review from January 2012 to 2019. A total of 526 patients with 1,020 unique administrations of HTS through a PIVC met inclusion criteria. The primary endpoint was PIVC failure due to infiltration or extravasation. The indication for the administration of HTS infusion was collected. Catheter data was captured, including the setting of catheter placement, anatomical location on the patient, gauge size, length of time from catheter insertion to HTS infusion, in situ duration of catheter lifespan, and removal rationale. The administration data for HTS was reviewed and included volume of administration, bolus versus continuous infusion, infusion rate, infusion duration, and vesicant medications administered through the PIVC. There were 843 bolus infusions of HTS and 172 continuous infusions. Of the bolus administrations, there were eight infiltrations (0.9%). The continuous infusion group had 13 infiltrations (7.6%). There were no extravasations in either group, and no patients required medical therapy or intervention by the wound care or plastic surgery teams. There was no significant morbidity attributed to HTS administration in either group. HTS administered through a PIVC infrequently infiltrates in critically ill pediatric patients. The infiltration rate was low when HTS is administered as a bolus but higher when given as a continuous infusion. However, no patient suffered an extravasation injury or long-term morbidity from any infiltration.

The effectiveness of on-line hemodiafiltration in patients with chronic kidney disease: risk factors and improving the assessment of fluid excretion values

Hemodiafiltration on-line (HDF OL) cannot be considered sufficiently studied in terms of its effect on the outcome. THE AIM. To identify the possible relationship of individual anthropometric, laboratory data and parameters of the prescribed treatment regimen with better survival when using the HDF OL. PATIENTS AND METHODS. A retrospective study of the EuCliD database of patients treated with HDF OL in 27 Fresenius Medical Care centers in the Russian Federation during 2014 was conducted. All patients received postdilution HDF OL procedures at least 3 times a week, lasting at least 12 hours a week, with adequacy of Kt/V procedures of at least 1,4. Data from survivors (9616) and deceased (370) patients were compared. The analyzed indicators were: gender, age, treatment experience, body weight, body mass index (BMI), body surface area (BSA), total body water volume (TBW), the volume of distribution (V Urea BCM), presence of diabetes mellitus, coronary heart disease, heart failure, as well as the parameters of the procedure: effective weekly dialysis time, Kt/V, effective in-fusion volume (EIV), effective convection volume (ECV). RESULTS. Risk factors for death in patients with CKD 5D treated with HDF OL include male gender, older age, con-comitant diseases, lower body weight, and BMI, shorter effective weekly dialysis time, lower EIV and ECV values, Kt/V, higher hypercalcemia, hypoalbuminemia, lower hemoglobin levels, higher b2-microglobulin levels, and CRP. Сomparing the normalized BMI, BSA, TBW, V Urea BCM indicators, we identified those that were associated with a high risk of mortality in the population of dialysis patients. CONCLUSION. As a result of this work, two normalized ratios were identified (the median ratio of effective infusion volume to body surface area and the median ratio of effective convection volume to body surface area), which were associated with a high risk of mortality in the population of dialysis patients.

A Comparison of Two Peripheral Nerve Blocks Combined With General Anesthesia in Elderly Patients Undergoing Arthroplasty for Hip Fractures: A Pilot Randomized Controlled Trial.

BackgroundCombined anesthesia can be a promising option for hip surgery when neuraxial anesthesia is contraindicated. Lumbar and sacral plexus blocks, and femoral nerve and lateral femoral cutaneous (LFC) nerve blocks in combination with general anesthesia (GA) are commonly used in elderly patients undergoing arthroplasty for hip fracture surgery. However, no study has compared these two anesthetic strategies in the perioperative period.MethodsA total of 41 elderly patients scheduled for arthroplasty for hip fracture surgery were randomized into group A (n = 20) and group B (n = 21). Group A received femoral nerve block, LFC nerve blocks, and GA, and group B received lumbar plexus block, sacral plexus block, and GA. Primary outcomes were incidences of hemodynamic events and changes in blood pressure (BP) and heart rate (HR). Secondary outcomes included time and drug consumption, infusion and bleeding volume, eyes opening time after surgery, and postoperative quality recovery rate.ResultsCompared with group B, group A showed a lower incidence of intraoperative hypotension (p < 0.001), higher BP [including mean arterial pressure (MAP), systolic BP (SBP), and diastolic BP (DBP)] following induction (IN), and higher HR from mid-surgery. Time required for nerve blockade (p < 0.001) and ephedrine consumption was significantly shorter in group A (p < 0.001), while sufentanil consumption was higher as compared to group B (p = 0.002). No significant differences in other intraoperative parameters and postoperative quality recovery rate were reported during the observation.ConclusionOur pilot data indicate that compared with lumbar and sacral plexus blocks, femoral nerve and LFC nerve blocks may provide more stable intraoperative hemodynamics and a comparable postoperative recovery for elderly patients undergoing arthroplasty for hip fracture under GA. Further studies with a larger sample size are needed to derive stronger evidence.

Can portable ultrasound bladder scanner be applied to young children less than three years old?

The bladder scanner (BS), a portable ultrasound device specialized in bladder volume measurement, has been developed and applied to clinical assessment of postvoid residual urine, which is a requisite in evaluating patients with voiding dysfunction. However, experiences in the application of the BS to the pediatric population remain limited despite commonly encountered reluctance to catheterization. This prospective observational study aimed to evaluate the correlation and accuracy of the newly developed pediatric module of the BS (BioCon-900) in measuring bladder volume in children 0-6 years old. This study included 29 patients scheduled to undergo preventive untethering for their spinal dysraphism. When they undergo cystometry for the confirmation of normal neurologic function, bladder volume was measured by BS when recorded volume infusion reached each quartile of the age-adjusted estimated bladder capacity (EBC). The difference (bias) between measured and infused volume was expressed as a percentage of EBC (%EBC). The correlation coefficient and the Bland-Altman plot were obtained to determine the discriminating power and accuracy, respectively. The acceptable limit was set as 30%EBC. A strong correlation between the measured and infused volume (r=0.95, P<0.001) was found for the entire age range. This excellent correlation remained comparable between children less than three years and the older ones. Bladder volume tended to be overestimated, and the mean bias was 33±22.3%EBC, and it became higher with increasing quartiles. The accuracy was acceptable in all ranges of measurement in the older group and first and second quartiles in the younger one. We have first evaluated the potential use of BS in 0-3 years old children and compared the results with 4-6-year-old children in whom the accuracy of BS has been demonstrated. The strong point of our study was the inclusion of data spanning all quartiles of bladder volume. The use of infused volume as reference enabled us to assess the accuracy in a more precise way than the use of ultrasound. Despite the good discriminating power, the accuracy was not acceptable in higher quartiles in the younger group. If the trend of overestimation especially higher volume, could be understood prior to measurement, it would be helpful to assume the real val. The children's module in BS showed excellent discriminating power and generally acceptable accuracy in more than four-year-old children. This may lose accuracy in higher quartiles among less than three years old children.

ERC-ESICM guidelines on temperature control after cardiac arrest in adults

The aim of these guidelines is to provide evidence‑based guidance for temperature control in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm. These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-resuscitation care guidelines co-issued by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM).The guideline panel included thirteen international clinical experts who authored the 2021 ERC-ESICM guidelines and two methodologists who participated in the evidence review completed on behalf of the International Liaison Committee on Resuscitation (ILCOR) of whom ERC is a member society. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations. The panel provided suggestions on guideline implementation and identified priorities for future research.The certainty of evidence ranged from moderate to low. In patients who remain comatose after cardiac arrest, we recommend continuous monitoring of core temperature and actively preventing fever (defined as a temperature > 37.7 °C) for at least 72 hours. There was insufficient evidence to recommend for or against temperature control at 32–36 °C or early cooling after cardiac arrest. We recommend not actively rewarming comatose patients with mild hypothermia after return of spontaneous circulation (ROSC) to achieve normothermia. We recommend not using prehospital cooling with rapid infusion of large volumes of cold intravenous fluids immediately after ROSC.

Effect of Thoracic Paravertebral Nerve Block on Blood Coagulation in Patients After Thoracoscopic Lobectomy: A Prospective Randomized Controlled Clinical Trial.

PurposeUltrasound-guided thoracic paravertebral block (TPVB) has become increasingly popular for postoperative analgesia after thoracic surgery. We designed this prospective, randomized, double-blind, placebo-controlled trial to investigate the effect of TPVB on blood coagulation in patients after thoracoscopic lobectomy.Patients and MethodsSixty patients scheduled for thoracoscopic lobectomy were randomly allocated to two groups. Patients underwent ultrasound-guided TPVB with 0.33% ropivacaine (T group) or 0.9% saline (C group) at the end of the surgery under general anesthesia. Patient-controlled intravenous analgesia (PCIA) was administered for both group after the surgery. The primary outcome was the thromboelastogram (TEG) parameters before anesthesia (T0), at the end of operation (T1) and in 1 day (T2) and 2 days (T3) after the operation, the second outcomes were the analgesic effect and the amount of intraoperative opioid consumption, operation time, infusion volume, blood loss and urine volume.ResultsThe visual analog scale (VAS) scores in group T were lower than group C (P < 0.05). In group T, compared with T0, the R value at T1 and T2 is significantly reduced, and the K value at T1 were significantly shortened, the α-angle and MA value at T1 were significantly increased (P < 0.05). In group C, compared with T0, the R value and K value were significantly shortened, the α-angle and MA value were significantly increased at all postoperative time points (P < 0.05). Compared with group C at the same time point, the R and K values of group T were significantly longer, and the α-angle and MA values were significantly reduced at T2 and T3 points, with statistically significant differences (P<0.05).ConclusionTPVB is beneficial to improve postoperative hypercoagulability and promote postoperative rehabilitation of patients after thoracoscopic lobectomy.

Oritavancin (KIMYRSA™) in acute bacterial skin and skin structure infections: a profile of its use in the USA

Oritavancin, a long-acting lipoglycopeptide, is the first single-dose intravenous (IV) antibacterial therapy approved in the USA for the treatment of adult patients with acute bacterial skin and skin structure infections (ABSSSIs) caused or suspected to be caused by susceptible isolates of designated gram-positive microorganisms. With its well-established antibacterial activity, efficacy and safety profiles, a new IV formulation of oritavancin (KIMYRSA™) has been developed to offer a more convenient treatment option for patients with ABSSSIs. Relative to the originally approved IV formulation of oritavancin (ORBACTIV®), the new IV formulation has better diluent compatibility, simpler preparation steps, a shorter infusion time of 1 h in a lower infusion volume of 250 mL. Approval was based on results of a phase 1 study in which pharmacokinetic similarity between the two IV formulations of oritavancin was demonstrated in patients with ABSSSIs. The tolerability profile of the new IV formulation of oritavancin revealed no new safety signals.

Clinical Analysis of Bloodstream Infection after Hematopoietic Stem Cell Transplantation

To analyze the clinical characteristics of bloodstream infection (BSI) in patients treated by hematopoietic stem cell transplantation (HSCT). The clinical characteristics, distribution of pathogenic bacteria causing BSI and drug sensitivity of 910 patients treated by HSCT in our department from January 2013 to June 2020 were retrospectively analyzed. Among 910 HSCT patients, 111 patients were diagnosed as BSI within 100 days after transplantation, and 98 patients showed BSI during the period of agranulocytosis. Multivariate analysis showed that the usage of anti-thymocyte globulin (ATG), long duration of agranulocytosis and low infusion volume of mononuclear cell (MNC) were the independent risk factors affecting BSI after HSCT. Among 121 pathogenic bacteria isolated, 76 Gram-negative (G-) bacteria (62.8%), 40 Gram-positive (G+) bacteria (33.0%), and 5 fungi (4.1%) were detected out. The top three pathogens were Escherichia coli, Staphylococcus epidermidis and Pseudomonas aeruginosa. The drug-resistance rates of Escherichia coli and Klebsiella pneumoniae to carbapenems was 14.3% and 7.7%, respectively, and Pseudomonas aeruginosa was 66.7%. The susceptibility of G+ bacteria to vancomycin, linezolid and teicoplanin was 97.5%, 100% and 100%, respectively. The crude mortality rate of the patients with BSI at 100 days after HSCT was significantly higher than that of patients without BSI (P<0.001). The usage of ATG, long duration of agranulocytosis and low infusion volume of MNC are independent risk factors for BSI after HSCT. The pathogens after HSCT are mainly G- bacteria. Pseudomonas aeruginosa is highly resistant to carbapenems. Key words ;

ERC-ESICM guidelines on temperature control after cardiac arrest in adults.

The aim of these guidelines is to provide evidence‑based guidance for temperature control in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm. These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-resuscitation care guidelines co-issued by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM). The guideline panel included thirteen international clinical experts who authored the 2021 ERC-ESICM guidelines and two methodologists who participated in the evidence review completed on behalf of the International Liaison Committee on Resuscitation (ILCOR) of whom ERC is a member society. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations. The panel provided suggestions on guideline implementation and identified priorities for future research. The certainty of evidence ranged from moderate to low. In patients who remain comatose after cardiac arrest, we recommend continuous monitoring of core temperature and actively preventing fever (defined as a temperature > 37.7°C) for at least 72h. There was insufficient evidence to recommend for or against temperature control at 32-36°C or early cooling after cardiac arrest. We recommend not actively rewarming comatose patients with mild hypothermia after return of spontaneous circulation (ROSC) to achieve normothermia. We recommend not using prehospital cooling with rapid infusion of large volumes of cold intravenous fluids immediately after ROSC.

A possible dose-response equation: Viral load after plasma infusion in COVID-19 patients and anti-SARS-CoV-2 antibody titers in convalescent plasma.

Clinical trials of convalescent plasma therapy for coronavirus disease 2019 (COVID-19) are extensive, but the relationship between antibody titers, infused volume of plasma and virus clearance in patients remains unknown. This study proposed a possible estimating equation for clinical use of high antibody titer convalescent plasma. A total of 38 patients were recruited in the Guanggu District Maternal and Child Health Hospital of Hubei Province from March 1 to 30, 2020. COVID-19 convalescent plasma was collected and high-titer (≥1:640) anti-S-RBD units used. The SARS-CoV-2 nucleic acid viral load was measured 24 h before and 72 h after convalescent plasma infusion. Convalescent plasma therapy was associated with reduced viral load in patients with moderate and severe severity. The viral negative rate at 72 h was 65.8%. The disappearance of viral nucleic acid in study patients was positively correlated with infuscate antibody titer and volume (r=0.3375, p=0.04). A possible estimation equation was as follows: Log10 (Reduction in viral load)=0.18 + 0.001 × (Log2 S-RBD antibody titer × Plasma infusion volume) (r=0.424, p=0.009). In a single case, the viral nucleic acid persisted 14 days after the fourth plasma infusion. This study proposes a potential dose-response equation that adds a convenient way to estimate the dose of convalescent plasma product. It is beneficial to facilitate the rational allocation of plasma with high antibody titers and provide an individualised use strategy for convalescent plasma therapy.

Базові основи та принципи керованої інфузійної терапії у хворих із невідкладною хірургічною патологією органів черевної порожнини

За останні п’ятнадцять років кількість ургентних лапаратомій становила 36–58 % з летальністю 30–80 %. Однією з головних причин такої високої смертності є гіповолемія, що формує гемодинамічні порушення, тканинну гіпоксію і розвиток поліорганної недостатності. Основним методом її лікування є поповнен­ня дефіциту об’єму циркулюючої крові. Препаратами вибору вважаються кристалоїди. Прогнозування ефектів кристалоїдних розчинів легко провести за допомогою фізико-хімічної моделі кислотно-лужної рівноваги Стюарта. Згідно теорії, характеристиками збалансованого кристалоїдного розчину є: SIDinf = 24 мEqL–1; відповідність вмісту електролітів до їх концентрації в плазмі; наявність у складі органічних іонів, що запобігають підвищенню концентрації Cl– в інфузійному розчині і є донаторами резервної лужності. Виходячи з цього ми виділяємо серед кристалоїдних розчинів незбалансовані (0,9% розчин NaCl); частково збалансовані (розчини Рінгера лактат і Хартмана); повністю збалансовані розчини (плазмаліт, плазмаліт А, стерофундін, стерофундін ISO). Використання незбалансованих розчинів небезпечно у зв’язку з розвитком гіперхлоремічного ацидозу. Використання частково збалансованих кристалоїдних розчинів може формувати або посилювати лактатацидоз в умовах тканинної гіпоксії і/або дисфункції печінки. Інфузія збалансованих розчинів дозволяє швидко коригувати метаболічний ацидоз.

Корекція гемодинаміки в періопераційному періоді (аналітичний огляд)

Аналітичний огляд присвячений перевагам та недолікам періопераційної корекції гемодинаміки шляхом проведення об’ємної інфузійної терапії та застосування симпатоміметиків. Порівнюються успішність використання ліберального й рестриктивного режиму інфузійної терапії. Вказано на індивідуальну варіабельність ефектів різних симпатоміметиків. Показано, що всі шляхи корекції гемодинаміки можуть мати серйозні недоліки, якщо корекція проводиться при можливостях гемодинамічного моніторингу.

Intraoperative Fluid Management a Modifiable Risk Factor for Surgical Quality - Improving Standardized Practice.

We aimed to determine a safe zone of intraoperative fluid management associated with the lowest postoperative complication rates without increased acute kidney injury (AKi) risk for elective colorectal surgery patients. To date, standard practice within institutions, let alone national expectations related to fluid administration, are limited. This fact has perpetuated a quality gap. Elective colorectal surgeries between 2018 and 2020 were included. Unadjusted odds ratios (ORs) for postoperative ileus, prolonged LOS, and AKi were plotted against the rate of intraoperative RL infusion (mL/ kg/h) and total intraoperative volume. Binary logistic regression analysis, including fluid volumes as a confounder, was used to identify risk factors for postoperative complications. A total of 2900 patients were identified. Of them, 503 (17.3%) patients had ileus, 772 (26.6%) patients had prolonged LOS, and 240 (8.3%) patients had AKI. The intraoperative fluid resuscitation rate (mg/kg/h) was less impactful on postoperative ileus, LOS, and AKI than the total amount of intraoperative fluid. A total fluid administration range between 300 mL and 2.7 L was associated with the lowest complication rate. Total intraoperative RL ≥2.7 L was independently associated with a higher risk of ileus (adjusted OR 1.465; 95% confidence interval 1.154-1.858) and prolonged LOS (adjusted OR 1.300; 95% confidence interval 1.047-1.613), but not AKI. Intraoperative RL ≤300 mL was not associated with an increased risk of AKI. Total intraoperative RL ≥2.7 L was independently associated with postoperative ileus and prolonged LOS in elective colorectal surgery patients. A new potential standard for intraoperative fluids will require anesthesia case planning (complexity and duration) to ensure total fluid volume meets this new opportunity to improve care.

Targeted temperature management after cardiac arrest : What is new?

The current guidelines of the European Resuscitation Council recommend targeted temperature management to improve functional neurological outcome in comatose survivors after cardiac arrest. With the pathophysiological background of hypothermia-induced neuroprotection for prevention of hypoxic-ischemic encephalopathy, targeted temperature management is akey measure and represents acentral aspect in postresuscitation care.In the 2021 guidelines the application of targeted temperature management in postresuscitation care has been recommended for all rhythms and irrespective of the location of cardiac arrest. Targeted temperature management is advocated for adult patients who remain unresponsive following return of spontaneous circulation (ROSC) after either out-of-hospital cardiac arrest or in-hospital cardiac arrest. The body temperature should be maintained at aconstant value between 32 °C and 36 °C for at least 24 h. To avoid rebound hyperthermia, fever following targeted temperature management, defined as atemperature above 37.7 °C, should be prevented and treated for at least 72 h after ROSC in persistently comatose patients. The routine use of prehospital cooling by rapid infusion of large volumes of cold i.v. fluid immediately after ROSC is not recommended.Based on asystematic review of the current literature, this article summarizes the results of randomized trials and new findings on targeted temperature management in comatose adult patients after cardiac arrest. The review has aparticular focus on the most recent evidence regarding the optimum range of target temperatures. Furthermore, recent data on preclinical management, different patient populations, the duration of targeted temperature management, cooling methods and rebound hyperthermia are discussed.The impact of targeted temperature management on neurological outcome after cardiac arrest has been amatter of controversy. Despite contradictory results and heterogeneity of study designs, the current evidence supports the relevance and the necessity of strict temperature control in postresuscitation care for neuroprotection and improvement in functional neurological outcomes.

Reaction pattern of the autonomic nervous system to the infusion load in the intensive care in children: a prospective comparative study

INTRODUCTION. The leading role in the water and electrolyte balance in critical conditions belongs to infusion therapy. Hemodynamic stabilization is achieved by fluid bolus with risk of hypervolemia. Non-invasive monitoring in ICU is relevant in children. Cardiointervalography is characterized by nosological non-specificity and high sensitivity to neurohumoral changes. The stress index and spectral analysis allow the assessment of therapeutic efficacy. OBJECTIVES. To study the features of the electrophysiological response to the emergency rehydrate volume in children upon admission to the intensive care unit. MATERIALS AND METHODS. A prospective comparative study was conducted with the participation of 172 patients, the age from 0 to 15 years. There were 71 newborns in the first group (21 surgical cases, 50 somatic ones). The second group enrolled children aged 1 to 15 years, in 40 % of all underwent surgical treatment. The characteristic of the electrophysiological response to the hydration was carried out in an intergroup and interstage comparison in different age and nosological groups. DISCUSSION. The autonomic nervous system response to infusion therapy has not been studied in children of different ages. The stress index and frequency analysis reflect the degree of regulatory systems tension and are promising in intensive care monitoring. RESULTS. In newborns with sensory block, it was expressed by tachycardia (p = 0.02); without block — arterial hypotension (p = 0.000) without chronotropic component. The implementation of sympathetic reactions was suppressed in children in the early postoperative period. In children without surgical treatment, the volume of infusion had a sympatholytic effect. CONCLUSIONS. In the early postoperative period, the electrophysiological response in children was limited. Age-related features of reactions to hydration in children with somatic pathology were revealed. In children, infusion therapy contributed to a cardiovascular economical work; in newborns, it was associated with a breakdown in sympathetic adaptation.