Intravenous Fluid Therapy Research Articles

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<0.05).

Risk Factors for Bloodstream Infection in Patients Receiving Peripheral Parenteral Nutrition.

Background Intravenous fluid therapy, including peripheral parenteral nutrition (PPN), administered via a peripheral intravenous catheter (PVC) can occasionally lead to bloodstream infections (BSIs). PPN may thus be a risk factor for PVC-related BSI (PVC-BSI). However, the risk factors and incidence of PVC-BSI have not been previously reported, and evidence for these conditions remains unclear. Methods We retrospectively collected data from 391 patients who underwent PPN therapy with PVC at the Fukujuji Hospital from August 2022 to November 2023. We compared 20 patients who developed BSI during PPN therapy (BSI group) with 371 who did not develop BSI during PPN therapy (no-infection group). Results The incidence rate of PVC-BSI during PPN therapy was 5.1%. The BSI group had a significantly longer average daily infusion time of PPNs (median 24.0 [range 6.0-24.0] h vs. 6.0 [2.0-24.0] h, p<0.001) and of all intravenous fluids (median 24.0 [range 8.8-24.0] h vs. 10.3 [2.0-24.0] h, p<0.001) than the no infection group. An average daily infusion time of PPNs ≥12.0 h and an average daily infusion time of intravenous fluids ≥18.0 h were identified as predictive risk factors for BSI. When both risk factors were present, the sensitivity, specificity, and odds ratio for the development of BSI were 85.0%, 83.2%, and 27.9, respectively. Conclusion This study identified the incidence of and risk factors for developing BSI, such as a longer average daily infusion time of PPNs and all intravenous fluids, in patients receiving PPN therapy.

Registered Nurses' Knowledge of Intravenous Fluid Therapy at a Teaching Hospital in Namibia: A Cross-Sectional Survey.

Insufficient knowledge of intravenous fluid therapy is a significant challenge contributing to morbidity and mortality in hospitalized patients. Nurses play a critical role in evaluating patients' fluid and electrolyte balance as well as in restoring fluid levels. Various studies have indicated a deficiency in nurses' knowledge of intravenous therapy, yet this remains understudied in many settings, including Namibia. To assess nurses' knowledge of intravenous fluid therapy and to describe the variables associated with knowledge of intravenous fluid therapy at a teaching hospital in Namibia. A cross-sectional online survey involving 164 nurses who were recruited using total population sampling. Data were collected between September and November 2021, using a self-administered 14-item validated tool (α = 0.8). Data analysis was conducted using SPSSv28.0 software. The majority of nurses (84%) in this study exhibited an insufficient level of knowledge regarding intravenous therapy, with only a minority (16%) demonstrating a moderately adequate understanding of intravenous fluid therapy. A significant positive correlation was found between educational qualification and knowledge of intravenous therapy (r = 0.21; p = .01). The study's results indicate a worrying trajectory in nurses' knowledge of intravenous therapy. These findings underscore the need for hospitals to establish comprehensive training programs for nurses to guarantee the provision of secure and efficient intravenous therapy. Additional research is needed to investigate how educational qualifications impact patient outcomes related to intravenous therapy.

Clinical severity of Omicron and Delta SARS-CoV-2infections in children.

We aimed to compare the clinical features and severity of the Omicron and Delta variant infections among children hospitalized for coronavirus disease 2019 (COVID-19). Children 12 years old or less hospitalized for COVID-19 across five hospitals between January 1, 2021 and March 31, 2022 were identified using the state's pediatric COVID-19 registry. Delta and Omicron-infected patients without previous COVID-19 infection, COVID-19 vaccination, or co-infections were propensity-score matched 1:1 to control for differences in baseline characteristics. Clinical manifestations, treatments, and outcomes were analyzed. Disease severity was assessed using an adapted WHO ordinal scale. Of the initial 1367 patients, 668 had Delta infection and 699 had Omicron infection. Propensity-score matching produced 558 matched pairs. Patients with Omicron infection were more likely to present with croup (the odds ratio, OR, was 10.87, with a 95% confidence interval, CI, ranging from 2.54 to 46.59), lower respiratory tract infection (OR 2.32, 95% CI, 1.48-3.64) and seizures (OR 8.39, 95% CI, 5.04-13.99) compared with those with Delta infection. Omicron was associated with increased odds of moderate/severe disease (OR 6.14, 95% CI, 4.72-7.99) and a greater need for intravenous fluid therapy (OR 6.00, 95% CI, 4.29-8.39), corticosteroids (OR 3.08, 95% CI, 1.66-5.72), empirical antibiotics (OR 1.70, 95% CI, 1.10-2.64), and low-flow nasal oxygen therapy (OR 3.68, 95% CI, 2.17-6.22) in comparison with Delta. Children hospitalized with Omicron infection demonstrated a distinct clinical profile compared to those with Delta infection, with increased likelihood of moderate/severe disease and higher utilization of health-care resources.

Distraction Technique using a Cooling Vibrator Reduces the Pain of Vein-puncture in Children

Background: Typhoid fever is commony found disease at the hospital. One of the treatments for typhoid fever is intravenous fluid therapy. This procedure certainly causing pain. Actions to minimize pain to children when infusion is carried out are part of the principles of atraumatic care. One of the atraumatic principle can be performed on children is the use of vibrators and cold compresses to minimize pain.Purpose: To determine the effectiveness of vibrator and cold compress against pain in children when taking venous blood.Methods: This research using true experimental with a post-test in control group and divided into 2 groups, intervention and control groups. This research will determine the effectiveness of cooling vibrator. Assessing children's pain using the FLACC instrument. The study was conducted at Tidore Islands Hospital. Data processing was tested with Mann-Whitney test.Result: Mostly respondents are 4 years old. both of them experiencing of having blood drawn before. Most of the control and intervention groups were women. There are differences pain scores founded, in the intervention group was 3.13 and in the control group was 7.87. The results of statistical tests showed that there was a significant difference in pain during venipuncture in the intervention group and the control group.Conclusion: The statistical test show there was a significant difference in intervention group and the control group. The use of a cooling vibrator can be an alternative to reduce pain in children during venipuncture.

EFFECTIVENESS ENHANCED RECOVERY AFTER CAESAREAN SURGERY (ERACS) ON CONSCIOUS RECOVERY TIME IN SECTIO CAESAREA PATIENTS IN THE RECOVERY ROOM OF RSAD TK. II UDAYANA

Background: Enhanced recovery after Caesarean surgery (ERACS) is a method of perioperative care in the form of a multimodal approach. ERACS is a good method of pain management by reducing opioid use by 30-50 percent and using intravenous fluid therapy and a good combination of anti-nausea drugs. The ERACS technique was carried out starting from pre-intra and post-surgery. In its implementation, ERACS has various benefits, namely reducing postoperative complications, accelerating conscious recovery, saving costs and reducing morbidity. Urgency of this research is to find out effective surgical methods to speed up early postpartum mobilization without pain.&#x0D; Objective: To determine the effectiveness of the ERACS technique for conscious recovery in sectio caesarea patients with spinal anesthesia in the recovery room.&#x0D; Method: This study used a quasi-experimental with a cross-sectional approach using 2 groups, namely the control group and the treatment group. This research was carried out in June-August 2022 at TK II Udayana Hospital with 60 respondents for the control group and 60 for the treatment group. The research instrument uses a standard bromage score observation sheet. The research process was carried out by giving informed consent to the 2 groups and then post-surgery an assessment of conscious recovery was carried out in both groups.&#x0D; Results: The results of the study in the treatment group showed that the ERACS method had a faster recovery time of 15-30 minutes. The control group, namely the conventional method, has a longer conscious recovery time of 30-60 minutes. The statistical test Mann-Whitney test is sig &lt;0.05 that can be concluded that ERACS is effective in decreasing the time to recover consciousness in the recovery room in patients with elective sectio caesarea surgery at RSAD Tk.II Udayana.&#x0D; Conclusion: The ERACS method is effective in accelerating the time to recover from consciousness in the recovery room and accelerating recovery in patients with elective sectio caesarea surgery at RSAD Tk.II Udayana. Therefore, the application of ERACS can be an effective choice to accelerate postoperative recovery with caesarean section.&#x0D;

Plasma Volume Oscillations during Fluid Therapy in Humans

Introduction: Oscillations are frequently observed on plasma dilution curves during intravenous fluid therapy. This study aimed to examine how common these oscillations are and what they represent. Methods: Fourier transforms were used to analyze the residuals obtained during fitting of a volume kinetic model to 269 plasma dilution curves. Oscillating patterns were identified in two-thirds of the fluid infusion experiments. Results: The wave frequency usually had a dominating frequency of 1 h or multiples thereof. The wave amplitudes varied between 1% and 4% of the plasma volume. The “peak-to-peak” amplitudes were then twice as large, which corresponded to blood volume changes of 60–240 mL. A population kinetic analysis of the distribution of infused fluid between body fluid compartments was then applied to search for clues that could explain the oscillations. This analysis showed that amplitudes >1.5% were associated with doubled turnover of fluid in a fast-exchange interstitial fluid compartment and, together with data on plasma albumin, suggested that oscillations might represent bursts of efferent lymph. Conclusions: Oscillations with very low frequency were often observed on plasma dilution-time curves obtained during fluid therapy. They were associated with fast turnover of interstitial fluid and can possibly have resulted from accelerated lymphatic flow.

Management of Low Sodium in AMU

Hyponatremia is a common finding in acutely ill patients and is defined as serum sodium (Na) level less than 135 mEq/L which is due to a relative excess of water in relation to serum sodium. Reasons for hyponatremia are increase in water intake (hypotonic intravenous fluid therapy or primary polydipsia) or impaired water excretion due to renal failure or increase release of antidiuretic hormone. Optimum management depends on the duration and severity of hyponatremia and involves close monitoring and accurate fluid balance assessment. We will discuss in this article the basics of management, pitfalls to avoid in Hyponatremia and recommended approach based on literature review when reviewing a patient with Hyponatremia, firstly to enquire about the duration of Hyponatremia to differentiate acute from chronic as the threshold for treatment is different, following duration is assessment of severity (clinically by symptoms and signs as well as biochemistry) as severity will affect the management. Following duration and severity the acute physician should assess the volume status of the patient to hypovolemic, euvolemic or hypervolemic Hyponatremia which aids in reaching the possible cause of Hyponatremia and the right treatment.

Delphi Process for Validation of Fluid Treatment Algorithm for Critically Ill Pediatric Trauma Patients

IntroductionWhile intravenous fluid therapy is essential to re-establishing volume status in children who have experienced trauma, aggressive resuscitation can lead to various complications. There remains a lack of consensus on whether pediatric trauma patients will benefit from a liberal or restrictive crystalloid resuscitation approach and how to optimally identify and transition between fluid phases. MethodsA panel was comprised of physicians with expertise in pediatric trauma, critical care, and emergency medicine. A three-round Delphi process was conducted via an online survey, with each round being followed by a live video conference. Experts agreed or disagreed with each aspect of the proposed fluid management algorithm on a five-level Likert scale. The group opinion level defined an algorithm parameter's acceptance or rejection with greater than 75% agreement resulting in acceptance and greater than 50% disagreement resulting in rejection. The remaining were discussed and re-presented in the next round. ResultsFourteen experts from five Level 1 pediatric trauma centers representing three subspecialties were included. Responses were received from 13/14 participants (93%). In round 1, 64% of the parameters were accepted, while the remaining 36% were discussed and re-presented. In round 2, 90% of the parameters were accepted. Following round 3, there was 100% acceptance by all the experts on the revised and final version of the algorithm. ConclusionsWe present a validated algorithm for intavenous fluid management in pediatric trauma patients that focuses on the de-escalation of fluids. Focusing on this time point of fluid therapy will help minimize iatrogenic complications of crystalloid fluids within this patient population.

Fluid therapy for emergent and critical cases: hypovolaemia vs dehydration

Intravenous fluid therapy is commonly used in emergent and critical patients. Water is a nutrient that is vital to the survival of patients, but one that must be replenished daily. Fluid in the body can be subdivided into intracellular and extracellular portions, with extracellular being further divided into interstitial and intravascular compartments. Fluid loss from all compartments is called dehydration – this is not immediately life threatening. Hypovolaemia is fluid loss from the intravascular compartment – this is life-threatening and requires immediate treatment. Prompt patient assessment and identification of these conditions is essential in selecting the right treatment for the patient. Goal-directed therapy is the gold standard approach for patients receiving intravenous fluid therapy and the veterinary nurse has a key role to play in patient monitoring.

Variations in intravenous fluid management for paediatric hypernatraemia in South Africa: A survey of junior and senior South African paediatric doctors

Background. Paediatric hypernatraemia is a severe and life-threatening electrolyte abnormality that is associated with considerable morbidity and mortality. Although intravenous (IV) fluid therapy is a crucial component of management, there are no management guidelines, and varying approaches to IV fluid therapy are commonplace in clinical practice. Objectives. To determine the variance in IV fluid therapy in the management of paediatric hypernatraemia among paediatric registrars and consultants in South Africa. Methods. A self-administered online survey was conducted from November 2020 to February 2021. The survey assessed paediatricians’ management of three typical clinical scenarios of community-acquired hypernatraemia seen in South Africa. Descriptive results were presented as proportions, frequencies and medians with interquartile ranges. Comparisons were done using contingency tables. Results. Responses from 119 participants were analysed. Most respondents worked in the state sector (69.8%), and were based mainly in Gauteng (46.2%) or Western Cape (25.2%) province. Most (60.2%) respondents considered a serum sodium level ≥146 mmol/L indicative of hypernatraemia, and 43.6% (n=51/117) reported seeing &gt;10 cases of paediatric hypernatraemia in 2019. For all three cases, at least eight different types of infusate (of varying sodium concentrations) were chosen as maintenance fluids. Fluid deficits were calculated using either the free water method or based on the perceived degree/percentage of clinical dehydration. Conclusion. There is considerable variability in the management of hypernatraemia among paediatricians in South Africa. There is an urgent need to develop a standardised guideline for the treatment of paediatric hypernatraemia.

Volume replacement in the resuscitation of trauma patients with acute hemorrhage: an umbrella review

BackgroundThe use of intravenous fluid therapy in patients with major trauma in prehospital settings is still controversial. We conducted an umbrella review to evaluate which is the best volume expansion in the resuscitation of a hemorrhagic shock to support the development of major trauma guideline recommendations.MethodsWe searched PubMed, Embase, and CENTRAL up to September 2022 for systematic reviews (SRs) investigating the use of volume expansion fluid on mortality and/or survival. Quality assessment was performed using AMSTAR 2 and the Certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.ResultsWe included 14 SRs investigating the effects on mortality with the comparisons: use of crystalloids, blood components, and whole blood. Most SRs were judged as critically low with slight overlapping of primary studies and high consistency of results. For crystalloids, inconsistent evidence of effectiveness in 28- to 30-day survival (primary endpoint) was found for the hypertonic saline/dextran group compared with isotonic fluid solutions with moderate certainty of evidence. Pre-hospital blood component infusion seems to reduce mortality, however, as the certainty of evidence ranges from very low to moderate, we are unable to provide evidence to support or reject its use. The blood component ratio was in favor of higher ratios among all comparisons considered with moderate to very low certainty of evidence. Results about the effects of whole blood are very uncertain due to limited and heterogeneous interventions in studies included in SRs.ConclusionHypertonic crystalloid use did not result in superior 28- to 30-day survival. Increasing evidence supports the scientific rationale for early use of high-ratio blood components, but their use requires careful consideration. Preliminary evidence is very uncertain about the effects of whole blood and further high-quality studies are required.

Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease.

While intravenous fluid (IVF) therapy in patients with sickle cell disease (SCD) admitted for a vaso-occlusive episode (VOE) can help reduce red blood cell sickling, clinical practice varies across institutions. We examined the relationship between IVF therapy and hospital length of stay (HLOS), as well as adverse events, such as acute chest syndrome (ACS), pediatric intensive care unit (PICU) transfer, and 28-day re-admission. This is a single-center retrospective analysis of SCD VOE hospitalizations between January 2015 and April 2020. Patients with SCD, age 0-30, with consecutive hospitalizations for VOE were included. For the first 3days of each admission, an "IVF ratio" was calculated by dividing actual IVF rate administered by weight-based maintenance IVF (mIVF) rate. A total of 617 hospitalizations for 161 patients were included. Mean HLOS was 5.7days, (SD 3.9), and mean IVF volume over the first 3days of admission was 139.6mL/kg/day (SD 57.8). Multivariate analysis showed that for each additional 0.5 times the mIVF rate, HLOS increased by 0.53day (p<.001; 95% confidence interval [CI]: 0.609-0.989), but there was no significant association between IVF therapy and adverse events. History of chronic pain was associated with increased odds of re-admission (OR 6.4; 95% CI: 3.93-10.52). Despite the theoretical potential for IVF therapy to slow down the sickling process, our findings suggest that increased IVF therapy was associated with prolonged HLOS, which places a burden on patients, families, and the health system.

1376. A Retrospective Analysis of Intravenous Fluid Therapy Practice at Hospital Admission for Adults with Dengue

Abstract Background Dengue epidemics in Asia was almost exclusively a childhood disease but recently dengue in adults have become increasingly prevalent. Yet intravenous fluid replacement (IVFR), the main supportive therapy for dengue, was developed for pediatric dengue. Evidence-based guidance for fluid replacement, especially for older adults with concomitant chronic diseases that both increases risk of severe dengue and complicate fluid replacement, is lacking. We retrospectively analyzed the use of IVFR in adult dengue patients at admission to a tertiary hospital. Methods Medical records of patients diagnosed with dengue (confirmed by rapid NS1 kit or laboratory confirmation of RT-PCR, NS1 or IgM) from January 2020 to December 2022 were analyzed. Recovery phase was defined as fever defervescence for &amp;gt;12 hours with rising platelet count. Appropriateness of IVFR was based on disease severity according to the 2009 WHO dengue classification scheme. Results Preliminary analysis of the first 30 patients found an almost equal number of males (47%) and females. The median age was 52.5 years (range 15.0-83.0). 20 patients had at least one comorbidity with hyperlipidemia (33%), hypertension (23%) and ischemic heart disease (10%) being the most common. Average time from onset to presentation was 4.3 days (95% CI: 3.8-4.9). 16 (53%) met the WHO classification scheme as requiring IVFR at admission; 4 hypotension, 5 acute kidney injury (AKI), 2 hypotension with AKI, 4 hemoconcentration, 1 AKI with hemoconcentration. Of these 16, one also had altered mental status and another had hemophagocytic lymphohistiocytosis-like presentation. Despite 47% having uncomplicated dengue, all patients had IVFR at admission. Total fluid volume administered during hospitalization varied across the population and fluctuated daily for each patient, with 8 patients receiving IVFR beyond the recovery phase. One developed fluid overload while another had IV cannula-related thrombophlebitis. There was no mortality. Conclusion Preliminary findings of our on-going study suggest excessive use of IVFR and the lack of standardization possibly contributed to two iatrogenic complications. We call for development of evidence-based protocol on fluid management in older dengue patients. Disclosures All Authors: No reported disclosures

Nurses' behavioural intentions towards intravenous fluid administration for pediatric patients: Application of the theory of planned behaviour

BackgroundFor pediatric patients, the demand for quality and safe Intravenous Fluid (IVF) therapy is huge. This is because, compared to adults, children have a lower tolerance for IVF therapy errors and present devastating physiological responses to errors. Nurses play a vital role in IVF administration; therefore, adequate knowledge, positive attitudes, positive perceived behavioural control, and good behavioural intentions are required to achieve effective and successful therapy, patient safety and prevention of complications, and overall positive patient outcomes. This study sought to assess the behaviour of nurses towards IVF administration for pediatric patients. MethodA cross-sectional facility-based study was designed and randomly recruited 112 nurses. The theory of planned behaviour was used as a conceptual framework to assess nurses' behavioural intentions towards IVF administration for pediatric patients. Mean scores and their respective standard deviations, reliability tests, exploratory factor analysis, and linear logistic regression were all performed using SPSS version 27, with the level of significance set at 0.05. ResultsNurses' behavioural intentions for IVF administration for pediatric patients were influenced by their knowledge of standards and protocols for IVF use (β = 0.320; p = 0.01), attitudes (β = 0.339; p = 0.006) subjective norms (β 0.240; p = 0.003) and perceived behavioural control (β = 0.26; p = 0.001). ConclusionNurses' behavioural intentions for IVF administration were significantly influenced by their knowledge of procedures and standards for IVF administration. Additionally, the nurses' subjective norms, perceived behavioural control, and attitude towards IVF administration have a significant effect on their behavioural intentions to administer IVFs to pediatric patients. For nurses to administer IVF effectively, safely, and successfully to pediatric patients, there is a need to enhance their knowledge of standards and guidelines for IVF administration. The nurses need to have good attitudes and positive support and influence from all others to be able to administer IVFs safely and successfully to their pediatric patients.

Restrictive versus standard IV fluid therapy in adult ICU patients with septic shock-Bayesian analyses of the CLASSIC trial.

The CLASSIC trial assessed the effects of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock. This pre-planned study provides a probabilistic interpretation and evaluates heterogeneity in treatment effects (HTE). We analysed mortality, serious adverse events (SAEs), serious adverse reactions (SARs) and days alive without life-support within 90 days using Bayesian models with weakly informative priors. HTE on mortality was assessed according to five baseline variables: disease severity, vasopressor dose, lactate levels, creatinine values and IV fluid volumes given before randomisation. The absolute difference in mortality was 0.2%-points (95% credible interval: -5.0 to 5.4; 47% posterior probability of benefit [risk difference <0.0%-points]) with restrictive IV fluid. The posterior probabilities of benefits with restrictive IV fluid were 72% for SAEs, 52% for SARs and 61% for days alive without life-support. The posterior probabilities of no clinically important differences (absolute risk difference ≤2%-points) between the groups were 56% for mortality, 49% for SAEs, 90% for SARs and 38% for days alive without life-support. There was 97% probability of HTE for previous IV fluid volumes analysed continuously, that is, potentially relatively lower mortality of restrictive IV fluids with higher previous IV fluids. No substantial evidence of HTE was found in the other analyses. We could not rule out clinically important effects of restrictive IV fluid therapy on mortality, SAEs or days alive without life-support, but substantial effects on SARs were unlikely. IV fluids given before randomisation might interact with IV fluid strategy.

Duodenal volvulus of the sigmoid flexure in five cows. A retrospective study

Medical data of five Holstein Friesian cows with duodenal volvulus of the sigmoid flexure admitted to the Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany during a two-year period were reviewed in this study. The aim of this study was to present the clinical, laboratory and surgical findings as well as the postoperative healing progress and therapy of these five cases. All cows showed a loss of appetite and were dehydrated, with a marked drop in milk yield. The rumen motility was severely reduced and an untypical tympanic resonance or ping and a splashing sound were present at the right flank at auscultation. All the cows had only a small amount of faeces. All animals had hypochloraemic metabolic alkalosis and most of them hyperlactatemia. Two of the cows were hypokalaemic. Hyperbilirubinaemia was revealed in all cows. Four of the cows had an increased haematocrit level. A standing right flank laparotomy was performed in all cows. A common surgical finding was the severely dilated, dorsally dislocated and twisted sigmoid flexure of the duodenum, and the empty descending duodenum. The abomasum of all cows was dilated, but not displaced. An enlarged gall bladder was found in four animals. The duodenal sigmoid loop was manually untwisted, followed by promoting gas and ingesta flow aborally in the descending duodenum. Omentopexy was performed in each cow. No cow had had any history of omentopexy or other abdominal surgery. All cows received intravenous fluid therapy after the surgery. A total of 10-20 L 0.9 % NaCl solution containing an additional KCL (30 mmol/L) was administered intravenously via drip infusion daily for the first two days after surgery. Amoxicillin (10 mg/kg; s.c.) was administered once daily (SID) in two cases. Three of the cows were additionally drenched with 30 L water and 100-150 g KCL via an orogastric tube once per day for two days postoperatively. Four cows received neostigmine s.c. after surgery and for the following one to two days (every 8 or 12 hours; 0.02 mg/kg or 0.025 mg/kg, respectively). All cows were administered meloxicam (0.5 mg/kg; s.c.) before and on the first postoperative day. Sodium sulphate (250 g per os; SID) was administered to four cows for one to two days. Feed intake, rumen motility and defaecation were normalised gradually after surgery. All cows had a positive post-surgical outcome and were discharged from the clinic after 7 to 15 days.&#x0D; Keywords: ileus; dairy cattle; duodenum; intestinal obstruction

Current definition, diagnosis, and treatment of canine and feline idiopathic vestibular syndrome.

Idiopathic vestibular syndrome (IVS) is one of the most common neurological disorders in veterinary medicine. However, its diagnosis and treatment varies between publications. The aim of the current study was to gather experts' opinion about IVS definition, diagnosis, and treatment. An online-survey was used to assess neurology specialists' opinion about the definition, diagnosis and treatment of IVS. The study demonstrated that the definition, diagnosis, and treatment of IVS are largely consistent worldwide, with the EU prioritising less frequently advanced imaging and more often otoscopy to rule out other diseases. IVS was defined by most specialists as an acute to peracute, improving, non-painful peripheral vestibular disorder that often affects cats of any age and geriatric dogs. Regarding diagnosis, a detailed neurological examination and comprehensive blood tests, including thyroid values, blood pressure, and otoscopic examination, was seen as crucial. A thorough workup may also involve MRI and CSF analysis to rule out other causes of vestibular dysfunction. Treatment of IVS typically involved intravenous fluid therapy and the use of an antiemetic, with maropitant once daily being the preferred choice among specialists. Antinausea treatment was considered, however, only by a handful specialists. This survey-based study provides valuable insights from neurology experts and highlights areas that require further research to bridge the gap between theory and practice.

A randomized single-blinded comparative experimental study to test the influence of timing of intravenous fluid therapy on maternal hemodynamics during lower segmental caesarean section under spinal anaesthesia

: Spinal anaesthesia-induced hypotension can be prevented by several techniques and methodologies, which is very important as the life of the mother and fetus is at risk. This study compared the efficacy of crystalloid administration 6 hours and half an hour before spinal anaesthesia on reducing hypotension.: After obtaining informed consent, 110 ASA 2 patients aged between 20 and 40 were scheduled for elective lower segmental caesarean section under spinal anaesthesia. Patients were randomly allocated into two groups. Group 1: Participants were kept nil per oral overnight, and Ringer's lactate was administered over half an hour before surgery. Group 2: participants were given ringer lactate. The amount was based upon the Holiday Segar formula (first 10 kg received 4ml/kg, 10-20 kg- 2ml/kg and remaining received 1 ml/kg) and given steadily over half an hour and 6 hours respectively in both groups. The incidence of hypotension and the need for rescue vasopressor in the two groups was recorded.: The two groups were statistically comparable in terms of age, height and weight. The incidence of Hypotension in Group 1 was 12.7%, and in Group 2 was 25%, which was statistically insignificant. Seven out of 55 patients in Group 1 had SBP&amp;#60;20% from baseline, whereas in Group 2, 14 patients out of 55 patients had SBP &amp;#60;20% from baseline, which was statistically insignificant. The incidence of ephedrine usage was statistically insignificant in both groups.: This study's results showed no statistically significant difference in preventing hypotension whether the fluids were given as 6 hours or half an hour before surgery. Therefore, to deliver preload of fluid, it is unnecessary to delay surgery.

A 12-month retrospective descriptive analysis of a single helicopter emergency medical service operator in four South African provinces.

Helicopter Emergency Medical Services (HEMS) is integrated into modern emergency medical services because of its suggested mortality benefit in certain patient populations, it is an expensive resource and appropriate use/feasibility in low- to middle income countries (LMIC) is highly debated. To maximise benefit, correct patient selection in HEMS is paramount. To achieve this, current practices first need to be described. The study aims to describe a population of patients utilising HEMS in South Africa, in terms of flight data, patient demographics, provisional diagnosis, as well as clinical characteristics and interventions. A retrospective flight- and patient-chart review were conducted, extracting clinical and mission data of a single aeromedical operator in South Africa, over a 12-month period (July 2017 - June 2018) in Gauteng, Free State, Mpumalanga and North-West provinces. A total of 916 cases were included (203 primary cases, 713 interfacility transport (IFT) cases). Most patients transported were male (n=548, 59.8%) and suffered blunt trauma (n=379, 41.4%). Medical pathology (n=247, 27%) and neonatal transfers (n=184, 20.1%) follows. Flights occurred mainly in daylight hours (n=729, 79.6%) with median mission times of 1-hour 53 minutes (primary missions), and 3 hours 10 minutes (IFT missions). Median on-scene times were 26 minutes (primary missions) and 55 minutes (IFT missions). Almost half were transported with an endotracheal tube (n=428, 46.7%), with a large number receiving no respiratory support (n=414, 45.2%). No patients received fibrinolysis, defibrillation, cardioversion or cardiac pacing. Intravenous fluid therapy (n=867, 94.7%) was almost universal, with common administration of sedation (n=430, 46.9%) and analgesia (n=329, 35.9%). Apart from the lack of universal call-out criteria and response to the high burden of trauma, HEMS seem to fulfil an important critical care transport role. It seems that cardiac pathologies are under-represented in this study and might have an important implication for crew training requirements.