Received Fluid Therapy Research Articles

Icing treatment in rats with crush syndrome can improve survival through reduction of potassium concentration and mitochondrial function disorder effect.

Crush syndrome (CS), a serious medical condition, which is characterized by damage to myocytes due to pressure and is associated with high mortality, even when patients receive fluid therapy. Icing therapy over the affected muscle has been reported to be effective in improving mitochondrial dysfunction and inflammation. These effects are thought to be secondary to improvements in the leakage of potassium and myoglobin from the damaged myocytes in the early stages of disease. However, their effects on the various symptoms of CS are unclear. It was hypothesized that treatment with icing will inhibit the influence of potassium by vasoconstriction, exert anti-inflammatory effects in the affected myocytes and improve mitochondrial function The CS model constructed by subjecting anesthetized rats to bilateral hindlimb compression with a rubber tourniquet for 5 h. The rats were then randomly divided into six groups: i) Sham; ii) CS without treatment (CS); iii) and iv) icing for 30 or 180 min over the entire hindlimb on CS rats (CI-30 and -180), respectively; and v) and vi) local icing for 30 or 180 min over the affected area on CS rats (CLI-30 and -180), respectively. Under continuous monitoring and recording of arterial blood pressures, blood and tissue samples were collected for biochemical analyses at designated time points prior to and following reperfusion. The survival rate, vital signs, and blood gas parameters in the CS group were lethal compared with the sham group. These were also improved in the CI-30 and CLI-30 groups compared with the CS group; however, they worsened in the CI-180 and CLI-180 groups due to hypothermia. The CI-30 and CLI-30 groups demonstrated tendencies of improvements compared with the CS group. Systemic inflammation and mitochondria dysfunction had improved in these groups compared with the CS group. We suggest icing therapy to temporarily prolong the viability after crush injury. Its effectiveness can be improved by combining it with other infusion therapies.

Respiratory Variability of Pulmonary Velocity-Time Integral As a New Gauge of Fluid Responsiveness For Mechanically Ventilated Patients in the ICU.

To evaluate reliability and feasibility of the respiratory variability of pulmonary velocity-time integral as a new dynamic marker of fluid responsiveness in mechanically ventilated patients. Prospective observational study. Medical-surgical ICU of a general hospital. Fifty mechanically ventilated patients with acute circulatory failure. Transthoracic echocardiography was performed at inclusion (transthoracic echocardiography baseline). Fluid therapy was prescribed to patients exhibiting one value greater than or equal to 13% among commonly used variables of fluid responsiveness: respiratory variability of aortic velocity-time integral, respiratory variability of inferior vena cava diameter, or pulse pressure variation. Respiratory variability of pulmonary velocity-time integral was assessed at baseline. Respiratory variability of pulmonary velocity-time integral was significantly greater in patients who received fluid therapy (26.9 ± 12.5% vs 6.2 ± 4.3%; p < 0.0001). Respiratory variability of pulmonary velocity-time integral was correlated with respiratory variability of aortic velocity-time integral (r = 0.75; p < 0.0001), respiratory variability of inferior vena cava diameter (r = 0.42; p < 0.01), and pulse pressure variation (r = 0.87; p < 0.0001) at baseline and with the relative increase in cardiac output after fluid therapy (r = 0.44; p = 0.019). Fluid responsiveness was defined as a 10% increase in cardiac output after fluid therapy, assessed by a second transthoracic echocardiography. Respiratory variability of pulmonary velocity-time integral was associated with fluid responsiveness (adjusted odds ratio, 1.58; 95% CI, 1.08-2.32; p = 0.002). Area under the receiver operating characteristics curve was 0.972, and a value of respiratory variability of pulmonary velocity-time integral greater than or equal to 14% yielded a sensitivity of 92% and specificity of 87% to predict fluid responsiveness. Interobserver reproducibility was excellent (intraclass correlation coefficient = 0.94). Respiratory variability of pulmonary velocity-time integral is a simple and reliable marker of fluid responsiveness for ventilated patients in ICU.

Evaluation of the Efficacy and Safety of 3 Different Management Protocols in Pediatric Diabetic Ketoacidosis.

Management protocols for pediatric diabetic ketoacidosis (DKA) vary considerably among medical centers. The aim of this study was to investigate the efficacy and safety of 3 different fluid protocols in the management of DKA. Fluid management protocols with sodium contents of 75, 100, and 154 mEq/L NaCl were compared. In all groups, after the initial rehydration, the protocols differed from each other in terms of the maintenance fluid, which had different rates of infusion and sodium contents. Clinical status and blood glucose levels were checked every hour during the first 12 hours. Biochemical tests were repeated at 2, 6, 12, 24, and 36 hours. The medical records of 144 patients were evaluated. Cerebral edema developed in 18% of the patients. The incidence of cerebral edema was lowest in the group that received fluid therapy with a sodium content of 154 mEq/L NaCl at least 4 to 6 hours and had a constant rate of infusion for 48 hours. The patients with cerebral edema had lower initial pH and HCO3 and severe dehydration with higher initial plasma osmolality. There was no significant difference between the groups in terms of the recovery times of blood glucose, pH, HCO3, and the time of transition to subcutaneous insulin therapy. Severity of acidosis and dehydration are associated with the development of cerebral edema. It can be concluded that fluid therapy with higher Na content and a constant maintenance rate may present less risk for the patient with DKA.

Life Quality of Pediatric Patient with Dengue Hemorrhagic Fever (DHF) Who Received Crystalloid and Colloid Fluid Treatment in PKU Muhammadiyah Hospital Yogyakarta

Dengue hemorrhagic fever (DHF) in the community can have an impact of panic, death, and reduced age of hope in the family. Research on the quality of life of DHF pediatric patient who got the treatment of crystalloid and colloid fluids has never been done before. The purpose of this study was to determine the quality of life of DHF pediatric patients who received crystalloids and colloids with PedsQL instruments. The study design was a cohort with block randomization. The inclusion criteria in this study were hospitalized DHF pediatric patients aged one month -18 years from February to May 2018. The exclusion criteria were DHF patients who came with referrals from other hospitals who had received fluid therapy. Research data include the length of stay (LOS) and quality of life score with the PedsQL questionnaire. The statistical analysis was using an independent t-test and the Mann Whitney test. The length of stay for the crystalloid group is five days longer than the colloid group, which is four days. From a total of 48 subjects studied, the score for the physical function of the crystalloid fluid group 84.54 ± 9.90 was higher than the colloid group of 77.58 ± 19.30 (p = 0.125). The emotional functions in the crystalloid group obtained a score of 81.88 ± 12.14 higher than the colloid group, i.e., 79.17 ± 18.5 (p = 0.552). The social function in the crystalloid group had a score of 92.08 ± 8.84 higher than the colloid group of 86.67 ± 13.96 (p = 0.232). The school functions in the crystalloid group had a score of 50.42 ± 33.68 higher than in the colloid group of 37.92 ± 36.62 (p = 0.225). The results of this study showed that the crystalloid group had a higher quality of life score compared to the colloid group, although it was not significant.

A novel method to assess the severity and prognosis in crush syndrome by assessment of skin damage in hairless rats.

Crush syndrome (CS), a serious medical condition characterised by damage to the muscle cells due to pressure, is associated with high mortality, even when patients receive fluid therapy during transit to the hospital or admission to the hospital. There is no standard triage approach for earthquake victims with crush injuries due to the scarcity of epidemiologic and quantitative data. We examined whether mortality can be predicted based on the severity of skin damage so that assess the severity and prognosis in crush syndrome by assessment of skin damage in hairless rats because we have previously observed that CS results in oedema and redness of the skin in rats. Anaesthetised rats were subjected to bilateral hind limb compression [1kg (mild) and 2kg (severe) loads] with a rubber tourniquet for 5h. The rats were then randomly divided into three groups: sham, mild CS, and severe CS. The mild and severe CS groups had mortality rates of 20 and 90%, respectively. The severe CS group demonstrated higher rates of hyperkalaemia, hypovolemic shock, acidosis, and inflammation. Skin damage was significantly worse in the severe CS group compared to the mild CS group. Skin damage showed good correlation with pathological severity. Skin damage is a valid measure of transepidermal water loss and severity of CS. We suggest that these models may be useful to professionals who are not experienced in disaster management to identify earthquake victims at high risk of severe CS.

AFAST technique (Abdominal Focused Assessment Ultrasonography for Trauma)

The AFAST technique is used especially for the rapid detection of abdominal fluids. In this regard, it was supplemented by the “abdominal fluid score” (AFS) system at the time of examination and observation of the same patient four hours after the initial examination. If done properly, the AFAST technique allows an accurate identification of the presence of small amounts of abdominal fluids, unlike radiographic abdominal examination, where small amounts of fluid and serous details are rarely observed. In this way, an assessment of the patient’s condition can be made quickly and blood transfusion can be administered more quickly (when the abdominal fluid score is increased 4 hours after the initial examination). It is also possible to evaluate the integrity of the bladder during the initial examination and at four hours (during which the patient has also received fluid therapy). In general, it is considered that a bladder with more or less content is integral, although there have been cases where there were small cracks in the bladder wall, and the extravasation of the contents in the abdomen is done only in the case of large accumulations in the bladder.

Effect of Implementing Fluid Therapy Protocol on Pregnant and Postpartum Women Outcomes Who At Risk For Developing Acute Kidney Injury

Acute kidney injury (AKI) is a common and serious problem affecting millions and causing death and disability for many people. Aim of the study was to evaluate the effect of implementing fluid therapy protocol for pregnant and postpartum women outcomes who at risk for developing acute kidney injury. Patients and Methods: Quasi experimental research design was used to conduct this study; the study was carried out in Obstetric ICU at Assiut University Hospital. The study sample consisted of intervention group (15 patients) who received fluid therapy protocol and control group (15 patients) who received only the routine hospital care, the study was conducted in 6 months. Tools: first tool Renal impairment assessment sheet, second tool Protocol of fluid flow chart , third tool Patients' outcomes evaluation sheet. Results: No patients in the intervention group developed acute kidney injury but 60% of control group developed AKI with a statistical significant difference between intervention and control groups in relation to developing AKI (P=0.001). Conclusion: Implementing fluid therapy protocol was significantly effective in preventing developing AKI among at risk pregnant and postpartum women. Recommendations: Emphasize on the importance of accurate monitoring of urine output and CVP in obstetric patients who at risk for developing AKI in detection and preventing any problem or deterioration.

Low-Dose Sodium Nitrite Fluid Resuscitation Prevents Lethality From Crush Syndrome by Improving Nitric Oxide Consumption and Preventing Myoglobin Cytotoxicity in Kidney in A Rat Model.

Crush syndrome (CS) is a serious medical condition characterized by muscle cell damage resulting from pressure. CS has a high mortality, even when patients receive fluid therapy. We examined whether administration of NaNO2-containing fluid can improve survival in a rat model of CS. The CS model was generated by subjecting anesthetized rats to bilateral hind limb compression with a rubber tourniquet for 5 h. Rats were then randomly divided into six groups: sham; CS with no treatment; CS with normal saline treatment; CS with normal saline + 25 mEq/L bicarbonate treatment; and CS with normal saline + 200 or 500 μmol/kg NaNO2. Blood and tissue samples were collected for histological and biochemical analyses at predetermined time points before and after reperfusion. Ischemic compression of rat hind limbs reduced nitrite content in the crushed muscle, and subsequent reperfusion resulted in reactive oxygen species-induced circulatory dysfunction and systemic inflammation. Rats treated with 200 μmol/kg NaNO2 showed increased nitric oxide (NO) levels, blood circulation, and neoangiogenesis, decreased generation of reactive oxygen species, and suppression of the inflammatory response, leading to complete recovery. Treatment with 200 μmol/kg NaNO2 prevents muscle damage induced by ischemia reperfusion via the protective effects of NO and suppression of systemic inflammation, thereby increasing survival rates in CS.

Maintenance fluid therapy in a tertiary hospital: A prevalence study

Abstract Objective To assess the types of maintenance fluids used in our hospital, comparing their volume and composition to the standards recommended by the guidelines. Material and methods Observational, cross-sectional study. Volume and type of fluid therapy administered during 24 h to patients admitted to various hospital departments were recorded. Patients receiving fluid therapy because of water-electrolyte imbalance were excluded. Results Out of 198 patients registered, 74 (37.4%) were excluded because they did not meet the criteria for inclusion. Mean administered volume was 2500 cc/day. Mean daily glucose dose was 36 g per 24 h (SD: 31.4). The most frequent combination included normal saline solution (NSS) and glucose 5% (64.4%). Mean daily dose of sodium and chlorine was, respectively, 173 mEq (SD: 74.8) and 168 mEq (SD: 75), representing a surplus daily dose of +87.4 mEq and +85 mEq. Potassium, magnesium and calcium daily deficit was, respectively, −50 mEq, −22 mEq and −21 mEq per day. Buffer administration was exceptional, bicarbonate (2.29%), acetate (1.29%), lactate (1.15%) and gluconate (1.10%) being the buffering agents most frequently used. Conclusion NNS is the most frequently used solution. In contrast to excess doses of sodium and chlorine, there is a great deficit of other ions, buffering agents and caloric intake in the fluid therapy regimens that are usually prescribed.

Fluidoterapia de mantenimiento administrada en un hospital terciario: estudio de prevalencia

ObjectiveTo assess the types of maintenance fluids used in our hospital, comparing their volume and composition to the standards recommended by the guidelines. Material and methodsObservational, cross-sectional study. Volume and type of fluid therapy administered during 24h to patients admitted to various hospital departments were recorded. Patients receiving fluid therapy because of water-electrolyte imbalance were excluded. ResultsOut of 198 patients registered, 74 (37.4%) were excluded because they did not meet the criteria for inclusion. Mean administered volume was 2,500cc/day. Mean daily glucose dose was 36g per 24h (SD: 31.4). The most frequent combination included normal saline solution (NSS) and glucose 5% (64.4%). Mean daily dose of sodium and chlorine was, respectively, 173mEq (SD: 74.8) and 168mEq (SD: 75), representing a surplus daily dose of +87.4mEq and +85mEq. Potassium, magnesium and calcium daily deficit was, respectively, –50mEq, –22mEq and –21mEq per day. Buffer administration was exceptional, bicarbonate (2.29%), acetate (1.29%), lactate (1.15%) and gluconate (1.10%) being the buffering agents most frequently used. ConclusionNNS is the most frequently used solution. In contrast to excess doses of sodium and chlorine, there is a great deficit of other ions, buffering agents and caloric intake in the fluid therapy regimens that are usually prescribed.

Fluid Therapy Management in Hospitalized Patients: Results From a Cross-sectional Study

PurposeIntravenous (IV) fluid therapy is widely used in hospitalized patients. It has been internationally studied in surgical patients, but little attention to date has been dedicated to medical patients within the Italian context. The aims of the present study were to describe the prevalence of fluid therapy and associated factors among Italian patients admitted to medical and surgical units, describe the methods used to manage fluid therapy, and analyze the monitoring of patients by clinical staff. MethodsIn this cross-sectional study of 7 hospitals in northern Italy, data on individual and monitoring variables were collected, and their associations with in-hospital fluid therapy were analyzed by using logistic regression analysis. Patients aged ≥18 years who were admitted to medical and surgical units were included. Patients who received at least 500 mL of continuous fluids were included in the fluid therapy group. FindingsIn total, 785 (median age, 72 years; women, 52%) patients were included in the study, and 293 (37.3%) received fluid therapy. Maintenance was the most frequent reason for prescribing IV fluid therapy (59%). The mean (SD) volume delivered was 1177 (624) mL/d, and the highest volume was infused for replacement therapy (1660 [931] mL/d). The mean volume infused was 19.55 (13) mL/kg/d. The most commonly used fluid solutions were 0.9% sodium chloride (65.7%) and balanced crystalloid without glucose (32.9%). The proportion of patients assessed for urine output (52.6% vs 36.8%; P < 0.001), serum electrolyte concentrations (74.4% vs 65.0%; P = 0.005), and renal function (70.0% vs 58.7%; P = 0.002) was significantly higher in patients who did receive fluid therapy versus those who did not. In contrast, the use of weight and fluid assessments was not significantly different between the 2 groups (P = 0.216 and 0.256, respectively). Patients admitted for gastrointestinal disorders (odds ratio [OR], 3.5 [95% CI, 1.8–7.05) and for fluid/electrolyte imbalances (OR, 3.35 [95% CI, 1.06–10.52) were more likely to receive fluids. However, the likelihood of receiving fluids was lower for patients admitted to a surgical unit (OR, 0.36 [95% CI, 0.22–0.59]) and with cardiovascular diseases (OR, 0.37 [95% CI, 0.17–0.79). ImplicationsOnly one third of the study patients received fluid therapy. Crystalloid fluids, are the fluids of choice for maintaining plasma volume. During fluid therapy, measurement of the serum electrolyte concentrations, renal function, and urine output was largely used while weight and fluid balance were rarely assessed.

Effect of tetrastarch (hydroxyethyl starch 130/0.4) on plasma creatinine concentration in cats: a retrospective analysis (2010-2015).

Objectives The objective was to determine survival and changes in creatinine concentrations after administration of 6% tetrastarch (hydroxyethyl starch [HES] 130/0.4) vs crystalloids in critically ill cats. Methods The medical records were reviewed for cats admitted to the intensive care unit with at least two plasma creatinine measurements and initial concentrations not exceeding the upper reference interval. Cats were excluded if they had received HES prior to admission or if they had received fluid therapy for <24 h between initial and subsequent measurements. Changes in creatinine concentrations were evaluated as the percentage change from initial values to the maximum subsequent measurements. Cats receiving only crystalloids were assigned to the crystalloid group; cats receiving only HES or HES and crystalloids were assigned to the HES group. Results Ninety-three cats were included in the study (62 in the crystalloid group, 31 in the HES group). The total median cumulative HES dose was 94 ml/kg (range 26-422 ml/kg) and 24 ml/kg/day (range 16-42 ml/kg/day). No difference was detected between the groups for age, sex, body weight or mortality. The HES group had a significantly longer length of hospitalisation ( P = 0.012), lower albumin concentrations ( P <0.001), higher Acute Patient Physiologic and Laboratory Evaluation scores ( P = 0.037) and higher incidence of systemic inflammatory response syndrome ( P = 0.009) and sepsis ( P = 0.013). There was no significant difference in initial, maximum or maximum change in creatinine concentrations between the groups. Moreover, there was no significant difference in maximum change in creatinine concentrations in the subgroups of cats with systemic inflammatory response syndrome or sepsis. Conclusions and relevance In this population of cats, the administration of HES did not result in a significantly greater increase in creatinine from values measured on admission or higher mortality compared with administration of crystalloids. Further prospective studies are needed to assess both safety and efficacy of HES in cats before recommendations can be made.

Step sequential therapy for treating children with post-renal acute renal failure induced by Ceftriaxone

Objective To analyze the clinical characteristics and treatment of post-renal acute renal failure(ARF) induced by Ceftriaxone in children. Methods The clinical data of 7 cases of post-renal acute renal failure in children from June 2012 to June 2014 induced by Ceftriaxone were analyzed.According to the changes in urine volume, serum creatinine, blood urea nitrogen and serum potassium level, liquid therapy, retrograde ureteral catheterization(RUC) and peritoneal dialysis was performed by step sequential therapy respectively. Results Seven cases were given intravenous Ceftriaxone under the fluid loss state.Abdominal pain, sudden anuria or oliguria appeared in the children after 2.6 d on the average, B ultrasonography and CT scanning showed multiple calculus in the bilateral renal pelvis and ureteral calculi.Blood BUN was 15.2-37.9 mmol/L[(23.3±8.6) mmol/L], and blood Cr was 180-636 μmol/L[(378.9±148.4) μmol/L]. These indicators met the diagnostic criteria for acute renal failure.In 7 cases, 2 cases (28.6%) received fluid therapy of sodium bicarbonate alkalization and anisodamine spasmolytic, 4 cases (57.1%) received fluid therapy and RUC, and 1 case (14.3%) underwent fluid therapy and RUC and peritoneal dialysis.All of 7 cases (100%) were alive.In the average 4.4 days renal function of 7 cases was returned to normal, and urine volume and electrolyte were also restored. Conclusions Step sequential therapy including fluid therapy, RUC and peritoneal dialysis is effective with post-renal ARF in children induced by Ceftriaxone. Key words: Ceftriaxone; Acute renal failure, post-renal; Child

ROLES OF SO2 INDEX FOR PREDICTING OF FLUID RESPONSIVENESS IN HIGH RISK CARDIAC SURGICAL PATIENTS

Purpose: (1) Study the change in SO2 value in fluid therapy in patients after cardiac surgery; (2) Evaluate the role of SO2 monitoring in serving as an indicator of fluid responsiveness in patients after cardiac surgery. Methods: This was a prospective study reported earlier on critically ill patients with clinical hypovolemia after cardiac surgery. Fluid therapy was guided by changes in pulmonary artery wedge pressure or central venous pressure. Fluid responsiveness was defined as ≥15% increase in cardiac index. Hemodynamics, including left ventricular ejection fraction, cardiac index, and oxygen delivery were measured when SO2 blood samples taken. Results: There was 110 patients receiving fluid therapy in postoperative period. The SO2 increased in 104 patients responding to fluid loading (≥15% in cardiac index in n=107) versus those not responding (n=6). The increase in ejection fraction, cardiac index and oxygen delivery was also greater in responders (p=0.005). The area under the receiver operating characteristic curve for fluid responsiveness of changes in SO2 was 0.78 (p=0.05), with an optimal cutoff of 2%. The value of SO2 increased to reflect cardiac index increases with fluid loading was in 66.7% of patients. Conclusions: An increase in SO2 ≥ 2% can thus be used as an indicator of fluid responsiveness in clinically hypovolemic patients after cardiac surgery, particularly in those with systolic cardiac dysfunction. Fluid responsiveness concurs with increased tissue oxygen delivery. Key words: mixed venous oxygen saturation (SO2); oxygen delivery (DO2); oxygen consumption (VO2); central venous pressure (CVP), pulmonary artery wedge pressure (PAWP); cardiac index (CI); hypovolemia; fluid therapy.

Circulating tumour necrosis factor receptors 1 and 2 predict contrast-induced nephropathy and progressive renal dysfunction: a prospective cohort study.

Contrast-induced nephropathy (CIN) is an important cause of hospital-acquired acute kidney injury. An accurate understanding of the pathogenesis of CIN is crucial. The aim of this study was to evaluate the clinical role of circulating tumour necrosis factor receptors (cTNFRs) in CIN. From May 2013 to February 2014, 262 patients who underwent coronary angiography and/or percutaneous coronary intervention at Seoul National University Boramae Medical Center were enrolled. CIN was defined as either an increase in serum creatinine ≥ 22.1 μmol/L or ≥ 25% within 48 h after the procedure. Diabetes and chronic kidney disease accounted for 27.5% and 17.6% of the patients, respectively, and the mean age was 65 years. All patients received fluid therapy, and 36.3% underwent percutaneous coronary intervention. A total of 4.2% of the patients developed CIN; younger age, underlying diseases (e.g., stroke and chronic kidney disease), the use of N-acetylcysteine, and elevated concentrations of ln(cTNFRs) were associated with development of CIN. Increased values of ln(cTNFR1) (OR 6.32, 95% CI 2.46-16.28, P < 0.001) and ln(cTNFR2) (OR 3.24, 95% CI 1.26-8.31, P = 0.015) were significantly associated with CIN after adjusting for other risk factors, including baseline renal function. Moreover, an increase of cTNFRs levels was independently correlated with the deterioration of renal function. Markedly elevated concentrations of circulating TNFRs were correlated with the occurrence of CIN and significantly associated with prolonged renal dysfunction regardless of the development of CIN.

Perioperative fluid therapy: a statement from the international Fluid Optimization Group.

BackgroundPerioperative fluid therapy remains a highly debated topic. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. Maintaining effective circulating blood volume and pressure are key components of assuring adequate organ perfusion while avoiding the risks associated with either organ hypo- or hyperperfusion. Relative to perioperative fluid therapy, three inescapable conclusions exist: overhydration is bad, underhydration is bad, and what we assume about the fluid status of our patients may be incorrect. There is wide variability of practice, both between individuals and institutions. The aims of this paper are to clearly define the risks and benefits of fluid choices within the perioperative space, to describe current evidence-based methodologies for their administration, and ultimately to reduce the variability with which perioperative fluids are administered.MethodsBased on the abovementioned acknowledgements, a group of 72 researchers, well known within the field of fluid resuscitation, were invited, via email, to attend a meeting that was held in Chicago in 2011 to discuss perioperative fluid therapy. From the 72 invitees, 14 researchers representing 7 countries attended, and thus, the international Fluid Optimization Group (FOG) came into existence. These researches, working collaboratively, have reviewed the data from 162 different fluid resuscitation papers including both operative and intensive care unit populations. This manuscript is the result of 3 years of evidence-based, discussions, analysis, and synthesis of the currently known risks and benefits of individual fluids and the best methods for administering them.ResultsThe results of this review paper provide an overview of the components of an effective perioperative fluid administration plan and address both the physiologic principles and outcomes of fluid administration.ConclusionsWe recommend that both perioperative fluid choice and therapy be individualized. Patients should receive fluid therapy guided by predefined physiologic targets. Specifically, fluids should be administered when patients require augmentation of their perfusion and are also volume responsive. This paper provides a general approach to fluid therapy and practical recommendations.

A Randomized Trial of Goal Directed vs Standard Fluid Therapy in Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

The use of adequate fluid therapy during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial. The aim of the study was to assess whether the use of fluid therapy protocol combined with goal-directed therapy (GDT) is associated with a significant change in morbidity, length of hospital stay, and mortality compared to standard fluid therapy. Patients American Society of Anesthesiologists (ASA) II–III undergoing CRS and HIPEC were randomized into two groups. The GDT group (N = 38) received fluid therapy according to a protocol guided by monitored hemodynamic parameters. The control group (N = 42) received standard fluid therapy. We evaluated incidence of major complications, total length of hospital stay, total amount of fluids administered, and mortality rate. The incidence of major abdominal complications was 10.5 % in GDT group and 38.1 % in the control group (P = 0.005). The median duration of hospitalization was 19 days in GDT group and 29 days in the control group (P < 0.0001). The mortality rate was zero in GDT group vs 9.5 % in the control group (P = 0.12). GDT group received a significantly (P < 0.0001) lower amount of fluid (5812 ± 1244 ml) than the control group (8269 ± 1452 ml), with a significantly (P < 0.0001) lower volume of crystalloids (3884 ± 1003 vs 68,528 ± 1413 ml). In CRS and HIPEC, the use of a GDT improves outcome in terms of incidence of major abdominal and systemic postoperative complications and length of hospital stay, compared to standard fluid therapy protocol.

Four phases of intravenous fluid therapy: a conceptual model

I.V. fluid therapy plays a fundamental role in the management of hospitalized patients. While the correct use of i.v. fluids can be lifesaving, recent literature demonstrates that fluid therapy is not without risks. Indeed, the use of certain types and volumes of fluid can increase the risk of harm, and even death, in some patient groups. Data from a recent audit show us that the inappropriate use of fluids may occur in up to 20% of patients receiving fluid therapy. The delegates of the 12th Acute Dialysis Quality Initiative (ADQI) Conference sought to obtain consensus on the use of i.v. fluids with the aim of producing guidance for their use. In this article, we review a recently proposed model for fluid therapy in severe sepsis and propose a framework by which it could be adopted for use in most situations where fluid management is required. Considering the dose-effect relationship and side-effects of fluids, fluid therapy should be regarded similar to other drug therapy with specific indications and tailored recommendations for the type and dose of fluid. By emphasizing the necessity to individualize fluid therapy, we hope to reduce the risk to our patients and improve their outcome.

Comparsion of stroke volume variation with central venous pressure for guiding intraoperative fluid management in elderly patients undergoing gastrointestinal surgery

Objective To investigate the applicability of stroke volume variation (SVV) as an index for guiding fluid management in gastrointestinal surgery in elderly patients and the effect of SVV-guided volume management on gastrointestinal functional recovery and postoperative outcome.Methods Forty ASA Ⅰ or Ⅱ elderly patients undergoing gastrointestinal surgery were randomized into two groups [group SVV and group central venous pressure (CVP),20 patients in each group].The patients in group SVV received fluid therapy with Hydroxyethyl Starch depending on SVV which was maintained＜10％ and kept CVP in normal range.The patients in group CVP received fluid therapy with Hydroxyethyl Starch depending on CVP which was maintained at 8 mmHg-12 mmHg (1 mmHg=0.133 kPa) and circulatory stability.All patients were given same anaesthesia protocol.Hemodynamic parameters were recorded at instant time before induction (T0),before intubation (T1),after intubation (T2),after the abdominal cavity opened (T3),after bowel anastomose (T4),after abdomen wall closure (T5).Duration of surgery,intravenous fluid volume,blood loss,urine output were also recorded.The laboratory data such as hemoglobin (Hb),hematocrit (Hct),creatinine,blood urea nitrogen were examined the day before and after surgery.The time of passing gas,liquid intake time after surgery,length of hospital stay was examined.Results Compared with group SVV,CVP in group CVP was higher at T5[(11.6±2.0) cmH2O(1 cmH2O=0.098 kPa),P＜0.05)],SVV was lower at T4,T5 [(4.5±1.5)％,(4.2±1.4)％,P＜0.05].No differences in mean artery pressure (MAP),heart rate (HR),cardiac output (CO),stroke volumn (SV) between groups were found (P＞0.05).Compared with T0,MAP,CO,SV in both groups were lower at T1[Group SVV:(74±13) mmHg,(3.7±1.0) L/min,(59±11) ml/b.Group CVP:(71±12) mmHg,(3.8±1.1) L/min,(58±13) ml/b](P＜0.05),HR in both groups was lower at T4 and T5 [Group SVV:(61±8),(61±9) bpm.Group CVP:(60±7),(61±9) bpm)](P＜0.05).The intraoperative intravenous fluid volume in group SVV [(2 560±462) ml] was less than in group CVP [(3 153±823) ml] (P＜0.05).Urine output showed no difference between groups (P＞0.05).Postoperative Hb,Hct were significantly lower than that in preoperative.Creatinine,blood urea nitrogen in group SVV did not differ between pospoperative and preoperative,while in group CVP,blood urea nitrogen [(4.0±2.0) mmol/L] is significant lower postoperatively than preoperatively (P＜0.05).The time of passing gas [(2.6±1.2) d] liquid intake time [(4.0±1.7) d] in group SVV were significant shorter than in group CVP (P＜0.05).The length of hospital stay did not differ between the two groups (P＞0.05).Conclusions Stroke volume variation could be used for guiding fluid management in elderly patients undergoing gastrointestinal surgery,which could reduce introperative fluid administration,result in more stable hemodynamic,improve postoperative outcomes. Key words: Stroke volume variation ; Central venous pressure ; Gastrointestinal surgery ; Fluid management ;

English

OBJECTIVES: To verify and evaluate the role of maternal intravenous infusion of fluids, amino acids and progestogens in increasing the liquor amount and fetal weight in IUGR and oligohydramnios. METHODS: 90 patients with USG confirmed oligohydramnios and IUGR were admitted and divided into three groups. Group I was given high protein diet, bed rest, Intravenous fluids Ringer lactate and 5% Dextrose in 2:1 ratio on alternate days. Group II received fluid therapy RL and 5% dextrose in the ratio of 2:1 on alternate days for three days, amino acid drip 100ml twice daily on alternate days for 3 days a week and Group III received fluid therapy and amino acid infusion on alternate days along with natural progestogens 100mg once a week. Liquor was assessed clinically as well as by USG after a week and after 3 weeks. RESULTS: Amniotic fluid index increased in Group II and Group III significantly and increase in fetal weight was more so in Group III. Normal deliveries without complications were much more in Group II and Group III. Fetal distress was reduced in Group II and comparatively more so in Group III. CONCLUSION: Intravenous infusion of amino acids along with Intravenous fluid therapy given on alternate days as a weekly regime with addition of progestogens to this regime was beneficial to both the mother and fetus in oligohydramnios and IUGR. INTRODUCTION: IUGR is failure of the fetus to reach genetic potential for growth1 . 24 - 30% incidence in developing country2. It is multifactorial, maternal, fetal and placental factors and environmental toxins interfere with normal growth mechanism 1 . (8). Fetus with IUGR has got increased risk of disease 3 and death during antenatal, intrapartum, neonatal, paediatric and adult life. Short term morbidities like prematurity, RDS, necrotising