Plasma-Lyte Research Articles

Evaluation of Plasma-Lyte Versus Lactated Ringer's in Surgical Intensive Care Unit Trauma Patients as Fluid Resuscitation.

In critically ill patients, fluid resuscitation with balanced crystalloids close to plasma osmolarity have a lower risk of electrolyte imbalances and demonstrated better clinical outcomes compared to normal saline (NS). While lactated ringer's (LR) has shown benefit over NS, plasma-lyte (PL) with a higher osmolarity and different electrolyte formulation is hypothesized to be superior. We performed a retrospective observational cohort study over 37 months at a tertiary hospital. Inclusion criteria were hospitalization in the surgical intensive care unit (SICU), trauma indication, ≥18 years old, and received either PL or LR. All PL administrations and every fifth patient with LR as resuscitation were included in order to match the sample size in each group. Primary outcomes were SICU length of stay (LOS), hospital LOS, and mortality. Secondary outcomes were biomarker changes from baseline. There were 113 patients in both PL and LR groups. The PL arm had higher APACHE II scores (16 vs 13, P = .033) and were more likely ventilated (39.3% vs 20.4%, P = .002) compared to LR. Median hospital LOS (12.0 vs 8.0, P < .001) and SICU LOS (6.0 vs 3.0, P < .001) are significantly longer in PL group compared to the LR group. However, there was no difference in in-hospital mortality (5.3% vs 3.5% P = .519) and SICU mortality (9.7% vs 5.3%, P > .208) between PL and LR. Overall, PL use was associated with prolonged hospital and SICU LOS. PL use did not demonstrate mortality benefit. However, patients were more critically ill in PL group based on higher APACHE II scores and higher rates of mechanical ventilation, which could be contributing to these unfavorable outcomes.

A Comparison Between Saline and Balanced Solutions in Kidney Transplants: A Randomized Clinical Trial.

Objective This study aimed to investigate the impact of different types of intravenous fluids -normal saline (NS), lactated Ringer's solution (LR), and PlasmaLyte (PL) - on the acid-base balance and electrolyte concentration following kidney transplant, a common procedure for patients with end-stage renal disease (ESRD). Methodology A randomized controlled trial design was employed, wherein the primary parameters analyzed were postoperative pH and serum potassium levels. Postoperative concentrations of serum bicarbonate, sodium, chloride, and creatinine, as well as graft functionality, were assessed as secondary outcomes. These measurements were performed at the start and end of surgery, as well as 24 and 72 hours postoperatively. Results A total of 53 patients were included in the study and randomized into three cohorts: NS, LR, and PL, each of which showed comparability in terms of demographic and transplantation specifics. Notably, patients in the NS group exhibited a more significant decrease in pH (NS group: 7.285 ±0.098, LR group: 7.324 ±0.075, PL group: 7.7338 ±0.059) and bicarbonate levels (17.0 ±4.2, 20.9 ±2.8, 20.0 ±4.5) post24 hours after the operation and displayed a similar patternimmediately after the surgery. However, there were no discernible differences in potassium (p=0.460), sodium (p=0.681), and chloride (p=0.321) levels across the groups. Furthermore, the study did not observe any significant differences in postoperative graft functionality. Conclusion The use of NS as the intraoperative fluid of choice led to lower pH and bicarbonate levels following kidney transplant, as compared to LR and PL. However, these results did not correlate with improvements in graft functionality.

Self-constituted modified del Nido cardioplegia solution in pediatric congenital heart defect surgery.

ABSTRACT… Objective: To present our experience of modified del Nido Cardioplegia for chemical arrest and myocardial protection during congenital heart defect in pediatric cardiac surgeries. Study Design: Retrospective Cross Sectional. Setting: Department of Cardiac Surgery, PAQSJIMS, Gambat, Khairpur. Period: 15th March, 2021 to 10th October, 2022. Material &amp; Methods: del Nido solution is generally constituted in plasma lyte A solution, not available in Pakistan; therefore, we constituted del Nido solution in ringer lactate solution. We had collected our data retrospectively for our study to assess the safety and efficacy of modified del Nido cardioplegic arrest during the open heart surgeries for congenital heart defects. We report clinical outcomes of our patients that include spontaneous rhythm, ionotropic score and duration of mechanical ventilation underwent open heart surgeries with. Results: During the study period we had performed 102 surgeries for correction or palliation of congenital heart defects. We have included 54 patients in our study co with 28 (52%) male and 26 female (48%) patients; had a mean age 8.9 (±3.7) years and mean weight 22.4 (±12.7) kg. Majority of patients 29 (54%) belonged to Category 2 on RACHS-1 scale. Our average cross clamp time was 39.7min, and 37(68%) patients required a single dose of cardioplegia. Spontaneous sinus rhythm was established in 48(89%) patients; average ionotropic score of patients at the time of PICU arrival was 8.6 (±5.6) with 31(57%) have score of less than 10, while 2(4%) patients were received without the ionotrope. All the patients were shifted on mechanical ventilators with average time of 253.6 (±219.6) min of mechanical ventilation. Conclusion: Our results show modified del Nido solution is safe, with added benefits of fewer interruption in surgery, greater magnitude of spontaneous sinus rhythm and fewer ionotropic requirements.

Effect of Normal Saline versus PlasmaLyte on Coagulation and Metabolic Status in Patients Undergoing Neurosurgical Procedures.

Background The choice of intraoperative fluid in neurosurgical patients is important as we need to maintain adequate cerebral perfusion and oxygenation and also avoid cerebral edema. Normal saline (NS) is commonly used in neurosurgeries, but it leads to hyperchloremic metabolic acidosis, which may result in coagulopathy. Balanced crystalloid with physiochemical composition akin to that of plasma has favorable effects on metabolic profile and may avoid the problems associated with NS. Against this background, the present study aimed to compare the effects of NS versus PlasmaLyte (PL) on coagulation profile in patients undergoing neurosurgical procedures. Methods This prospective, randomized, double-blinded study was conducted in 100 adult patients scheduled to undergo various neurosurgical procedures. Patients were randomly allocated in two groups of 50 each to receive either NS or PL intraoperatively and postoperatively till 4 hours after the surgery. Hemoglobin, hematocrit, coagulation profile (PT, PTT, and INR), serum chloride, pH, blood urea, and serum creatinine were measured prior to induction (baseline) and 4 hours after completion of surgery. Results Demographic characteristics were statistically similar between the two groups. Coagulation profile parameters were comparable between the two groups at baseline as well as 4 hours after surgery. pH was significantly lower in the NS group as compared to the PL group at 4 hours after surgery. Postoperatively blood urea, serum creatinine, and serum chloride levels were significantly raised in the NS group as compared to the PL group. Hemoglobin and hematocrit values were similar between the two groups. Conclusion Coagulation profile parameters were normal and statistically similar with intraoperative infusion of NS versus PL in patients undergoing neurosurgical procedures. However, use of PL was associated with a better acid-base and renal profile in these patients.

A Comparative Study of Peri-Operative Fluid Therapy With Ringer Lactate and PlasmaLyte in Children Undergoing Intra-Abdominal Surgery: A Randomized Control Trial.

Background In this study, we compared Ringer's lactate solution (RL) with PlasmaLyte (PL), a relatively new IV fluid, for perioperative fluid therapy in the pediatric population. Methods This prospective and interventional randomized comparative study was carried out after obtaining clearance from the Institutional Ethics Committee. The study period was from November 2016 to December 2017. Results Hemodynamic parameters such as SpO2, ETCO2, heart rate, blood pressure, temperature, and urine output were stable in both groups throughout the perioperative period without any statistically or clinically significant variations. Children receiving PL (group PL) had better acid-base status, serum electrolytes, and blood lactate profiles compared with children receiving RL (group RL), who had hyponatremia and increased blood lactate levels, which continued to increase in the immediate postoperative period. No significant differences in pH, pCO2, HCO3, serum potassium, serum chloride, blood urea, serum creatinine, or blood sugar were observed. Conclusions PL is better than RL for perioperative fluid therapy in children undergoing abdominal surgeries.

Comparison of Mean Arterial Blood Pressure and Heart Rate Changes in Response to Three Different Randomized Isotonic Crystalloid Boluses in Hypotensive Anesthetized Dogs.

Simple SummaryAnecdotal reports of a paradoxical exacerbation of hypotension in response to a bolus of a balanced isotonic crystalloid solution containing acetate buffers in dogs under general anesthesia was studied in a prospective clinical trial. The response to three different balanced isotonic crystalloid solutions administered as an intravenous bolus to dogs experiencing hypotension while anesthetized for elective orthopedic or dental procedures was investigated. None of the subjects experienced a paradoxical hypotensive reaction or an increase in blood pressure in response to a fluid bolus.The aim of this prospective, randomized, nonblinded, controlled clinical trial was to compare mean arterial blood pressure (MAP) and heart rate (HR) during an intravenous bolus of three different balanced isotonic crystalloid solutions in euvolemic, anesthetized dogs with hypotension. Thirty healthy dogs (American Society of Anesthesiologists Physical Status I–II) weighing at least 15 kg that presented for elective orthopedic or dental surgical procedures at the Ryan Veterinary Hospital for Small Animals of the University of Pennsylvania were included in this study. Anesthetized hypotensive patients (defined as a MAP ≤ 65 mmHg), were administered an infusion of Lactated Ringer’s solution (LRS), Plasma-Lyte (PLYTE) or Canadian Plasma-Lyte (PLYTECA), selected at random. The infusion was administered over 15 min via a volumetric fluid pump. Differences in oscillometric MAP and HR between time points and across treatments were evaluated by mANOVA. Intravenous isotonic crystalloid infusions over 15 min did not significantly change MAP or HR in hypotensive dogs under general anesthesia. Neither LRS, PLYTE nor PLYTECA exacerbated hypotension or caused tachycardia.

Effects of the Administration of Different Buffered Balanced Crystalloid Solutions on Acid–Base and Electrolyte Status in Dogs with Gastric Dilation–Volvulus Syndrome: A Randomized Clinical Trial

ObjectiveTo investigate the effect of three different buffered balanced crystalloid solutions on acid–base status and electrolyte concentrations in dogs with gastric dilation–volvulus (GDV) syndrome. MethodsThe study design was a prospective, randomized clinical trial of 40 dogs. The dogs were randomly assigned to one of three groups according to the fluid used: Hartmann's solution (H), Plasmalyte (PL), and Ringerfundin (RF). Hemoglobin, albumin, lactate, electrolyte, and acid–base parameters were determined before fluid administration (T0) and at the end of surgery (T1). Results were assessed by one-way ANOVA, Fisher's exact test, the Wilcoxon signed-rank test, the Kruskal–Wallis test, and a linear mixed-effect regression model. A significance level of 0.05 was used in all analyses. ResultsBicarbonate and base excess (BE) levels increased and chloride concentration decreased in the PL group; in contrast, strong ion difference apparent (SIDapp) decreased and chloride concentration increased in the RF group. The mixed-effect model confirmed a significant interaction between the type of solution and time on the changes in bicarbonate, BE, anion gap (AG), SIDapp, and chloride levels. Clinical significanceSignificantly different effects in acid–base parameters were observed in dogs after intravenous administration of H, PL, and RF. However, clinical significance of these changes is lacking, requiring further investigation in a larger randomized controlled clinical trial.

Normal Saline Versus Balanced Crystalloids in Renal Transplant Surgery: A Double-Blind Randomized Controlled Study.

BackgroundThe importance of optimal acid-base balance during renal transplant surgeries cannot be stressed enough. Optimal preload and electrolyte balance is important in maintaining this. There has been a debate on the choice of perioperative crystalloids in renal transplant surgeries over the past decades. Normal saline (0.9% saline) is more likely to cause hyperchloremic acidosis when compared to balanced salt solutions (BSS) with low chloride content whereas BSS may cause hyperkalemia. We aim to compare the safety and efficacy of normal saline (NS), Ringer’s lactate (RL) and Plasmalyte (PL) on acid-base balance and electrolytes during living donor kidney transplantation.Materials and methodsPatients were randomized to NS group (n = 60), RL group (n = 60) and Plasmalyte group (n = 60). Arterial blood samples were collected for acid-base analysis after induction of anaesthesia (T0), prior to clamping the iliac vein (T1), 10 minutes after reperfusion of the donated kidney (T2) and at the end of surgery (T3). In addition, serum creatinine and 24-hour urine output were recorded on postoperative days one, two and seven.ResultsThere was a statistically significant difference (p < 0.001) in the pH at the end of surgery between the three groups with the NS group being more acidotic (pH 7.29 ± 0.06, 95% CI 7.27-7.32), although this was not clinically relevant. This was explainable by the parallel increase in chloride in the NS group. Early postoperative graft functions in terms of serum creatinine, urine output and graft failure requiring dialysis were not significantly different between the groups.ConclusionBalanced salt solutions such as Plasmalyte and Ringer’s lactate are associated with better pH and chloride levels compared to normal saline when used intraoperatively in renal transplant patients. This difference, however, does not appear to have any bearing on graft function. Plasmalyte seems to maintain a better acid-base and electrolyte balance, especially during the postreperfusion period.

The Effect of Normal Saline and Plasmalyte on Acid-Base Status in Patients Undergoing Head-and-Neck Surgery with Free Flap Reconstruction: A Prospective, Observational Cohort Study.

Background:Intraoperative fluid strategy may affect the graft viability in head-and-neck surgeries with free flap reconstruction (HNS-FFR). Studies to guide regarding association of intraoperative fluid with metabolic parameters during such surgeries are infrequent.Aim:This study aimed to compare plasmalyte (PL) and normal saline (NS) (0.9%) in terms of acid–base balance and electrolytes in the peri-operative period along with graft viability during above-mentioned surgeries.Settings and Design:Prospective, observational cohort study was conducted in patients, 18–65 years, undergoing HNS-FFR at a tertiary care center.Materials and Methods:The cohort was categorized into two groups based on the intraoperative fluid used, i.e., PL (Group A) and NS (Group B) group. The primary objective was to compare arterial blood gas parameters at seven time points till the 3rd postoperative day. We studied the effect on graft viability and length of hospital stay.Statistical Analysis Used:The independent t-tests, Chi-square, or Fisher's exact test were used to evaluate the categorical variables with a repeated measures analysis of variance for inter-group comparison with P < 0.05 as significant.Results:Seventy-one (36 in Group A and 35 in Group B) patients were included in the study with comparable baseline characteristics. Group A had a better acid–base status, especially after the conclusion of vascular anastomosis (pH 7.37 ± 0.06 vs. 7.33 ± 0.04, P = 0.014) and in the postoperative period (pH 7.35 ± 0.07 vs. 7.31 ± 0.05, P = 0.013). No statistically significant difference was observed in outcome parameters between the groups.Conclusions:PL may be preferred over NS due to better metabolic milieu during HNS-FFR surgery.

Effect of 0.9% NaCl compared to plasma-lyte on biomarkers of kidney injury, sodium excretion and tubular transport proteins in patients undergoing primary uncemented hip replacement \u2013 a randomized trial

BackgroundIsotonic saline (IS) is widely used to secure perioperative cardiovascular stability. However, the high amount of chloride in IS can induce hyperchloremic acidosis. Therefore, IS is suspected to increase the risk of acute kidney injury (AKI). Biomarkers may have potential as indicators.MethodsIn a double-blinded, placebo-controlled study, 38 patients undergoing primary uncemented hip replacement were randomized to IS or PlasmaLyte (PL). Infusion was given during surgery as 15 ml/kg the first hour and 5 ml/kg the following two hours. Urinary samples were collected upon admission and the day after surgery. As surgery was initiated, urine was collected over the course of 4 h. Hereafter, another urine collection proceeded until the morning. Urine was analyzed for markers of AKI neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1). Arterious and venous blood samples for measurements of pH and plasma electrolytes including chloride (p-Cl) were collected as surgery was initiated, at the end of surgery and the following morning.ResultsIS induced an increase in p-Cl (111 ± 2 mmol/L after IS and 108 ± 3 after PL, p = 0.004) and a decrease in pH (7.39 ± 0.02 after IS and 7.43 ± 0.03 after PL, p = 0.001). Urinary NGAL excretion increased in both groups (ΔNGAL: 5.5 [4.1; 11.7] μg/mmol creatinine p = 0.004 after IS vs. 5.5 [2.1;9.4] μg/mmol creatinine after PL, p < 0.001). No difference was found between the groups (p = 0.839). Similarly, urinary KIM-1 excretion increased in both groups (ΔKIM-1: IS 115.8 [74.1; 156.2] ng/mmol creatinine, p < 0.001 vs. PL 152.4 [120.1; 307.9] ng/mmol creatinine, p < 0.001). No difference between the groups (p = 0.064).FENa increased (1.08 ± 0.52% after IS and 1.66 ± 1.15% after PL, p = 0.032). ENaC excretion was different within groups (p = 0.019).ConclusionA significantly higher plasma chloride and a lower pH was present in the group receiving isotonic saline. However, u-NGAL and u-KIM-1 increased significantly in both groups after surgery despite absence of changes in creatinine. These results indicate that surgery induced subclinical kidney injury. Also, the IS group had a delayed sodium excretion as compared to the PL group which may indicate that IS affects renal sodium excretion differently from PL.Trial registrationClinicalTrials.gov Identifier: NCT02528448, 19/08/2015

3 Comparison of Normal Saline and Plasmalyte in the Management of Acute Pancreatitis

INTRODUCTION: Acute pancreatitis (AP) is one of the most common causes of hospitalization in the United States. Intravenous (IV) hydration with normal saline (NS) is the most commonly used fluid for resuscitation. Recent studies have shown better outcomes with use of more pH balanced fluid like ringer's lactate and Plasmalyte (PL). We conducted a retrospective review to evaluate differences in outcomes of AP in patients who received NS compared to PL. METHODS: All patients &gt;18 years of age admitted to our hospital with the diagnosis of AP from November 2016 to October 2018. Primary outcomes were persistent SIRS at 48 hours and mortality. Secondary outcomes were readmission within 30 days and length of stay (LOS). Categorical characteristics of NS and PL patients were compared using Pearson's chi-square or Fisher's exact tests and continuous ones were compared using Student's t-tests or Wilcoxon rank-sum tests. Odds ratios (OR) and their 95% confidence intervals (CI) were estimated using a multivariable logistic regression model for 30 days readmission. The model adjusted for age, sex, SIRS at 48 hours, and LOS. A multivariable linear regression model on a natural log transformation of LOS was used to estimate the effect of fluid type on LOS for NS and PL patients. Statistical analysis was conducted using SAS 9.4. RESULTS: 343 patients met our inclusion criteria. 192 patients received NS and 151 received PL for IV hydration. There were no differences in the baseline demographics including age, sex, BMI and comorbidities as calculated by Charlson comorbidity index. Persistent SIRS at 48 hours was significantly higher in patients who received NS compared to PL (26.8% vs 7.7%; P = &lt;0.0001). LOS was significantly higher in patients who received NS (4.7 days vs 3.7 days, P = 0.0039). 30 days readmission was also significantly higher in NS group (22.8% vs 12.8%; P = 0.0195). Mortality although trended lower in PL group, was not significantly different (7.3% NS group vs 2.6% PL group, P = 0.0556). In multivariable analysis use of PL is associated with lower odds of 30 days readmission [OR = 0.515 (CI: 0.280–0.950); P = 0.0338] and shorter LOS [%decrease = 16.6% (CI: −26.4%, −5.5%); P = 0.0045]. CONCLUSION: Our study revealed that use of PL in AP is associated with lower rate of persistent SIRS at 48 hours, shorter LOS, and 30 days readmission rate. Larger randomized controlled trials are needed to further strengthen the association of PL for outcomes in AP.

Comparison of crystalloid resuscitation fluids for treatment of acute brain injury: a clinical and pre-clinical systematic review and network meta-analysis protocol

BackgroundCurrent guidelines identify the choice of fluid resuscitation as important in minimizing the incidence of secondary brain injury from cerebral edema. It is widely accepted that isotonic crystalloid resuscitation fluids, specifically normal saline (NS), are optimal for resuscitation and that other relatively hypotonic fluids, such as Ringer’s lactate (RL), should be avoided in this patient population. The aim of this review is to systematically compare the use of relatively hypotonic versus isotonic crystalloid resuscitation fluids in clinical and pre-clinical models of acute brain injury and their effect on outcomes. In recognition of the potential need for a network meta-analysis (NMA), we have also included all other relevant crystalloid resuscitation fluids as interventions of relevance to potentially inform indirect comparisons.MethodsSystematic searches of MEDLINE, Embase, and Web of Science BIOSIS Previews® will be used to identify eligible clinical and pre-clinical studies, which included studies examining acute brain injury (human and in vivo animal brain injury models) within the first 7 days of therapy. The intervention of interest is the intravenous use of relatively hypotonic crystalloid resuscitation fluids (e.g., Ringer’s lactate, Hartmann’s or Plasma Lyte® fluids). The main comparator of interest is an isotonic crystalloid resuscitation fluid, specifically normal saline (0.9%). Other crystalloid resuscitation fluids (e.g., hypertonic saline (3–23.4%)) will also be included as an additional intervention of interest. The primary outcome measures of interest are intracranial pressure (ICP) and cerebral perfusion pressure (CPP). Secondary outcomes include the effect of resuscitation on cerebral edema, brain and serum osmolarity, and electrolyte concentrations and clinical outcomes including modified Rankin Scale (mRS), (extended) Glasgow Outcome Scale (GOS/eGOS), and mortality. Separate meta-analyses will be conducted to quantify the effects of the different fluid resuscitation on acute brain injury outcomes in clinical and pre-clinical populations. Network meta-analyses to compare interventions will also be performed to compare the effects of different interventions.DiscussionThis systematic review will comprehensively summarize the difference in treatment efficacy of various crystalloid resuscitation fluids in acute brain injury. This review is essential to underscore the evidence, or lack thereof, present in the literature to date to support current preference-driven practice and to direct future study.Systematic review registrationPROSPERO #CRD42016042960

Acid-based disturbances due to perioperative fluid therapy with slightly alkalized and acid-based neutral balanced crystalloids: a comparative study

The study aimed at comparing the effects of perioperatively administered balanced crystalloid infusion solutions, containing varied quantities of metabolizable anions, on homeostasis. In the prospective rand-omized open label study, patients were as-signed to Plasmalyte (PL) and Ringerfun-din (RF) Groups. The infusion solutions were parenterally administered at 1000 mL/6 hours. Arterialized capillary blood was sampled at the time of transfer to the Intensive Care Unit (ICU) (Time 0), and again at both 2 and 6 hours from Time 0. The collected blood was tested for blood gas parameters. A total of 112 patients were en-rolled in the study. There was no significant difference (P=0.329) in baseline pH values between the same-sized PL and RF Groups, with median pH values of 7.34 and 7.32, respectively. Similarly, no significant dif-ferences were seen in pH values measured after 2 hours (P=0.436), with median values of 7.38 for the PL Group and 7.37 for the RF Group. Finally, no significant differenc-es were observed after 6 hours (P=0.528), with median values of 7.41 and 7.40, re-spectively. Over time, pH values increased significantly in both groups (P≤0.001). There were no significant changes in either baseline base excess, actual bicarbonate, standard bicarbonate, partial pressure O2 and CO2 values, measured after 2 and 6 hours between the PL and RF Groups. The study failed to show differences between the balanced solutions Plasmalyte, in 5% glucose, and Ringerfundin, on the effects of pH and other acid-base parameters in pa-tients receiving postoperative care follow-ing elective surgery.

Normal Saline and Plasma-Lyte Perform Comparably in the ICU

Resuscitation with normal saline commonly results in a hyperchloremic, metabolic acidosis. Based mostly on observational studies, concern has emerged

Plasma-Lyte Versus Normal Saline for Resuscitation of Trauma Patients

Use of Plasma-Lyte, a calcium-free crystalloid with an electrolyte profile similar to blood, for the resuscitation of trauma patients has not previously been studied. At a level I trauma center in California, researchers randomized 46 severely injured trauma patients to resuscitation with normal saline or Plasma-Lyte for the initial 24 hours. Patients with life- or limb-threatening …

Balanced vs unbalanced crystalloid resuscitation in a near-fatal model of hemorrhagic shock and the effects on renal oxygenation, oxidative stress, and inflammation

BackgroundThe aim of the present study was to test the hypothesis that balanced crystalloid resuscitation would be better for the kidney than unbalanced crystalloid resuscitation in a rat hemorrhagic shock model. MethodsMale Wistar rats were randomly assigned to four groups (n=6/group): (1) time control; (2) hemorrhagic shock control; (3) hemorrhagic shock followed by unbalanced crystalloid resuscitation (0.9% NaCl); and (4) hemorrhagic shock followed by acetate and gluconate-balanced crystalloid resuscitation (Plasma Lyte). We tested the solutions for their effects on renal hemodynamics and microvascular oxygenation, strong-ion difference, systemic and renal markers of inflammation and oxidative stress including glycocalyx degradation as well as their effects on renal function. ResultsThe main findings of our study were that: (1) both the balanced and unbalanced crystalloid solutions successfully restored the blood pressure, but renal blood flow was only recovered by the balanced solution although this did not lead to improved renal microvascular oxygenation; (2) while unbalanced crystalloid resuscitation induced hyperchloremia and worsened metabolic acidosis in hemorrhaged rats, balanced crystalloid resuscitation prevented hyperchloremia, restored the acid–base balance, and preserved the anion gap and strong ion difference in these animals; (3) in addition balanced crystalloid resuscitation significantly improved renal oxygen consumption (increased VO2, decreased EFNa+); and (4) however neither balanced nor unbalanced crystalloid resuscitation could normalize systemic inflammation or oxidative stress. Functional immunohistochemistry biomarkers showed improvement in L-FABP in favor of balanced solutions in comparison to the hemorrhagic group although no such benefit was seen for renal tubular injury (measured by NGAL) by giving either unbalanced or balanced solutions. ConclusionsAlthough balanced crystalloid resuscitation seems superior to balanced crystalloid resuscitation in protecting the kidney after hemorrhagic shock and is certainly better than not applying fluid resuscitation, these solutions were not able to correct systemic inflammation or oxidative stress associated with hemorrhagic shock.

175 HUMAN AMNIOTIC FLUID STEM CELL THERAPY FOR URETHRAL SPHINCTER REGENERATION

was 24.28 1.47 cm H20 in rats transplanted with MSCs and 16.21 1.26 cm H20 in SUI controls injected with Plasma Lyte (p 0.001). CONCLUSIONS: Bone marrow rat MSCs have the ability to differentiate and skew their phenotype towards smooth and striated muscles, as demonstrated by SMA up-regulation and desmin expression. Periurethral injection of MSCs in an animal model of SUI restored the damaged external urethral sphincter and significantly improved VLPP.

174 BONE MARROW MESENCHYMAL STROMAL CELL THERAPY FOR EXTERNAL URETHRAL SPHINCTER RESTORATION IN A RAT MODEL OF STRESS URINARY INCONTINENCE

You have accessJournal of UrologyStem Cell Research1 Apr 2011174 BONE MARROW MESENCHYMAL STROMAL CELL THERAPY FOR EXTERNAL URETHRAL SPHINCTER RESTORATION IN A RAT MODEL OF STRESS URINARY INCONTINENCE Oleg Loutochin, Lysanne Campeau, Nicoletta Eliopoulos, Manaf Bouchentouf, Bertil Blok, Jacques Galipeau, and Jacques Corcos Oleg LoutochinOleg Loutochin Montreal, Canada More articles by this author , Lysanne CampeauLysanne Campeau Montreal, Canada More articles by this author , Nicoletta EliopoulosNicoletta Eliopoulos Montreal, Canada More articles by this author , Manaf BouchentoufManaf Bouchentouf Montreal, Canada More articles by this author , Bertil BlokBertil Blok Montreal, Canada More articles by this author , Jacques GalipeauJacques Galipeau Montreal, Canada More articles by this author , and Jacques CorcosJacques Corcos Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.243AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the effect of intra-sphincteric injections of bone marrow mesenchymal stromal cells (MSCs) on Valsalva leak point pressure (VLPP) changes in an animal model of stress urinary incontinence (SUI). METHODS 24 female Sprague-Dawley rats underwent bilateral pudendal nerve section for SUI induction. Six rats were SUI controls, 6 received periurethral injection of Plasma-Lyte (SUI placebo control) and 12 were given periurethral injection of PKH26-labelled MSCs. Four weeks after injection, conscious cystometry was undertaken in animals and VLPP recorded. All groups were sacrificed, and frozen urethra sections were submitted to pathology assessment. RESULTS Rat MSCs were positive for the cell surface antigens CD44, CD73, CD90, and RT1A, and negative for CD31, CD45, and RT1B, confirming their stem cell phenotype. In vitro, differentiated MSCs expressed α-smooth muscle actin (SMA) and desmin, markers of smooth and striated muscles. Immunohistochemistry of rat urethras revealed PKH26-labelled MSCs in situ and at the injection site. LPP was significantly improved in animals infused with MSCs. Mean LPP was 24.28 ± 1.47 cm H20 in rats transplanted with MSCs and 16.21 ± 1.26 cm H20 in SUI controls injected with Plasma Lyte (p<0.001). CONCLUSIONS Bone marrow rat MSCs have the ability to differentiate and skew their phenotype towards smooth and striated muscles, as demonstrated by SMA up-regulation and desmin expression. Periurethral injection of MSCs in an animal model of SUI restored the damaged external urethral sphincter and significantly improved VLPP. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e72-e73 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oleg Loutochin Montreal, Canada More articles by this author Lysanne Campeau Montreal, Canada More articles by this author Nicoletta Eliopoulos Montreal, Canada More articles by this author Manaf Bouchentouf Montreal, Canada More articles by this author Bertil Blok Montreal, Canada More articles by this author Jacques Galipeau Montreal, Canada More articles by this author Jacques Corcos Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparison between in vitro qualities of platelets washed with commercially available additive solutions and those washed with M‐sol

We previously developed a novel additive solution (M-sol) with a high ability to preserve the in vitro qualities of platelets (PLTs) in washed PLTs Here, we compared the ability of M-sol with that of commercially available additive solutions (ASs) to preserve the in vitro qualities (pH, mean PLT volume, %disc, P-selectin, %hypotonic shock response and aggregation) of PLTs at a low plasma concentration. The platelet concentrate was divided into two equal aliquots (control group and test group). After centrifugation of both groups and removal of as much supernatant as possible, the pellet of the control group was resuspended in M-sol and those of the test group were resuspended in other ASs, and subsequently stored in polyolefin bags with agitating at 20-24 degrees C. Compared with those stored in M-sol, the qualities of PLTs stored in PAS-B (alternative name; PAS-II or T-sol), PAS- C (alternative name; PAS-III or Intersol) or Plasma Lyte were degraded as early as 24 h after washing. The qualities of PLTs stored in PAS-D (alternative name; Composol PS) or PAS-E (alternative name; PAS-IIIM or SSP+) were comparable to that of those stored in M-sol 24 h after washing; however, the qualities had deteriorated 72 h after washing. At a low plasma concentration (5% or less), the M-sol showed a higher ability to preserve PLTs than the five ASs studied here. Although PAS-D and PAS-E are available as an AS for short-term storage of washed PLTs, M-sol is thought to be preferable for longer storage.

Influence of acute hypervolemic hemodilution on pharmacodynamics of cisatracurium in patients undergoing general anesthesia

Objective To investigate the influence of acute hypervolemic hemodilution (AHH) on pharmacodaynamics of cisatracurium in patients undergoing general anesthesia. Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-60 yr scheduled for major abdominal surgery under general anesthesia were randomly allocated into 2 groups (n = 30 each): control group and AHH group. Each group was further divided into 3 subgroups according to the initial dose of cisatracurium (30, 40, 50 μg/kg) . The radial artery and right internal jugular vein were cannulated. BP, HR, CVP, SpO_2, P_(ET) CO_2 and body temperature were continuously monitored. The response of left adductor pollicis muscle to TOF stimulation of ulna nerve was monitored using TOF- Watch~R SX (Organon). Both groups received 10 ml/kg multiple electrolyte solution (plasma-Lyte A) during induction of anesthesia. In group AHH 15 ml/kg 6% hydroxyethyl starch (HES) 130/0.4 solution was infused via internal jugular vein over 30-40 min in addition to plasma-Lyte A. Five minutes after completion of plasma-Lyte A or HES, cisatracurium 30, 40 or SO fig/kg was injected iv in the respective subgroups. After the maximal T_1 block was achieved, the second dose was given to reach a total dose of 100 μg/kg. The onset time, duration of clinical action, total duration of action and recovery index were recorded. The doses for 50% , 90% and 95% T_1 depression (ED_(50), ED_(90), ED_(95)) were calculated by Probit method. Results The ED_(50), ED_(90), ED_(95) of cisatracurium were significantly higher in AHH group than in control group. The onset time of cisatracurium was significantly longer but clinical and total duration of action was significantly shorter in AHH group than in control group. There was no significant difference in recovery index between the two groups. Conclusion AHH can decrease the potency of cisatracurium. Key words: Atracurium; Hemoodilution; Neruomuscular blockade