Positive Fluid Balance Research Articles

Postoperative Fluid Therapy in Adult Cardiac Surgical Patients and Acute Kidney Injury: A Prospective Observational Study

Abstract Background Normal saline (0.9% NS) is a common intravenous fluid used worldwide. Recent studies have shown that NS use is associated with increased incidence of acute kidney injury (AKI) and a need for renal replacement therapy (RRT). The practice is changing toward using balanced solutions to prevent AKI. Postcardiac surgery patients are more prone to develop AKI after cardiopulmonary bypass (CPB). We aim to study the type of fluid administrated, incidence of AKI, need for RRT, and overall outcome of these patients. Methods This prospective observational study was conducted in the cardiothoracic intensive care unit (cardiothoracic and vascular surgery intensive care unit) in a cohort of 197 adult patients who underwent on pump cardiac surgery in our hospital from July 2021 to October 2021 as a pilot study. Data was analyzed using SPSS 20.0 (IBM, Chicago, Illinois, United States). A p-value < 0.05 was considered significant. Results In our study, 58 (29.34%) patients developed AKI in the first three postoperative days and 16 (8.12%) patients required RRT. Incidence of AKI was found to be higher in patients who received NS only, as fluid of choice was 34.48% compared with other intravenous fluids. Patients with AKI had higher positive fluid balance (p < 0.001), longer CPB (p < 0.001), and aortic cross clamp (p = 0.006) times. Intensive care unit and hospital stay and mortality rates were higher in AKI patients than those without AKI (p < 0.001). Conclusion Our study demonstrated that NS was the commonly used crystalloid in our patients and was associated with increased incidence of AKI and RRT when compared with other balanced salts solutions.

Prognostic Prediction Using the Clinical Data and Ultrasomics-Based Model in Acute Respiratory Distress Syndrome (ARDS) Combined with Acute Kidney Injury (AKI).

Objective A model was constructed based on clinical and ultrasomics features to predict the prognosis of patients in the respiratory intensive unit (RICU) who had acute respiratory distress syndrome (ARDS) combined with acute kidney injury (AKI). AKI ensues after ARDS in RICU ordinarily. The prognostic prediction tool was further developed on this basis. Methods We collected clinical and ultrasonic data from 145 patients who had ARDS combined with AKI and received continuous renal replacement therapy (CRRT) in the RICU of Xiangyang Hospital of Traditional Chinese Medicine from March 2016 to November 2019. The patients were divided into the survival group (n = 51) and the death group (n = 94), depending on the treatment outcome. The training set (n = 102) and the testing set (n = 43) were established based on patient data. The clinical and ultrasomics features and the CRRT parameters were compared between the two groups. The influence factors of death were analyzed by logistic regression, and four predictive models were established. The predictive performance of 4 models was compared using the R Software 4.1.3. The decision curve analysis graphs were drawn using the R language to determine the net benefit of each. Result Univariate analysis was conducted in the training set. The following risk factors for poor prognosis were identified: age, concurrent cancers, sequential organ failure assessment score (SOFA), number of organ dysfunctions, positive cumulative fluid balance at 72 h, time from ICU admission to CRRT, mean arterial pressure, oxygenation index, and gray-level size zone matrix, GLSZM (SumEntropy.239/SmallDependenceHighGrayLevelEmphasis.314/Maximum.327/Variance.338) (P < 0.05). Four models were built based on the above factors: clinical model, CRRT model, ultrasomics-based model, and combination model. Comparison using the MedCalc software indicated that the best predictive performance achieved with the combination model. The decision curve analysis also suggested that the combination model had the highest net benefit. Similar results were reported after validation on the testing set. Conclusion The prognosis of ARDS patients combined with AKI is usually poor. The combination model based on clinical and ultrasomics features had the highest predictive performance. This model can be used to improve the clinical outcome and prognosis.

Evaluating the Impact of Positive Fluid Balance on Mortality and Length of Stay in Septic Shock Patients.

BackgroundSepsis is accountable for major morbidity and mortality in patients with critical illnesses. The present research was undertaken to evaluate the correlation between fluid balance during hospitalizations and patient outcomes in patients with sepsis.MethodsAn observational study was undertaken at the Critical Care Department, Shifa International Hospital, Islamabad, Pakistan between December 2021 to April 2022. The patients included were over the age of 17 years, with a proven diagnosis of infection. These patients either had positive bacterial cultures, suffered from organ failure secondary to sepsis, or had clinically evident signs of infection. Patients who were discharged during the period of study were eliminated from the study population. All patients were informed of the process and signed consent was obtained. Basic demographic information was recorded, which included the existence of any comorbid conditions, organ failure, medication use, or infection history. The severity of critical illness was determined for every single patient along with organ damage. The final patient outcome was recorded as in-hospital mortality.ResultsA total of 307 patients were included in the study with a total of 165 (53.75%) male patients. The overall mortality rate was 39.74%. The mean length of hospitalization was 17.42 ± 8.3 days. A high SOFA score was significantly associated with quartile 4 with a mean score of 14.1 (p < 0.001). Similarly, a significantly higher APACHE score was found in patients in quartile 4 (p < 0.001) thus indicating a relationship between severity of illness and positive fluid balance. Upon further assessment, it was found that the 28th day and 90th day were significantly greater in quartile 4 in comparison to other quartiles. Similarly, the overall length of stays in the hospital and in the ICU were also significantly associated with greater fluid balance (p < 0.001). ConclusionIn our study, it was concluded that monitoring fluid balance in critically ill patients is very important. The highest 28-day and 90-day mortality were seen in patients with the greatest positive fluid balance. However, the cause of high mortality in this cohort could be multifactorial; therefore, the relationship of positive fluid balance with patient outcome remains debatable.

MO336: Renal Recovery After Acute Kidney Injury Associated to COVID Requiring CRRT During ICU Hospitalization

BACKGROUND AND AIMSRenal recovery (RR) after AKI is a determinant outcome of future comorbidity and mortality in critical care patients. Related predictive factors remain uncertain.METHODWe retrospectively analyzed patients admitted to ICU between January 2020 and February 2021 from our critical nephrology database.We analyzed adult patients with diagnosis of AKI (KDIGO criteria) treated with renal replacement therapy (RRT) during ICU hospitalization. We excluded patients with dialysis support previous to the admission.The main outcomes we evaluated were(1) RR (successful suspension of RRT without hyperkalemia, increase in serum creatinine (SCr), hypervolemia or acidemia after 1 week without RRT, with urine volume > 500 mL/d without diuretic treatment or > 2000 mL/d with diuretics).(2) Mortality during hospitalization.RESULTSWe found 1442 patients were admitted to ICU, 418 presented AKI (29.8%), of them, 178 patients (64% male) required RRT (AKI-RRTd) in ICU during follow-up, with mean age of 66 year old (52.8% >65 year). Main comorbidity and demographic data are in Table 1. Mean time in ICU was 19 days (RIC 11–35). The most frequent admission cause was non-surgical pathologies (93%), 53% of admitted patients had COVID-19 as main diagnosis (95 patients). There was need of vasoactive support in 73.6%, ventilatory support (82.6) and 67.2% of patients had fluid overload.The indication of dialysis was determined by a nephrologist: mainly oliguria, acidosis, hyperkalemia, fluid overload and increase SCr. Mean SCR at admission was 2.5 mg/dL. There were missing data in 48% of basal SCr (known SCr between 1 and 12 months prior to admission). Total mortality in AKI-RRTd was 70.8% (126 patients). In COVID patients, was 77.9% (74 patients).We found renal recovery in 63.4% of total survivors (33/52 patients). When analyzing COVID, there were 21 survivors, and we found renal recovery in 80.9% of patients.Patients who did not achieved renal recovery had longer ICU stay (median: 20 days, RIC: 4–26) and inhospitalization (median: 41 days, RIC: 29–58). Those patients were older, and had higher morbidity (diabetes), higher SCr at ICU admission and lower urine output. Their fluid balance was higher at 48 h after CRRT initiation (OR 3.05, 95% CI 1.39–6.65, P <.01). In COVID population without renal recovery, there were more urgent dialysis onset (OR 8.33, 95% confidence interval (95% CI) 1.04–66.2; P = .04), age > 65 year (OR 6.48, 95% CI 1.94–21.6; P < .01), positive fluid balance at 48 h after RRT (OR 3.25; 95% CI 1.09–9.69; P = .03).The risk factors for mortality, were age > 65 year (OR 4.14, 95% CI 2.05–8.35; P < .01), mechanical ventilation (OR 3.28, 95% CI 1.48–7.30; P < .01), haemodynamic support (OR 4.37, 95% CI 2.14–8.92; P < .01). Otherwise, lower SCr at admission (OR 0.82, 95% CI 0.71–0.93; P < .01) and at instauration of RRT (OR 0.75, 95% CI 0.065–0.88; P < .01) were associated to lower mortality.In COVID patients, fluid overload at RRT initiation (OR 10.83, 95% CI 1.37–85.36; P = .02), age > 65 year old (OR 8.85, 95% CI 2.68–29.1; P < .01) and FiO2 > 50% at RRT start (OR 2.77, 95% CI 1.02–7.50; P = .04) were associated to higher mortality.CONCLUSIONIn ICU patients with AKI-RRT dependence, negative fluid balance at 48 h after RRT onset and in COVID patients, age < 65 year old, negative fluid balance at 48 h after RRT onset and non-urgent onset of RRT were related with renal recovery.

Clinical effect of fluid resuscitation guided by intra-abdominal pressure and oxygenation index for severe acute pancreatitis patients

To investigate the effect of the liquid resuscitation therapy strategy using intra-abdominal pressure (IAP) and oxygenation index (PaO2/FiO2) as the end point in patients with severe acute pancreatitis (SAP). A retrospective study was performed, including 84 patients with SAP in emergency intensive care unit of Qingzhou Hospital Affiliated to Shandong First Medical University from January 2018 to August 2021. According to the status of fluid balance at admission, all patients were divided into the positive fluid balance group (43 cases) and the negative fluid balance group (41 cases). The clinical data including gender, age, etiology, underlying disease, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) of all patients were collected. Fluid balance, PaO2/FiO2, IAP, compliance rate, new mechanical ventilation rate and overall hospital stay of 1 week after admission were recorded and compared between the two groups. After 72 hours of treatment, the cumulative fluid balance was (5 219.5±1 038.4) mL in the positive fluid balance group; IAP was higher than that before treatment [mmHg (1 mmHg ≈ 0.133 kPa): 11.9±2.0 vs. 11.7±2.1], but no significant difference was found (P > 0.05); PaO2/FiO2 was significantly higher than that before treatment (mmHg: 299.8±51.4 vs. 220.5±50.4, P < 0.05). After 72 hours of treatment, the cumulative fluid balance in negative fluid balance group was (-3 542.4±1 310.6) mL; IAP was significantly lower than before treatment (mmHg: 11.4±1.8 vs. 15.2±1.9, P < 0.05); PaO2/FiO2 was significantly higher than that before treatment (mmHg: 309.9±50.9 vs. 215.4±49.7, P < 0.05). In the fluid resuscitation goals, after 72 hours of treatment, the compliance rate in the negative fluid balance group was significantly higher than that in the positive fluid balance group [82.93% (34/41) vs. 62.79% (27/43), P < 0.05]; 1 week after admission, the new mechanical ventilation rate in the negative fluid balance group was significantly lower than that in the positive fluid balance group [21.95% (9/41) vs. 41.86% (18/43), P < 0.05]; however, there was no significant difference in overall hospital stay between the two groups (days: 41.2±10.9 vs. 39.1±11.5, P > 0.05). After treatment, 70 patients survived and 14 patients died (including 9 cases in the positive fluid balance group and 5 cases in the negative fluid balance group). Using IAP and PaO2/FiO2 to guide liquid therapy could result in effective fluid resuscitation in SAP. The treatment strategy effectively improved prognosis of patients with SAP.

Development and External Validation of a Nomogram for Predicting Acute Kidney Injury in Cardiogenic Shock Patients in Intensive Care Unit.

BackgroundThe aim of this study was to construct and external validate a nomogram for predicting cardiogenic shock acute kidney injury (CS-AKI) in patients in intensive care unit (ICU).MethodsAll patients diagnosed with CS from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and the eICU Collaborative Research Database (eICU-CRD) were included in this study. Least absolute shrinkage and selection operator (LASSO) regression and recursive feature elimination for support vector machine (SVM-RFE) were used to determine the overlapping clinical features associated with CS-AKI. The predictive nomogram was established based on the significant clinical parameters and externally verified in this study.ResultsLASSO regression and SVM-RFE demonstrated that Charlson Comorbidity Index (CCI), usage of mechanical ventilation, SOFA score, white blood cell, albumin, eGFR, anion gap, and positive fluid balance were closely associated with CS-AKI in the training cohort. The predictive nomogram based on the eight parameters showed good predictive performance as calculated by C-index were 0.823 (95% confidence index, 95% CI 0.798–0.849), 0.819 (95% CI 0.769–0.849), and 0.733 (95% CI 0.704–0.763) in the training set, in the internal validation set and in the external validation sets, respectively. Moreover, the nomogram exhibited not only encouraging calibration ability but also great clinical utility in the training set and in the validation sets.ConclusionCCI, usage of mechanical ventilation, SOFA score, white blood cell, albumin, eGFR, anion gap, and positive fluid balance were closely associated with CS-AKI. The predictive nomogram for CS-AKI manifested well-predictive ability for the identification of ICU patients with CS-AKI.

Dynamic and Static Cardiac Function Measurements During Sepsis.

Dynamic and Static Cardiac Function Measurements During Sepsis.

Safety of adaptive ventilation modes ISV and PSV when weaning the patient from a respirator

Introduction.Currently there are no reports or recommendations concerning the ventilator weaning process. Appliance of the intellectual adaptive ventilation mode (iSV) represented in indigenous Russian unit ALV ZISLINE МV200 К 1.19 («Triton» Yekaterinburg) is highly potential. It provides minute ventilation target volume regardless of spontaneous patient’s respiratory activity and controls the pressure-support ventilation level (PSV) after each ventilatory cycle. Object was to increase safety of a patient’s spontaneous breathing adaptation period after longtime artificial lung ventilation.Materials and methods.Using the continuous sampling method we’ve surveyed 46 patients at the ages from 34 to 81 y.o. (median is 65.5 y.o.) being under prolonged artificial lung ventilation treatment at ICU from 5 to 28 full days. The groups are divided into 2 depending on the assisted respiration method for spontaneous breathing adaptation. In the 1st group (n = 25) the PSV mode was used for the purpose of spontaneous breathing adaptation. In the 2nd group (n = 21) the iSV mode was employed. The safety of conducting artificial lung ventilation was estimated by the dynamic of the arterial CO2 level, arterial oxygen saturation, pressure-support value, oxygen and energy intake value and a 24-hour fluid balance.Results.The comparison study of the metabolic indicants showed a higher rate of estimated energy requirement in the PSV mode authentically different by 3-5 full days, positive fluid balance conditioned by positive airway pressure and certain fluid retention which confirms more active respiratory load in the PSV mode. In the iSV mode from the 3rd till the 5th full day there’s negative fluid balance. By the 7th-10th full day it becomes slightly positive which proves electrolyte and fluid balance stabilization.Discussion.Most of the studies related to the study of the advantages of one or another method of auxiliary ventilation used the success of weaning as the primary indicator. In our study, we focused on the main respiratory indicators and the adequacy of ventilation when using auxiliary modes, as well as metabolic costs. In our study, we noted a decrease in the number of days spent by patients in IUC when using the iSV mode compared with the use of the PSV mode. We have determined a significant reduction in the estimated energy demand when using the adaptive ventilation mode compared to the pressure support mode, regardless of the PS level, as well as an increase in VO2 and VCO2.Conclusion.Thus, the iSV mode is believed to be more physiological than the PSV as it not only makes less demands on the respiratory system but it also allows to stabilize a patient's fluid balance during recovery after his/her critical condition.

Analysis of Fluid Balance as Predictor of Length of Assisted Mechanical Ventilation in Children Admitted to Pediatric Intensive Care Unit (PICU).

Background Ventilator-associated lung injury (VALI) is a devastating complication of assisted mechanical ventilation (AMV) and is one of the root causes of prolonged AMV. Many strategies were made to decrease the effect of the same. This study is conducted to determine the association of prolonged AMV with fluid balance and pediatric index of mortality 2 (PIM2) score. Methods This prospective observational study was carried out in a PICU of a tertiary care centre over a period of 12 months. Patient's fluid balance was calculated by tabulating fluid input-output over initial 48 hours of AMV. The PIM2 score on admission was documented. The association between qualitative variables was assessed by a chi-square test. Comparison of quantitative data measured between cases with duration of AMV ≥ 7 days and <7 days was done using the Mann–Whitney U test. Correlation between quantitative data was done by using the Pearson product moment correlation. Results Out of 40 patients, 27 patients who had ≥15% positive fluid balance required prolonged mechanical ventilation. Similarly, 27 patients with PIM2 score ≥ 5 required prolonged AMV. On applying the Pearson chi-square test, we found a significant association between positive fluid balance and prolonged mechanical ventilation (P value = 2.25 × 10−7 (<0.05)). Likewise, a statistically significant association was found between PIM2 score and prolonged ventilation (P value = 1.19 × 10−5 (<0.05)). Conclusion There is a significant association of prolonged AMV with positive fluid balance (>15%) and PIM2 score (>5). By strict maintenance of fluid balance with appropriate intervention, the length of AMV and PICU stay can be decreased.

A Positive Fluid Balance in the First Week Was Associated With Increased Long-Term Mortality in Critically Ill Patients: A Retrospective Cohort Study.

IntroductionEarly fluid balance has been found to affect short-term mortality in critically ill patients; however, there is little knowledge regarding the association between early cumulative fluid balance (CFB) and long-term mortality. This study aims to determine the distinct association between CFB day 1–3 (CFB 1–3) and day 4–7 (CFB 4–7) and long-term mortality in critically ill patients.Patients and MethodsThis study was conducted at Taichung Veterans General Hospital, a tertiary care referral center in central Taiwan, by linking the hospital critical care data warehouse 2015–2019 and death registry data of the Taiwanese National Health Research Database. The patients followed up until deceased or the end of the study on 31 December 2019. We use the log-rank test to examine the association between CFB 1–3 and CFB 4–7 with long-term mortality and multivariable Cox regression to identify independent predictors during index admission for long-term mortality in critically ill patients.ResultsA total of 4,610 patients were evaluated. The mean age was 66.4 ± 16.4 years, where 63.8% were men. In patients without shock, a positive CFB 4–7, but not CFB 1–3, was associated with 1-year mortality, while a positive CFB 1–3 and CFB 4–7 had a consistent and excess hazard of 1-year mortality among critically ill patients with shock. The multivariate Cox proportional hazard regression model identified that CFB 1–3 and CFB 4–7 (with per 1-liter increment, HR: 1.047 and 1.094; 95% CI 1.037–1.058 and 1.080–1.108, respectively) were independently associated with high long-term mortality in critically ill patients after adjustment of relevant covariates, including disease severity and the presence of shock.ConclusionsWe found that the fluid balance in the first week, especially on days 4–7, appears to be an early predictor for long-term mortality in critically ill patients. More studies are needed to validate our findings and elucidate underlying mechanisms.

Risk Factors for Mortality in Abdominal Infection Patients in ICU: A Retrospective Study From 2011 to 2018.

To identify the risk factors related to the patient's 28-day mortality, we retrospectively reviewed the records of patients with intra-abdominal infections admitted to the ICU of Nanfang Hospital, Southern Medical University from 2011 to 2018. Multivariate Cox proportional hazard regression analysis was used to identify independent risk factors for mortality. Four hundred and thirty-one patients with intra-abdominal infections were analyzed in the study. The 28-day mortality stepwise increased with greater severity of disease expression: 3.5% in infected patients without sepsis, 7.6% in septic patients, and 30.9% in patients with septic shock (p < 0.001). In multivariate analysis, independent risk factors for 28-day mortality were underlying chronic diseases (adjusted HR 3.137, 95% CI 1.425–6.906), high Sequential Organ Failure Assessment (SOFA) score (adjusted HR 1.285, 95% CI 1.160–1.424), low hematocrit (adjusted HR 1.099, 95% CI 1.042–1.161), and receiving more fluid within 72 h (adjusted HR 1.028, 95% CI 1.015–1.041). Compared to the first and last 4 years, the early use of antibiotics, the optimization of IAT strategies, and the restriction of positive fluid balance were related to the decline in mortality of IAIs in the later period. Therefore, underlying chronic diseases, high SOFA score, low hematocrit, and receiving more fluid within 72 h after ICU admission were independent risk factors for patients' poor prognosis.

Current Practice of Fluid Maintenance and Replacement Therapy in Mechanically Ventilated Critically Ill Children: A European Survey.

Appropriate fluid management in mechanically ventilated critically ill children remains an important challenge and topic of active discussion in pediatric intensive care medicine. An increasing number of studies show an association between a positive fluid balance or fluid overload and adverse outcomes. However, to date, no international consensus regarding fluid management or removal strategies exists. The aim of this study was to obtain more insight into the current clinical practice of fluid therapy in mechanically ventilated critically ill children. On behalf of the section of cardiovascular dynamics of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) we conducted an anonymous survey among pediatric intensive care unit (PICU) specialists in Europe regarding fluid overload and management. A total of 107 study participants responded to the survey. The vast majority of respondents considers fluid overload to be a common phenomenon in mechanically ventilated children and believes this complication is associated with adverse outcomes, such as mortality and duration of respiratory support. Yet, only 75% of the respondents administers a lower volume of fluids (reduction of 20% of normal intake) to mechanically ventilated critically ill children on admission. During PICU stay, a cumulative fluid balance of more than 5% is considered to be an indication to reduce fluid intake and start diuretic treatment in most respondents. Next to fluid balance calculation, the occurrence of peripheral and/or pulmonary edema (as assessed including by chest radiograph and lung ultrasound) was considered an important clinical sign of fluid overload entailing further therapeutic action. In conclusion, fluid overload in mechanically ventilated critically ill children is considered an important problem among PICU specialists, but there is great heterogeneity in the current clinical practice to avoid this complication. We identify a great need for further prospective and randomized investigation of the effects of (restrictive) fluid strategies in the PICU.

Effect of sodium administration on fluid balance and sodium balance in health and the perioperative setting. Extended summary with additional insights from the MIHMoSA and TOPMAST studies.

We aimed to provide an extended analysis of the physiological handling of of the sodium burden induced by maintenance fluids. We revisited two studies that demonstrated, in healthy volunteers and in surgical patients, that maintenance fluids with 154mmol/L of sodium lead to a more positive fluid balance than a regimen containing 54mmol/L. We report different unpublished data on the renal handling of the imposed sodium burdens with specific attention to the resulting fluid and sodium balances. The kidneys adapt to the sodium-rich fluids not only by altering sodium excretion, but also by retaining extra free water by concentrating urine. Realigning urinary sodium excretion with an increased administration takes around one day in health and much longer in the clinical setting. This difference may be explained by the presence of hypovolemia-induced aldosterone secretion in the latter group. Non-osmotic storage of sodium limits an unrestrained fluid retention even when very high amounts of sodium are administered but fluid accumulation will inevitably be further prolonged. Sodium administration induced by sodium-rich maintenance fluids leads, especially in the clinical setting, to prolonged fluid retention when compared with a regimen that resembles a healthy dietary sodium intake, even when kidney function is normal.

Comparison of 1.0 g/kg of 20% mannitol initiated at different time points and effects on brain relaxation in patients with midline shift undergoing supratentorial tumor resection: a randomized controlled trial.

Previous studies have suggested the use of 1.0 g/kg of 20% mannitol at the time of skin incision during neurosurgery in order to improve brain relaxation. However, the incidence of brain swelling upon dural opening is still high with this dose. In the present study, the authors sought to determine a better timing for mannitol infusion. One hundred patients with midline shift who were undergoing elective supratentorial tumor resection were randomly assigned to receive early (immediately after anesthesia induction) or routine (at the time of skin incision) administration of 1.0 g/kg body weight of 20% mannitol. The primary outcome was the 4-point brain relaxation score (BRS) immediately after dural opening (1, perfectly relaxed; 2, satisfactorily relaxed; 3, firm brain; and 4, bulging brain). The secondary outcomes included subdural intracranial pressure (ICP) measured immediately before dural opening; serum osmolality and osmole gap (OG) measured immediately before mannitol infusion (T0) and at the time of dural opening (TD); changes in serum electrolytes, lactate, and hemodynamic parameters at T0 and 30, 60, 90, and 120 minutes thereafter; and fluid balance at TD. The time from the start of mannitol administration to dural opening was significantly longer in the early administration group than in the routine administration group (median 66 [IQR 55-75] vs 40 [IQR 38-45] minutes, p < 0.001). The BRS (score 1/2/3/4, n = 14/26/9/1 vs 3/25/18/4, p = 0.001) was better and the subdural ICP (median 5 [IQR 3-6] vs 7 [IQR 5-10] mm Hg, p < 0.001) was significantly lower in the early administration group than in the routine administration group. Serum osmolality and OG increased significantly at TD compared to levels at T0 in both groups (all p < 0.001). Intergroup comparison showed that serum osmolality and OG at TD were significantly higher in the routine administration group (p < 0.001 and = 0.002, respectively). Patients who had received early administration of mannitol had more urine output (p = 0.001) and less positive fluid balance (p < 0.001) at TD. Hemodynamic parameters, serum lactate concentrations, and incidences of electrolyte disturbances were comparable between the two groups. Prolonging the time interval between the start of mannitol infusion and dural incision from approximately 40 to 66 minutes can improve brain relaxation and decrease subdural ICP in elective supratentorial tumor resection.

An Assessment of the Net Fluid Balance in the Alberta Basin

Net fluid balance in the Alberta Basin has been negative over the last 60 years because extensive fluid production has consistently exceeded injection during this period. However, future gigaton-scale carbon sequestration, among other activities, can result in future cumulative fluid injection exceeding extraction (i.e., a positive net fluid balance). The in-situ net fluid balance (i.e., total fluids produced minus total fluids injected) in this basin over the period 1960–2020 shows that a liquids deficit of 4.53 × 109 m3 and a gas deficit of 6.05 × 1012 m3 currently exist. However, fluid deficits are more significant in the upper stratigraphic intervals (located more than 1 km above the Precambrian Basement) than in the stratigraphic intervals located within 1 km of the Precambrian Basement in most geographic regions. This observation indicates that greater sustainable injection capacity for large-scale fluid injection may exist in the upper stratigraphic intervals (located at more than 1 km above the Precambrian Basement), reducing the potential for generating induced seismicity of concern. Additionally, while fluid depletion rates consistently increased over most of the last 60 years in the Alberta Basin, this trend appears to have changed over the past few years. Such analysis of regional net fluid balance and trends may be useful in assessing regional sustainable fluid storage capacity and managing induced seismicity hazards.

Вплив якісних та кількісних змін поповнення крововтрати на прояви синдрому поліорганної недостатності при політравмі

У роботі наведені результати аналізу 53 історій хвороб постраждалих із політравмою мирного та воєнного часу, яким проводили поповнення крововтрати за ліберальною стратегією, та обстеження 16 постраждалих, яким застосовували рестриктивну стратегію поповнення крововтрати. Обмеження інфузійно-трансфузійної терапії до 70 мл/кг не знизило її протишокового ефекту і в той же час дозволило зменшити позитивний водний баланс, скоротити тривалість вазопресорної підтримки та штучної вентиляції легень, зменшити кількість пневмоній та інших ускладнень, уникнути різких коливань гемоглобіну, гематокриту та загального білка в 1-шу добу, знизити кількість повторних трансфузій, зменшити летальність.

Risk Factors for High Blood Product Use in Patients with Stanford Type A Dissection.

Intraoperative and postoperative bleeding associated with allogeneic blood transfusion and reoperation is still a common and feared complication in patients undergoing surgery due to acute Type A Aortic Dissection (aTAAD). The aim of our study was to identify risk factors for higher transfusion rates. In this retrospective single center study we evaluated pre -, intra-, and postoperative data of 121 patients with aTAAD. Depending on the median of received packed red blood cells (PRBCs), patients were divided into Group A (<8 PRBC, n = 53) and Group B (≥8 PRBC n = 68). Statistical analyses (descriptive statistics, univariable and multivariable logistic regression) were performed using SPSS software 25.0. Statistical significance was assumed at p-value <0.05. A total of 120 patients received a blood product during their perioperative course. Among others we identified age, hemorrhagic pericardial effusion, and dual antiplatelet therapy as preoperative risk factors, low rectal temperature as intraoperative risk factor and low body temperature, positive fluid balance, high lactate level and beginning development of acute renal failure as postoperative risk factors. Our study identifies several factors which predict a higher likelihood of bleeding and consecutive blood transfusion. Knowledge of these factors could influence the therapy to reduce transfusion requirements and lead to a targeted and more efficient use of coagulation products.

ASSOCIATION BETWEEN 72-H CUMULATIVE FLUID BALANCE AND MORTALITY IN COVID-19 PATIENTS AT RSUD DR. SOETOMO SURABAYA

Cumulative fluid balance (CFB) with positive values mentioned in many studies is associated with mortality risk. In general, positive CFB was found in patients with sepsis, acute kidney injury (AKI), and heart failure. Meanwhile, COVID-19 is one of the causes of the conditions mentioned above. This study is a retrospective observational study using a cross-sectional method. Of the 97 samples obtained, 78 samples met the inclusion criteria. Obtained 69.2% male and 30.7% female. In this study, 45 (57.7%) patients had positive CFB, and 33 (42.3%) patients had negative CFB out of a total of 78 patients. The mortality rate was 32 (41.1%) patients who died from 78 patients in August 2020 s.d. October 2020. The optimal cut-off value for the amount of CFB in 72 hours is 516 ml (sensitivity 59.4%; specificity 71.7%). The result of the significant value of the number of CFB in 72 hours and mortality is (p) = 0.019 then p<0.05, which means there is a relationship between the number of CFBs in 72 hours and mortality in COVID-19 patients in the Ruang Isolasi Khusus (RIK) 1 RSUD Dr. Soetomo Surabaya Period August 2020-October 2020. Positive cumulative fluid balance (>516 ml) predicted to increase mortality of COVID-19 patients in Ruang Isolasi Khusus (RIK) 1 RSUD Dr. Soetomo Surabaya Period August 2020-October 2020

Complications associated with long-term positive-pressure ventilation in dogs and cats: 67 cases.

To determine the complications associated with positive-pressure ventilation (PPV) in dogs and cats. Retrospective study from October 2009 to September 2013. University Teaching Hospital. Fifty-eight dogs and 9 cats. Medical records were retrospectively reviewed; signalment, complications associated with PPV, duration of PPV, and outcome were recorded. Complications most commonly recorded during PPV included hypothermia 41/67 (61%), hypotension 39/67 (58%), cardiac arrhythmias 33/67 (49%), a positive fluid balance 31/67 (46%), oral lesions 25/67 (37%), and corneal ulcerations 24/67 (36%). A definition of ventilator-associated events (VAE) extrapolated from the Center of Disease Control's criteria was applied to 21 cases that received PPV for at least 4 days in this study. Ventilator-associated conditions occurred in 5 of 21 (24%) of cases with infection-related ventilator-associated conditions and ventilator-associated pneumonia identified in 3 of 21 (14%) cases. Complications are common and diverse in dogs and cats receiving long-term PPV and emphasizes the importance of intensive, continuous patient monitoring and appropriate nursing care protocols. Many of the complications identified could be serious without intervention and suggests that appropriate equipment alarms could improve patient safety. Development of veterinary specific surveillance tools such as the VAE criteria would aid future investigations and allow for effective multicenter studies.

Positive Cumulative Fluids Balance Related to Mortality Events in Sepsis Patients Treated at Intensive Care Unit, Dr. Mohammad Hoesin General Hospital Palembang

Introduction. Sepsis is a syndrome that describes physiological dysfunction, pathological, and biochemistry caused by infection. Fluid balance is an indicator that can monitor input and output. This study was aimed to evaluate the relationship between positive cumulative fluid balance and the mortality rate of sepsis patients treated in the intensive care unit.&#x0D; Method: This study design is a retrospective study. The inclusion criteria consist of patients diagnosed with sepsis written in the medical record, 18-65 years old, and patients admitted in intensive care unit dr Moh. Hoesin General Hospital. Data were analyzed using SPSS 22.0 with the normality of data distribution, independent sample t-test, Mann-Whitney analysis, chi-square, Fisher’s Exact to measure the relationship, and using Medcalc version 14 application to measure cut-off value, ROC curve AUC, cross-sectional point, sensitivity, and specificity.&#x0D; Result. The result showed that characteristic between age (p=0,491), gender (p=0,703) did not differ significantly between survived and non-survived patient. Length of stay (p=0,002), balance (p=0,000), and ward unit (p=0,014) has a significant different between survived and non survived patient. In chi square analysis, p value=0,000with odds ratio 7,083. Cut-off value of ROC curve is -97 mL with AUC 0,844, sensitivity 76,1% and specificity 79,3%.&#x0D; Conclusion. Cumulative positive balance patient in the sepsis patient correlates with increased mortality in a sepsis patient in Dr. Mohammad Hoesin General Hospital Palembang.