Intravenous Fluids Research Articles

Appropriateness of intravenous fluid prescriptions in hospitalised patients: a point prevalence study

Appropriateness of intravenous fluid prescriptions in hospitalised patients: a point prevalence study

Delivery room dextrose gel for preterm hypoglycaemia (the GEHPPI study): a randomised placebo-controlled trial

ObjectiveEarly hypoglycaemia at the time of neonatal intensive care unit (NICU) admission is common in very/extreme preterm infants. This study aimed to determine whether buccal dextrose gel in the delivery...

Evaluation of infectious agents in the pediatric palliative care unit

Aim: The use of broad-spectrum antibiotics, changes in patient profile, prolonged life expectancy, increased use of medical devices and technologies such as catheters, intravenous fluids, gastrostomy and tracheostomy have led to changes in the number and types of microorganisms isolated from infections and cultures. There are no data on infections seen in pediatric palliative care. The aim of this study was to determine the frequency of infections and the pathogens produced in culture, to identify the sites of growth and to review what should be done. Materials and Methods: This was planned as a cross-sectional, retrospective study between 11/18/2018 and 09/01/2023. Sociodemographic data, reason for hospitalization, number of hospitalizations, primary diagnoses, comorbid conditions, medical devices and technology used, time and place of culture, number of cultures, microorganisms grown and factors associated with culture growth were examined. Statistical analysis was performed with the SPSS 18.0 program. p

Viêm tĩnh mạch tại vị trí lưu kim luồn tĩnh mạch ngoại biên và một số yếu tố liên quan tại Trung tâm Thần kinh, Bệnh viện Bạch Mai

Introduction: Peripheral venous catheter-related phlebitis is a common complication in healthcare facilities, causing pain, disrupting treatment, and potentially leading to severe complications.Objective: This study investigates the incidence and risk factors associated with peripheral intravenous catheter-related phlebitis. Method: A prospective cross-sectional descriptive study was conducted using a self-designed questionnaire and the Visual Infusion Phlebitis (VIP) Scale to assess the degree of phlebitis. The study included 347 inpatients treated in the Emergency and Intensive Care Unit, Neurology Center, at Bach Mai Hospital. Data were collected from medical records and clinical observation. Results: Among the studied patients, the incidence of phlebitis was 17.6%, and 4.3% of catheter insertion sites exhibited signs of inflammation. Grade 1 and 2 were the most common phlebitis (43.1% and 54.2%), with a small number of grade 3 cases (2.8%) and no cases of grade 4 or 5. Factors such as catheter insertion sites in the forearm, elbow, or ankle; underlying conditions like hypertension, cerebral hemorrhage, pneumonia; paralysis; continuous fluid infusion; and certain intravenous medications were identified as being associated with an increased risk of phlebitis. Conclusion: Phlebitis at the PVC site is a significant concern during treatment in ICU and Neurology centers. Proper catheter site selection and effective management of underlying conditions can help reduce the risk of phlebitis. These findings may assist in developing clinical guidelines to improve patient care quality.

Comparing the Push–Pull Technique to Pressure Bag for Administration of Blood Products: A Prospective Nonblinded Observation Simulation-based Study (CoPP toP Study)

Abstract Introduction: Shock is defined as inadequate delivery of oxygen to meet the tissue’s demands. There are four main types of shock: cardiogenic, obstructive, distributive, and hypovolemic. Hypovolemic shock causes include hemorrhage, dehydration, and burns. Blood loss results in inadequate oxygen delivery to the cells resulting in tissue death if not reversed. Rapid infusers allow for the rapid administration of blood and crystalloid products to patients in shock; however, many community emergency departments do not have these devices. The aim of our study is to determine the fastest way to administer blood when the viscosity of the fluid is taken into consideration in a simulated setting. Methods: Volunteers were assigned to one of two arms: either the push–pull technique or pressure bag technique. The push–pull technique involved using a 50 cc syringe connected to a 3-way stop-cock to withdraw and infuse the fluid. The pressure bag technique involved pumping a pressure bag up to the maximum to infuse the fluids. The speed of infusing 250 mL of intravenous fluids was recorded. The time for the subjects to collect the materials throughout the emergency department was also recorded. Results: A total of three trials were conducted. On average, the push–pull technique took 228 s and the pressure bag technique took 340 s. The push–pull technique took an average of 112 s less than the pressure bag technique. Subjects took 62 s to find the materials for the pressure bag technique. It took 133 s to find the material for the push–pull technique. Conclusion: This prospective nonblinded observation simulation-based study demonstrated that the push–pull technique was significantly faster than the pressure bag technique.

Effect of Enhanced Recovery after Surgery (ERAS) Protocol on Maternal Outcomes Following Caesarean Delivery

Background: Caesarean Section is a commonly performed surgical procedure in obstetric practice, with its incidence rising every year. This increase has led to higher bed occupancy and cost burdens. Conventional Caesarean Sections have several drawbacks, including patients being kept nil per oral overnight before surgery and for 12-24 hours after surgery, immobilization for up to 24 hours or more, continuation of catheter use for 24 hours or more, and the use of opioid-based anesthetics. To address these issues, Enhanced Recovery after Surgery (ERAS) has been introduced. ERAS consists of multimodal pathways during the pre-, intra-, and post-operative periods. Numerous clinical trials, systematic reviews, and meta-analyses have shown that applying ERAS in Caesarean delivery reduces the length of hospital stay, decreases the use of opioid-based anesthetics, improves patient satisfaction, reduces post-operative pain scores, and increases compliance with breastfeeding. Objectives: To determine the outcome of Enhanced Recovery after Surgery (ERAS) pathway in Caesarean Delivery. Methodology: This was a prospective observational study conducted at Paropakar Maternity and Women’s Hospital. Total duration of study period was 3 months from July 2024 to September 2024. A total of 106 patients meeting the inclusion criteria were included in the study. Those receiving care as per the ERAS protocols and standard conventional protocols were observed throughout pre, intra and post-operative period. The two groups were compared in terms of demographic characteristics, intravenous fluid requirement, duration of surgery, length of hospital stay, post-operative pain scores and other post-operative characteristics such as nausea, vomiting, headache, urinary retention, hospital readmission and neonatal outcome. Results: Total of 106 patients were included in the study with 53 in each of ERAS and SC group. In this study, there was no statistical difference in age group, Body Mass Index (BMI), co morbid conditions, gravidity, duration of gestation, indication of CS, duration of surgery and estimated blood loss. The average amount of intravenous fluid required intra operatively in ERAS group was 1350 ml and in SC group was 1650 ml with difference of 300 which was statistically significant, p < .001. The mean length of post-operative hospital stay was 54 hrs. in ERAS group and 71 hrs. in SC group with difference of 17 hrs. which was statistically significant with p = 0.023. The mean post-operative score in ERAS group on Day 0, Day 1 and Day 2 were lower than in SC group with p value < .001. There was no significant difference in post-operative complications between two groups. Conclusion: This study showed that implementation of ERAS protocol is associated with decrease in intra operative fluid requirement, decrease in post-operative length of hospital stay and is associated with significant difference in post-operative pain with use of multi modal analgesia. ERAS can be implemented in Caesarean delivery for addressing the issues of prolonged immobilization, delayed discharge, increased bed occupancy and many more issues associated with it.

Psychedelic mushroom-containing chocolate exposures: Case series

IntroductionThe recreational use of psilocybin or psilocin-containing products, a chemical found naturally in certain mushroom species, is on the rise across the United States. Several cases of serious clinical effects related to mushroom-containing products have recently been reported to the Food and Drug Administration (FDA). The emergence of these new products and their health consequences are not yet well understood. This case series aims to characterize exposures to mushroom-containing chocolate products, including patient characteristics, clinical effects, treatment(s), and clinical outcome severity, reported to a poison center network. Material and methodsThis was a retrospective case series conducted in patients exposed to mushroom-containing chocolate products across three poison centers between January 2023 to August 2024. Patients were identified via a database search of ToxSentry®. Patients were included if they were exposed to a mushroom-containing chocolate product. Patients were excluded if they ingested an unrelated product or if there was insufficient information documented within ToxSentry®. The primary endpoint was to describe clinical outcome severity after exposure to mushroom-containing chocolate products. ResultsA query of ToxSentry® identified 164 cases; 36 cases met study criteria. The median age of patients in this case series was 17 years old. For most patients (23, 64 %), the reason for the exposure was intentional, with 20 reporting intentional abuse or misuse of the product. Common clinical effects reported included mental status changes (26, 76 %), paranoia/hallucinations (10, 28 %), dysrhythmias (7, 19 %) and gastrointestinal discomfort (6, 17 %). There was one report of seizure. Most clinical effects lasted between 3 and 24 h after ingestion (29, 81 %). Intravenous fluids (18, 50 %) and benzodiazepines (7, 19 %) were the most common treatments given. No fatalities were reported. DiscussionWhile most patients in this series experienced minor clinical effects, some developed serious effects after ingestion of a mushroom-containing chocolate product. Findings from this study further characterize the limited patient demographics, clinical effects, and outcomes published thus far. Further characterization in a larger cohort of patients could expand on our initial findings and is needed to better identify factors that may influence clinical outcomes.

061. A Rare Finding; Severe Intra Abdominal Infection and Colonic Necrosis in Geriatric Crohn’s Disease Patient

Background: Crohn's disease (CD) is an immune-mediated inflammatory bowel disease (IBD) marked by segments of transmural inflammation in the gastrointestinal tract. Only 10% to 15% of IBD cases occur in those over 65. In a retrospective study of 281 surgeries, 43 were in colitis patients and 242 in Crohn's patients. The mortality rate was 5.7%, with 9 deaths due to sepsis, mainly linked to emergency procedures and corticosteroid use. CD symptoms include fatigue, prolonged diarrhea, weight loss, and fever, with or without bleeding. Case: A 69-year-old female with a 15-day history of abdominal pain. Patient referred to our hospital after laparotomy and ileostomy 15-days ago. Patient condition worsened, sepsis condition. Upon arrival, the patient exhibited mild hypotension, abdominal distension with midline incision, intra abdominal drain, and an active ileostomy on the right lumbal region. Laboratory tests shows anemia, electrolyte imbalances, and hypoglycemia. A CT scan abdomen revealed pneumoperitoneum and intestinal inflammation. During relaparotomy operation, ileal perforation was found near the stoma, with full-thickness necrosis of the ascending colon extending into part of the transverse colon, and colitis with mucosal necrosis from part of the transverse colon to the rectum. So, we performed a total colectomy, and ileostomy relocation. Pathology confirmed Crohn's disease with granulomatous inflammation. The patient received intravenous fluids and antibiotics. She was subsequently admitted to the intensive care unit for further management. Conclusion: Crohn's disease with severe intra abdominal infected ec perforated colon in patients over 65 is a rare case. Timely diagnosis through detailed anamnesis and examination is crucial. Surgical options should be taken if there are signs of peritonitis.

Septic shock and death due to Dolosigranulum pigrum bacteremia: a case report.

We report the case of a 77-year-old Japanese woman with neuromyelitis optica spectrum disorder, treated with 15 mg of prednisolone daily, who presented with acute septic shock and altered consciousness due to Dolosigranulum pigrum bacteremia. Intravenous extracellular fluids and broad-spectrum antibiotics were administered as an initial treatment. However, the patient died shortly after admission. We performed 16S rRNA sequencing and analyzed the murJ gene. A phylogenetic tree constructed using the neighbor-joining method showed that the strain belonged to clade C3, according to the classification proposed by Flores Ramos et al. Although D. pigrum, a commensal bacterium of the upper respiratory tract, is rarely associated with infections, it occasionally causes serious infections. Accumulation of clinical and bacteriological data is crucial for understanding the pathogenicity and infections associated with this organism.

The path to individualization of infusion therapy for emergency conditions according to the ROSE concept

The article is devoted to the role of intravenous fluid therapy in conditions of impaired fluid homeostasis, which often occur during major surgical interventions and critical conditions, such as sepsis and trauma. The importance of adequate fluid administration to maintain cellular homeostasis, as well as the management of conditions associated with hypovolemia and hemodynamic disturbances, is described. It is noted that, despite numerous studies, the topic of optimal fluid management strategies remains controversial, with potential risks of adverse effects of excessive fluid administration on clinical outcomes. The concept of liquid resuscitation ROSE is presented, which includes four stages: resuscitation, optimization, stabilization and evacuation. This concept will assist physicians in making decisions about fluid therapy management. Different types of fluids are reviewed, including balanced solutions and the multifunctional hyperosmolar solution Reosorbilact, and the importance of individualizing therapy based on the needs of each patient is emphasized. The importance of the need for careful monitoring and control of fluid balance is emphasized to avoid complications and ensure improved clinical outcomes

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

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

Reperfusion injury case following cervical fusion with OPLL: a case report and literature review

IntroductionSpinal cord ischemic reperfusion injury is characterized by an abrupt decline in neurological function and only a few cases have been published in literature. Herein, we present a white cord syndrome following anterior decompression cervical fusion.Case ReportA 54-year-old Jewish male patient was diagnosed with disc herniation among the intervertebral discs at C2, C3, C4, C6, and C7, along with ossification of the posterior longitudinal ligament, pressuring more to the right side of the spinal canal, ruling-out cervical myelopathy. Under general anesthesia and multimodal intraoperative monitoring, he underwent laminectomy surgery from C3 to C6 and cervical fixation from C3 to C7. No blood pressure fluctuations occurred during surgery, and complete pressure release was achieved on the spinal cord and the nerve roots. In addition, neuromonitoring did not indicate any nerve damage during the surgery. A neurologic exam in the post-anesthesia care unit revealed weakness in his right hand and leg. A brain computed tomography scan ruled out cerebrovascular accident, neck computed tomography revealed optimal implant position, and magnetic resonance imaging ruled out spinal cord distress or injury. We treated him with intravenous fluids, steroids, painkillers, and anticoagulants. Following surgery, we involved the occupational therapy department. After a few days, we observed a significant improvement in motor function in the right leg; however, there was no change in the right hand.ConclusionWhite cord syndrome likely arises from reperfusion injury subsequent to surgical decompression of a compressed spinal cord segment. Although infrequent, it is imperative for spine surgeons to recognize this potential complication and apprise patients of it prior to the procedure.

Accuracy of right atrial pressure estimation by transthoracic echocardiography

Abstract Background/Introduction Transthoracic echocardiography provides an estimate of right atrial pressure (RAP) using the guideline-recommend method of measuring inferior vena cava (IVC) diameter and collapsibility. Despite being ubiquitously reported and necessary for the estimation pulmonary artery systolic pressure, the accuracy of this method for RAP estimation has not been rigorously validated. Purpose To evaluate the accuracy of the guideline-recommended method for the estimation of RAP by TTE. Methods A single center, retrospective chart review of patients who had a TTE and right heart catheterization (RHC) within 48 hours of each other from January 2018 to December 2020. Maximum and minimum IVC diameter were measured by trained study personnel. Accuracy was then stratified by the presence/absence of a history of two variables that could modify IVC diameter independent of RAP—syncope, which is associated with more dilated IVC in some studies and liver disease, which could result in compression (from parenchymal fibrosis surrounding the IVC) or dilation (from diversion of portal blood flow through the IVC among other mechanisms) of the IVC. Results The 117 patients who met inclusion criteria had a median age of 67 years old (interquartile range [IQR] 58 – 75) and median RAP of 13 mmHg (IQR 8 – 18) on RHC. The median time between TTE and RHC was 9.6 hours (IQR 3.8 – 24.5 hours) during which 24 (20.5%) patients received intravenous fluids (median 220 mL administered; IQR 145 – 320). Forty-three (35.9%) received diuretics between the studies with most patients receiving either 1 (26 patients, 61.9% of those who received diuretics) or 2 (13 patients, 31.0%) diuretic doses. In evaluating accuracy, only 26 patient’s (20.5%) RAP by RHC fell within estimated RAP range by TTE (Figure 1). After excluding the 60 patients who received fluids and/or diuretics between the TTE and RHC, the TTE estimate was still only accurate in 13 (22.8%) patients. When analyzing how each subcomponent of the TTE guidelines for RAP estimation correlated with RAP via RHC, maximum IVC diameter and percent collapsibility had Pearson’s correlation coefficients of 0.47 and 0.24 respectfully (Figure 2A and 2B). Past medical history was significant for syncope in 16 patients (13.7%) and liver disease in 8 patients (6.8%). Compared to those without each factor, the absolute accuracy of the TTE estimate was lower when stratified by a history of syncope (12.5% accurate vs 21.8%, p = 0.60) and liver disease (12.5% vs 21.2%, p = 0.90) though neither were statistically significant. Conclusion In this retrospective chart review, RAP estimation by TTE using the guideline-recommended method had limited accuracy. Prospective evaluation with minimal time between RHC and TTE is needed to validate the accuracy of the TTE guidelines.Accuracy of TTE for RAP estimationCorrelation between RAP &amp; TTE Variables

Assessment of fluid responsiveness as a component of hemodynamic monitoring in the operating room and intensive care unit

Fluid therapy is a critical, and often primary treatment modality in the management of various critical conditions. Like any therapeutic intervention, intravenous fluids require precise indications, contraindications, and dosing, all determined through the assessment of a patient’s volume status. Hemodynamic assessment plays a pivotal role in the treatment of critically ill patients, enabling clinicians to administer appropriate fluid therapy and cardiovascular support to optimize tissue perfusion and oxygenation. Traditional methods of assessing fluid responsiveness, which are predominantly static such as central venous pressure and pulmonary artery occlusion pressure, often fall short in their predictive accuracy under dynamic clinical conditions. Consequently, there is a growing interest in dynamic methods of fluid responsiveness assessment, which analyze cardiovascular response to specific preload changes. This literature review aims to explore various dynamic methods of hemodynamic assessment, discussing their advantages and limitations based on sources from databases like PubMed and MEDLINE.

Comparison of the Effectiveness of Warmed Versus Room Temperature Intravenous Fluids Administration to Prevent Intraoperative Heat Loss in Anaesthetised Calves Undergoing Umbilical Herniorrhaphy.

Warmed intravenous (IV) fluids administration to prevent hypothermia provide controversial results in humans, cats and dogs, but its effect on calves is unknown. To evaluate the effectiveness of warmed IV fluids administered to prevent intraoperative heat loss in anaesthetised calves undergoing umbilical herniorrhaphy. Thirty Simmental breed calves (aged 10-30days) were randomly divided between two equal groups, wherein the infusion fluid (Ringer's lactate, 5mL/kg/h) was administered either at room temperature (Group RoT) or warmed (Group WF). Pulse rate (PR), respiratory rate (fR), peripheral haemoglobin oxygen saturation (SpO2) and rectal temperature (RT) were recorded immediately after the onset of anaesthesia induction (T0) at T5, T10, T15, T30, T45 and T60. Duration of anaesthesia, surgery time and recovery scores were also noted. The PR, RT and fR values showed no significant difference between groups over time (p>0.05). There was no significant difference in duration of anaesthesia, surgery time or recovery score between groups (p>0.05). The findings of the current study suggest that warmed IV fluid as the warming method did not prevent intraoperative hypothermia in calves. A constant-rate infusion of warmed fluid (5mL/kg/h) is insufficient to prevent intraoperative hypothermia in calves.

The impact of intravenous metoprolol tartrate on mortality rates in patients with septic shock due to ventilator-associated pneumonia: A randomized clinical trial

Background: Septic shock, particularly due to ventilator-associated pneumonia (VAP), is a significant cause of mortality in critically ill patients. Traditional treatments include antimicrobial therapy, fluid resuscitation, and vasopressors. However, recent interest has emerged in using β-blockers to modulate the hyperadrenergic state seen in sepsis. β-blockers, like metoprolol, may improve cardiac efficiency, reduce myocardial oxygen demand, and ultimately enhance patient outcomes. Objective: This study aimed to assess the impact of administering intravenous metoprolol tartrate on the mortality rates of patients with septic shock due to VAP. Methods: This study employed a randomized clinical trial design within the Intensive Care Units of Alexandria Main University Hospital. A cohort of 100 patients diagnosed with septic shock due to ventilator-associated pneumonia (VAP) participated in the trial. Upon achieving hemodynamic stabilization, participants were randomly assigned to either receive standard care alone or standard care supplemented with intravenous metoprolol. Variables of interest included assessing 28-day mortality rates, duration of ICU stay and mechanical ventilation, reliance on intravenous fluids and vasopressors, acid-base balance, lactate levels, inflammatory markers, and mean arterial pressure (MAP). This comprehensive approach aimed to evaluate the impact of metoprolol on critical outcomes in this patient population. Results: The administration of intravenous metoprolol tartrate resulted in significant clinical benefits, including lower 28-day mortality rates (P = 0.013), shortened durations of ICU stay (P &lt; 0.001), and reduced mechanical ventilation periods (P &lt; 0.001). These outcomes were explained by the observed decreased reliance on intravenous fluids and vasopressors (P &lt; 0.001), improved acid-base balance and lactate levels. The rapid reduction of inflammatory markers (P &lt; 0.001) and the sustained improvement of MAP in the metoprolol group compared to the control group further contributed to the explication of these findings. Conclusion: Intravenous metoprolol tartrate effectively controlled inflammation, optimized hemodynamics, and improved patient outcomes compared to standard care, suggesting it as a beneficial adjunct in the management of septic shock. Trial registration: PACTR202404531355476. Keywords: Metoprolol; septic shock; ventilator-associated pneumonia; beta-blockers; mortality.

Large-volume intravenous fluid use before and after implementation of a fluid conservation strategy.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. We describe the implementation of a fluid conservation strategy in a 2-hospital community health system and its effects on utilization of 1,000-mL bags of 0.9% sodium chloride and lactated Ringer's solution. Disruptions to medical supply chains are unpredictable and can cause significant impacts on patient care. A fluid conservation strategy including guidance statements and mandatory order modifications in a 2-hospital community health system was associated with decreases in the use of 1,000-mL bags of 0.9% sodium chloride and lactated Ringer's solutions of 52% and 39%, respectively, compared with the utilization rates over the prior year. Institutions facing shortages should consider multidisciplinary strategies with trackable metrics when faced with supply chain disruptions.

Severe hyponatremia in obstetrics: Presentations and outcome. Retrospective cohort over 10 years.

Hyponatremia in labor and the postpartum period is generally underreported. In this study we aimed to identify attributable causes of severe hyponatremia in an obstetric population and define maternal outcomes. This was a retrospective cohort study, in a single center over a period of 10 years. The study setting was an NHS maternity trust serving a multi-ethnic population in southwest London. The hospital cared for 53 649 pregnant women in the study period. All patients with severe hyponatremia in labor and immediate postpartum period from January 2011 until December 2020 were identified from the laboratory database. Individual case notes were analyzed for fluid use, use and duration of oxytocin, medical conditions, and delivery details. Severe peripartum hyponatremia was identified in 77 patients. A total of 28% of those analyzed required ITU admission for electrolyte correction, of whom 6% presented with severe neurologic symptoms, making symptoms a poor marker of severity (P = 0.051). The main association was to oxytocin and intravenous fluid infusions (80% and 86%, respectively), only one-third of patients had pre-eclampsia. Other associated medical conditions did not appear to have a significant influence on disease course nor prognosis (P = 0.359). Hyponatremia during labor can have detrimental effect on maternal outcomes. Lower threshold for testing and diligent maintenance of fluid balance charts during labor can help with primary prevention.

Practice of Fluid and Vasopressor Therapy in Critically Ill Invasively Ventilated Patients (PRoFLUID)-study protocol for an international multicenter observational cohort study.

The practice of intravenous fluid and vasopressor therapy in intensive care unit (ICU) patients, particularly in those who receive invasive ventilation, has been subject to change. Traditional approaches of 'early and liberal fluid administration' and 'late and restrictive vasopressor use' have been challenged, leading to recommendations for giving less fluids and earlier administration of vasopressors. Recommendations for fluid deresuscitation-active fluid removal-are absent. The global approach to fluid and vasopressor therapy in invasively ventilated patients is currently unclear. Our aim is to explore the practice of intravenous fluid and vasopressor therapy in invasively ventilated ICU patients in a study named 'Practice of Fluid and Vasopressor Therapy in Critically Ill Invasively Ventilated Patients' (PRoFLUID). PRoFLUID is an international, multicenter, observational cohort study in critically ill adult patients that are invasively ventilated for more than 24 hours. The outcomes include various aspects of fluid and vasopressor therapy, urine output and cumulative fluid balances. We will also collect duration of ventilation, lengths of stay and mortality in ICU and hospital. We expect to collect granular data on fluid and vasopressor therapy in a sample of at least 2,500 patients. PRoFLUID will provide useful insights into the practice of fluid and vasopressor therapy in invasively ventilated critically ill patients. PRoFLUID also allows us to determine whether geo-economic differences in management of intravenous fluid and vasopressor therapy exist, and allows for analyses of associations of aspects of fluid and vasopressor therapy with outcomes. Last but not least, its findings could feed sample size calculations of future randomized clinical trials of fluid and vasopressor therapy. In conclusion, PRoFLUID will collect data on fluid and vasopressor therapy in invasively ventilated ICU patients worldwide, providing insights that will guide future clinical decisions and randomized trial designs. ClinicalTrials.gov NCT05968066. Registered on August 1, 2023. Intensive care; invasive ventilation; fluid therapy; fluid management; vasopressor.

Use of a two-bag fluid administration protocol in the treatment of paediatric diabetic ketoacidosis: A retrospective review

ABSTRACT Objectives The ‘two-bag method’ for the treatment of diabetic ketoacidosis (DKA) uses two intravenous fluid bags, only one of which contains 10% dextrose. The bags are run concurrently with rates adjusted according to a rate change table to allow the relative amount of dextrose administered to be adjusted over time, without the need for bag replacements. The Children’s Hospital at London Health Sciences Centre (CHLHSC) two-bag protocol is a simplified version of that used by other centres. The objective of this study was to ensure implementation of the CHLHSC two-bag protocol continues to provide safe and effective treatment of paediatric DKA and decreases resource utilization. Methods This retrospective chart review compared treatment pre- and post-protocol implementation. Results A total of 22 admissions were included. No significant differences in efficacy or safety outcomes were found between the protocol groups. There was no statistically significant difference between the two and one-bag protocols in time to normalization of serum bicarbonate (13.80 ± 7.68 versus 15.01 ± 7.53 h, P = 0.714), blood glucose correction (8.75 ± 4.86 versus 11.85 ± 4.92 h, P = 0.152), and critical care unit length of stay (24.26 ± 9.94 versus 32.30 ± 13.36, P = 0.399). The nursing staff appeared to appropriately implement the rate change table, but the chart documentation was poor. Conclusions The CHLHSC simplified two-bag protocol provides a safe and effective alternative to the one-bag protocol for DKA correction in paediatric patients and may also result in decreased resource utilization.