Fluid Responsiveness Research Articles

Intraoperative transfontanelle ultrasonography for pediatric patients

Cerebral blood flow (CBF) plays a vital role in delivering cerebral oxygen, and the accurate assessment of CBF is crucial for the intraoperative management of critically ill infants. Although the direct measurement of CBF is challenging, CBF velocity (CBFV) can be assessed using transcranial Doppler. Recent advances in point-of-care ultrasound have introduced brain ultrasound as a feasible intraoperative option, in which transfontanelle ultrasonography (TFU) has been applied to measure the CBFV through the anterior fontanelle. However, the intraoperative application of TFU in pediatric patients remains limited. The present review highlights the procedural aspects and clinical applications of TFU for anesthetic and intensive care management in pediatric patients. TFU facilitates the visualization of cerebral vessels and allows a noninvasive assessment of cerebral hemodynamics. The clinical significance of TFU involves its usefulness in various clinical scenarios, including monitoring CBF during cardiac surgery, assessing fluid responsiveness, and estimating intracranial pressure. TFU also enables the detection of cerebral emboli and the evaluation of anatomical abnormalities such as hydrocephalus or intracranial hemorrhage. TFU has demonstrated potential as an invaluable tool in pediatric care, despite limited familiarity among anesthesiologists. Additional research is needed to explore the associations between CBF and clinical outcomes, focusing on autoregulation, the impact of physiological changes, the associations of TFU findings with other brain monitoring tools such as electroencephalography, cerebral oximetry, and the implications of microemboli. TFU is a significant advancement and valuable tool for noninvasively assessing cerebral hemodynamics and CBF in pediatric patients with open fontanelles.

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

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

Immunocorrective effects of Tricor fenofibrate in the treatment of the early and intermediate stages of age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment, blindness and disability in the elderly. Treatment of end-stage AMD is extremely limited and requires invasive interventions. Currently, there is an active search for remedies aimed at preventing the degenerative process in the retina in the early stages of the disease. AMD is a multifactorial pathology, has common mechanisms with diseases associated with aging, metabolic shifts and hemodynamic disorders. The study of the effects of drugs already used to correct these disorders in the general clinic may also be of interest to ophthalmologists. The aim of the work was to study the dynamics of inflammatory markers of activation of the vascular endothelium and cytokines of the immune response in the tear fluid (TF) of patients with initial and intermediate stages of AMD against the background of the use of Tricor fenofibrate. 65 people were examined, divided into three groups according to the AREDS classification: group I – 20 people with early AMD (AREDS2), group II – 16 patients with intermediate AMD (AREDS3), 29 healthy elderly people without ophthalmopathology entered the age control group (AREDS1 – risk group). Patients of groups I and II received Tricor at a dose of 145 mg once a day for 9 months. Tear fluid (TF) was taken twice: before and immediately after the completion of the course of treatment. The determination of sICAM-1, sVCAM-1, sE-, sP-selectin and MCP-1/CCL2 in CS was performed by flow cytometry using a self-constructed multiplex panel from compatible simplex test kits Human FlowCytomixTM Simplex (Bender MedSystem GmbH, Germany); IL-1β, IL-2 IL-6 TNFα was determined within the framework of the Human Flow CytomixTM 15 Flex system (Bender MedSystem GmbH, Germany). Data processing was performed in the FlowCytomix Pro v 6.0 package (Bender Med Systems GmbH, Germany). According to the results of the study, a significant effect of Tricor fenofibrate was found on the initially high levels of local production of IL-1β, IL-2, IL-6, MCP-1/CCL2 and sICAM-1 in the AREDS2 group, which indicated a direct anti-inflammatory, vasoprotective effect in the treatment of the initial stage of AMD; a similar effect of the drug, but less pronounced, noted in the AREDS3 group. The ophthalmological examination data also indicated stabilization of visual functions and the clinical picture of the fundus, improvement of intraocular blood circulation in patients of the main groups. Thus, the use of Tricor can help prevent the degenerative process in the retina in the early stages of AMD development.

Quantitative Evaluation of Microcirculatory Alterations in Patients with COVID-19 and Bacterial Septic Shock through Remote Photoplethysmography and Automated Capillary Refill Time Analysis.

Background and Objectives: Sepsis, a leading global health challenge, accounts for around 20% of deaths worldwide. The complexity of sepsis, especially the difference between bacterial and viral etiologies, requires an effective assessment of microcirculation during resuscitation. This study aimed to evaluate the impact of infusion therapy on microcirculation in patients with sepsis, focusing on bacterial- and COVID-19-associated sepsis using remote photoplethysmography (rPPG) and the automated capillary refill time (aCRT). Materials and Methods: This single-center prospective study was conducted in the ICU of Pauls Stradins Clinical University Hospital, including 20 patients with sepsis/septic shock. The patients were selected based on hemodynamic instability and divided into COVID-19 and Bacterial Septic Shock groups. Fluid responsiveness was assessed using the Passive Leg Raising Test (PLRT). Systemic hemodynamics and microcirculation were monitored through MAP CRT, rPPG, and serum lactate levels. Statistical analyses compared responses within and between the groups across different stages of the protocol. Results: The Bacterial group exhibited higher initial serum lactate levels and more pronounced microcirculatory dysfunction than the COVID-19 group. rPPG was more sensitive in detecting perfusion changes, showing significant differences between the groups. The automated CRT demonstrated greater sensitivity compared to the manual CRT, revealing significant differences during PLRT stages between bacterial- and COVID-19-associated sepsis. Both groups had a transient hemodynamic response to PLRT, with subsequent stabilization upon fluid infusion. Conclusions: When managing patients with sepsis in intensive care, monitoring microcirculation is of paramount importance in infusion therapy. Our study highlights the potential of rPPG and aCRT as tools for this purpose. These techniques can be used in conjunction with routine parameters, such as lactate levels and systemic hemodynamic parameters, to provide a comprehensive assessment of a patient's condition.

Bedside imaging

Sonography, in particular echocardiography, is essential in the assessment of volume status and hemodynamics in critically ill patients. Examination of the left ventricle, in addition to assessing ventricular function, provides valuable information, including the "kissing papillary muscle sign," which may indicate fluid responsiveness. Examination of the right ventricle is also important because it is sensitive to both volume and pressure overload. Assessment of diastolic function and measurement of inferior vena cava width and variability provide clues to left and right ventricular preload, respectively. Measurement of stroke volume and cardiac output allows further assessment of hemodynamics and also permits determination of stroke volume variability.

Comparison of pulse pressure and stroke volume variations measured by three monitors in high-risk surgical patients

IntroductionDynamic indices of fluid responsiveness (FR) such as pulse pressure variation (PPV) and stroke volume variation (SVV) differ among hemodynamic monitors, which use proprietary algorithms, and vary even over a short period of time. We aimed to compare the baseline values, fluctuation and predictive value for FR of PPV and SVV measured by three minimally invasive monitors. Patients and methodsTwenty patients undergoing high-risk abdominal surgery were included and 45 fluid challenges were analysed. The patients were simultaneously monitored using Carescape B650, LiDCO Rapid and FloTrac/Vigileo system. Cardiac output (CO), PPV and SVV were recorded before and after the fluid challenge of 500ml of balanced crystalloid solution. An increase in CO ≥ 15 % defined fluid responders. Concurrently recorded arterial waveform was used for offline calculation of PPV. ResultsMean baseline values of the indices ranged between 8.6% and 13.4%. LiDCO showed higher fluctuation of indices compared to the other monitors. Area under the receiver operating characteristic curve (AUROC) ranged from 0.71 to 0.76 with optimal cut-off value between 7.5% and 13.9%. AUROC increased for all indices when FR was defined as an increase in stroke volume. Furthermore, a decrease in PPV or SVV after fluid challenge (ΔPPV, ΔSVV) proved a better marker of FR (AUROC 0.82 – 0.93) than baseline values with a uniform threshold of approximately -3%. ConclusionsAlthough a significant range of baselines variations and optimal cut-off values was observed, the predictive value of PPV and SVV from all the monitors was only moderate and comparable. Nevertheless, ΔPPV and ΔSVV appear to be a reliable and device-independent markers of FR.

Assessment of superior vena cava diameter and collapsibility index in liver transplantation: a prospective observational study

BackgroundSuperior Vena Cava (SVC) diameter and collapsibility index, dynamic measures of fluid responsiveness, have been successfully utilized as echocardiographic indices for fluid responsiveness in ventilated septic patients. Whether these measurements are correlated with Central Venous Pressure (CVP) measurements in liver transplant patients is unknown. We sought to assess the correlation of maximum and minimum SVC diameter and SVC collapsibility index measurements obtained intraoperatively by Transesophageal Echocardiography (TEE) with those of simultaneously recorded CVP measurements obtained through a right atrial port of a pulmonary artery catheter. The secondary aim of the study was to assess the correlation between SVC measurements and simultaneously obtained thermodilution cardiac index measurements. MethodsSingle center prospective observational trial of patients with end stage liver disease undergoing liver transplantation in an academic tertiary care center. ResultsThe minimum SVC exhibited a mild significant correlation with CVP as did the maximum SVC. The correlation between the SVC collapsibility index and CVP was not significantly different from zero. In our secondary analysis, the correlation between minimum SVC diameter and cardiac index was determined to be weak but non-zero as was the correlation between the maximum SVC diameter and cardiac index. The correlation between SVC collapsibility index and cardiac index was not different from zero. ConclusionWhile statistically significant, the weak clinical correlation of intraoperative SVC measurements obtained by TEE make them unsuitable as a replacement for central venous pressure or thermodilution cardiac index measurements in liver transplant recipients.

Acute local and non-local morphological, sensory and fluid responses to stretching and foam rolling in young females

BackgroundThis study aimed to compare and examine the local and non-local effects of a foam rolling (FR) and static stretching (SS) intervention applied to the plantar flexor (PF). MethodsFourteen female participants were investigated. Each participant underwent three conditions in a random order at least 48h apart and at the same time of the day: Control (CC), SS, and FR. Each condition was performed unilaterally in the dominant PF for 4 sets (apart from CC). SS was performed for 30 s. The FR included 30 rolls (15 in each direction) over a period of 30 s. A rest of 30 s was provided between each set for all conditions. Outcome variables were ankle dorsiflexion range of movement (ROM), tissue hardness, localized bioimpedance analysis at 50 kHz (L-BIA), and pain pressure thresholds (PPT). Tissue hardness, L-BIA, and PPT were measured in the lower leg and thigh. Measures were assessed pre (T0), immediately post (T1), and 10-min after (T2) the intervention. ResultsNo differences were found for time for the CC or between the T0 of each condition. Concerning the lower leg, ROM improved for SS and FR from T0 to T1 while returning to baseline in T2. A significant increase in PPT was observed only for SS in T1. L-BIA showed a significant increase for both phase angle and impedance only for FR in T1. Tissue hardness did not change for any group at any time-point. Concerning the thigh, no measure at any time point showed significant differences. ConclusionBoth, FR and SS were able to acutely improve ankle ROM. The observed changes were probably caused by a change in viscoelastic properties and local pain perception, without any variation in tissue morphology. FR was the only intervention to improve the intracellular-to-extracellular ratio and decrease fluids. Non-local effects were not observed.

Copeptin and Body Fluid Responses to the Combined Use of an SGLT2 Inhibitor and Conventional Diuretics in Patients with CKD: The DAPA-BODY Trial

Copeptin and Body Fluid Responses to the Combined Use of an SGLT2 Inhibitor and Conventional Diuretics in Patients with CKD: The DAPA-BODY Trial

A Mini-Fluid Challenge to Predict Fluid Responsiveness in Swine

Unnecessary and excessive fluid therapy increases the risk of adverse effects such as pulmonary edema. To prevent this, a mini-fluid challenge (MFC) has been utilized to predict whether fluid therapy will improve circulatory dynamics in human intensive care medicine. The study described here investigated whether MFC is also efficacious in pigs. Thirty-two domestic pigs anesthetized and maintained under mechanical ventilation were treated with successive IV fluid administrations of 2, 1, 1, and 2 mL/kg over a 10-min period for a total dose of 6 mL/kg of Ringer lactate. The percentage increase in mean arterial pressure (MAP) at 2, 3, and 4 mL/kg of cumulative fluid administration was examined to determine whether responders could be identified that would benefit hemodynamically from higher doses of fluids. For the purposes of this study, a 10% increase or more in MAP after 6 mL/kg of fluid administration defined responders, and an increase of less than 10% in MAP was used to define nonresponders. The percentage increase in MAP at 2, 3, and 4 mL/kg fluid administration was evaluated to determine whether this could predict responder status. Eleven of the 32 animals were determined to be responders. Responder status was predicted with high accuracy by the administration of 3 mL/kg (AUC = 0.98) and was moderately predicted with administration of 2 mL/kg (AUC = 0.80), as well as pulse pressure variation (AUC = 0.75). Thus, MFC may be helpful to maintain tissue perfusion in pigs through the use of managed fluid therapy.

Thermal modeling and analysis of multi-mover motors considering mover quantity and dynamic states

—Multi-mover motors are widely used in logistics transportation systems. However, the unique number of movers and variations in motion states complicate the distribution of loss and thermal characteristics, thereby increasing the difficulty of calculating temperature rise. In this paper, a winding loss calculation method that considers the multi-condition and dynamic characteristics of multi-mover motors is proposed. The convective heat transfer coefficient (CHTC) is calculated using computational fluid dynamics (CFD) and response surface methodology (RSM), with a detailed analysis of velocity distribution characteristics. The interactive effects of mover speed, acceleration, mover quantity, and the distance between adjacent movers on the CHTC are investigated. A simplified yet accurate thermal modeling is developed, reducing the required time for a single operating condition from 4 h to 0.5 h, with an error of only 4 %. Through both single variable and multivariable analyses, the thermal characteristics of multi-mover motors under different conditions are revealed. Finally, a prototype is created and tested under various operating conditions. The discrepancies between the experimental and calculated values are within 5 %, validating the accuracy of the proposed model and analysis.

Fluid management of acute kidney injury

Purpose of review Acute kidney injury (AKI) is commonly encountered in critical care medicine as is intravenous fluid therapy. It is accepted that there is interplay between fluid use and AKI, both potentially positive and negative. An understanding of the physiological rationale for fluid is important to help clinicians when considering fluid therapy in patients with, or at risk for AKI; this includes understanding choice of fluid, method of monitoring, administration and clinical sequelae. Recent findings There is increasing interest in combining both static and dynamic measures to assess fluid balance, fluid responsiveness effects of fluid therapy, which are areas requiring ongoing study to translate this theory into clinically useful practice at the bedside. Whilst the debate of choice of crystalloid in ICU practice continues, further evidence for benefits for balanced solutions emerges in the form of international guidelines and patient data meta-analysis of previously performed trials. Summary This review assesses the physiological rationale for fluid use in ICU cohorts with AKI of various types, as well as a systematic approach for choice of fluid therapy using a number of different variables, which aims to help guide clinicians in managing fluid use and fluid balance in critically ill patients with AKI.

Agreement between manual and automatic ultrasound measurement of the velocity-time integral in the left ventricular outflow tract in intensive care patients: evaluation of the AUTO-VTI® tool.

Transthoracic echocardiography is widely used in intensive care unit (ICU) to manage patients with acute circulatory failure. Recently, automated ultrasound (US) measurement applications have been developed but their clinical performance has not been evaluated yet. The aim of this study was to assess the agreement between automated and manual measurements of the velocity-time integral in the left ventricular outflow tract (VTI-LVOT) using the auto-VTI® tool. This prospective, single-center, interventional study included ICU patients with acute circulatory failure. The examination involved two successive manual measurements of VTI-LVOT (mean of 3 consecutive heartbeats in regular sinus rhythm, and 5 heartbeats in irregular rhythm), followed by a measurement using auto-VTI® software. In patients receiving a fluid challenge, trending ability in detecting fluid responsiveness was also evaluated. Seventy patients were included between January 19, 2020, and September 24, 2020, at the Nîmes University Hospital. The feasibility of the auto-VTI® was 94%. The mean difference between the two methods was 11% with limits of agreement from - 19% to 42%. The proportion of agreement at the 15% difference threshold was 68% [58%; 80%]. The precision and least significant change measured for the manual measurement of VTI were 7.4 and 10.5%, respectively, and by inference for the automated method 28% and 40%. The new auto-VTI® tool, despite interesting feasibility, demonstrated an insufficient agreement with a systematic bias and an insufficient precision limiting its implementation in critically ill patients.Clinical trial registration: ClinicalTrials.gov identifier: NCT04360304.

New training simulator for lumbar puncture base on magnetorheological

In response to the difficulties in accurately reproducing the resistance drop generated by puncturing key tissue layers with a needle and the poor experience in existing simulators, based on the continuous controllability and rapid response of magnetorheological fluid under the influence of a magnetic field, this paper proposes a lumbar puncture training simulator(LPTS) that can accurately simulate the puncture feedback force within tissues such as the skin, subcutaneous fat, and supraspinous ligament throughout the entire process. By using a dual rod structure and reasonably arranging the damping channel gap, the influence of mechanical friction and zero-field damping force on the feedback force during tissue progression is minimized. This paper introduces the acquisition and modeling analysis of raw data, and based on this, the design, simulation, and mechanical testing of the simulator are carried out. Finally, a performance testing platform for the simulator is established to evaluate its tracking performance of the expected puncture strength and the reproducibility of the puncture sensation. The results show that the experimental puncture strength deviates from the expected puncture strength by 0.35 N to 0.61 N in the crucial steps of breaking through the supraspinous ligament, interspinous ligament, ligamentum flavum, and dura mater, with a relative error below 10 %.

Fluid responsiveness in acute respiratory distress syndrome patients: a post hoc analysis of the HEMOPRED study.

Optimal fluid management in patients with acute respiratory distress syndrome (ARDS) is challenging due to risks associated with both circulatory failure and fluid overload. The performance of dynamic indices to predict fluid responsiveness (FR) in ARDS patients is uncertain. This post hoc analysis of the HEMOPRED study compared the performance of dynamic indices in mechanically ventilated patients with shock, with and without ARDS, to predict FR, defined as an increase in aortic velocity time integral (VTI) > 10% after passive leg raising (PLR). Among 540 patients, 117 (22%) had ARDS and were ventilated with a median tidal volume of 7.6 mL/kg [6.9-8.4] and a median positive end-expiratory pressure of 7 cmH2O [5-9]. FR was observed in 45 ARDS patients (39% vs 44% in non-ARDS patients, p = 0.384). Reliability of dynamic indices to predict FR remained consistent in ARDS patients, though with different thresholds. Collapsibility index of the superior vena cava (ΔSVC) showed the best predictive performance in both ARDS (area under the curve [AUC] = 0.763 [0.659-0.868]) and non-ARDS (AUC = 0.750 [0.698-0.802]) patients. A right to left ventricle end-diastolic area ratio > 0.8 or paradoxical septal motion were strongly linked to the absence of FR (> 80% specificity). FR was not associated with intensive care unit (ICU) mortality (47% vs. 46%, p = 1). However, hypovolemia, defined as an aortic VTI increase > 32% during PLR (median increase in patients with a partial SVC collapse) was independently associated with ICU mortality (odds ratio [OR] = 1.355 [1.077-1.705], p = 0.011), as well as pulse pressure variation (OR = 1.014 [1.001-1.026], p = 0.034). Performance of dynamic indices to predict FR appears preserved in ARDS patients, albeit with distinct thresholds. Hypovolemia, indicated by a > 32% increase in aortic VTI during PLR, rather than FR, was associated with ICU mortality in this population.

Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit.

Shock is a life-threatening condition that requires prompt recognition and treatment to prevent organ failure. In the intensive care unit, shock is a common presentation, and its management is challenging. Critical care ultrasound has emerged as a reliable and reproducible tool in diagnosing and classifying shock. This comprehensive review proposes an ultrasound-based protocol for the hemodynamic assessment of shock to guide its management in the ICU. The protocol classifies shock as either low or high cardiac index and differentiates obstructive, hypovolemic, cardiogenic, and distributive etiologies. In distributive shock, the protocol proposes a hemodynamic-based approach that considers the presence of dynamic obstruction, fluid responsiveness, fluid tolerance, and ventriculo-arterial coupling. The protocol gives value to quantitative measures based on critical care ultrasound to guide hemodynamic management. Using critical care ultrasound for a comprehensive hemodynamic assessment can help clinicians diagnose the etiology of shock and define the appropriate treatment while monitoring the response. The protocol's use in the ICU can facilitate prompt recognition, diagnosis, and management of shock, ultimately improving patient outcomes.

Assessment of fluid responsiveness after tidal volume challenge in renal transplant recipients: a nonrandomized prospective interventional study.

When applying lung-protective ventilation, fluid responsiveness cannot be predicted by pulse pressure variation (PPV) or stroke volume variation (SVV). Functional hemodynamic testing may help address this limitation. This study examined whether changes in dynamic indices such as PPV and SVV, induced by tidal volume challenge (TVC), can reliably predict fluid responsiveness in patients undergoing renal transplantation who receive lung-protective ventilation. This nonrandomized interventional study included renal transplant recipients with end-stage renal disease. Patients received ventilation with a 6 mL/kg tidal volume (TV), and the FloTrac system was attached for continuous hemodynamic monitoring. Participants were classified as responders or nonresponders based on whether fluid challenge increased the stroke volume index by more than 10%. The analysis included 36 patients, of whom 19 (52.8%) were responders and 17 (47.2%) were nonresponders. Among responders, the mean ΔPPV6-8 (calculated as PPV at a TV of 8 mL/kg predicted body weight [PBW] minus that at 6 mL/kg PBW) was 3.32±0.75 and ΔSVV6-8 was 2.58±0.77, compared to 0.82±0.53 and 0.70±0.92 for nonresponders, respectively. ΔPPV6-8 exhibited an area under the curve (AUC) of 0.97 (95% confidence interval [CI], 0.93-1.00; P≤0.001), with an optimal cutoff value of 1.5, sensitivity of 94.7%, and specificity of 94.1%. ΔSVV6-8 displayed an AUC of 0.93 (95% CI, 0.84-1.00; P≤0.001) at the same cutoff value of 1.5, with a sensitivity of 94.7% and a specificity of 76.5%. TVC-induced changes in PPV and SVV are predictive of fluid responsiveness in renal transplant recipients who receive intraoperative lung-protective ventilation.

QSOX1 exerts anti-inflammatory effects in sepsis-induced acute lung injury: Regulation involving EGFR phosphorylation mediated M1 polarization of macrophages

Sepsis is a systemic inflammatory response caused by an infection, which can easily lead to acute lung injury. Quiescin Q6 sulfhydryl oxidase 1 (QSOX1) is a sulfhydryl oxidase involved in oxidative stress and the inflammatory response. However, there are few reports on the role of QSOX1 in sepsis-induced acute lung injury (SALI). In this study, mice model of SALI was constructed by intraperitoneal injection with lipopolysaccharide (LPS). The increased inflammatory response and lactate dehydrogenase activity in bronchoalveolar lavage fluid (BALF) indicated successful modeling. Increased QSOX1 expression was both observed in lung tissues and lung macrophages of sepsis mice accompanied by increased polarization of M1-type macrophages. To explore the role of QSOX1 in the SALI, lentivirus containing QSOX1-specific overexpression or knockdown vectors were used to change QSOX1 expression in LPS-treated RAW264.7 cells. QSOX1 suppressed LPS-induced M1 polarization and further inhibited inflammatory response in RAW264.7 cells. Interestingly, the phosphorylation of epidermal growth factor receptor (EGFR), the promoter of M1 polarization in macrophages, was found to be downregulated upon QSOX1 overexpression in RAW264.7 cells. Mechanically, the binding of QSOX1 to EGFR protein promoted EGFR ubiquitination and degradation, thereby down-regulating EGFR phosphorylation. Moreover, inhibiting EGFR expression or its phosphorylation restored the impact of QSOX1 silencing on M1 polarization and inflammation in the LPS-treated RAW264.7 cells. In summary, QSOX1 may exert anti-inflammatory effects in SALI by inhibiting EGFR phosphorylation-mediated M1 macrophage polarization. This presented a potential target for the treatment and prevention of SALI.

The role of point-of-care ultrasound to assess fluid responsiveness and fluid tolerance in the intensive care unit

Fluid accumulation is epidemiologically associated with adverse outcomes in various clinical contexts. Assessing fluid responsiveness identifies conditions where intravenous fluids can increase cardiac output, improve organ blood supply during hypoperfusion and prevent the administration of ineffective fluids with deleterious effects. Point-of-care ultrasound (POCUS) enables fluid administration guided by fluid responsiveness, serving as one of the few non-invasive technological aids widely accessible both within and outside the intensive care unit. In this review, we focus on how POCUS can complement the evaluation of fluid responsiveness and fluid tolerance. The topics include a review of POCUS techniques to estimate the change in cardiac output following preload modifying manoeuvers, evaluation of thoracic fluid tolerance through lung ultrasound, and evaluation of systemic fluid tolerance through venous Doppler and the venous excess ultrasound (VExUS) assessment.

Intraoperative goal-directed hemodynamic therapy through fluid administration to optimize the stroke volume: A meta-analysis of randomized controlled trials

ObjectiveTo evaluate the clinical impact of optimizing stroke volume (SV) through fluid administration as part of goal-directed hemodynamic therapy (GDHT) in adult patients undergoing elective major abdominal surgery. MethodsThis systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered in the PROSPERO database in January 2024. The intervention was defined as intraoperative GDHT based on the optimization or maximization of SV through fluid challenges, or by using dynamic indices of fluid responsiveness, including stroke volume variation, pulse pressure variation, and plethysmography variation index compared to usual fluid management. The primary outcome was postoperative complications. Secondary outcome variables included postoperative acute kidney injury (AKI), length of stay (LOS), intraoperative fluid administration, and 30-day mortality. ResultsA total of 29 randomized controlled trials (RCTs) met the inclusion criteria. There were no significant differences in the incidence of postoperative complications (RR 0.89; 95% CI, 0.78–1.00), postoperative AKI (OR 0.97; (95% IC, 0.55–1.70), and mortality (OR 0.80; 95% CI, 0.50–1.29). GDHT was associated with a reduced LOS compared to usual care (SMD: −0.17 [−0.32; −0.03]). The subgroup in which hydroxyethyl starch was used for hemodynamic optimization was associated with fewer complications (RR 0.79; 95% CI, 0.65–0.94), whereas the subgroup of patients in whom crystalloids were used was associated with an increased risk of postoperative complications (RR 1.08; 95% CI, 1.04–1.12). ConclusionsIn adults undergoing major surgery, goal-directed hemodynamic therapy focused on fluid-based stroke volume optimization did not reduce postoperative morbidity and mortality.