Total Amount Of Fluid Research Articles

Excessive intravenous fluid therapy in head and neck cancer surgery

The purpose of this retrospective study was to present our assessment of modifiable perioperative factors for major cardiac and cerebrovascular events (MACCE). This study included an unselected cohort of patients with head and neck cancer (n = 456) treated in Turku University Hospital between 1999 and 2008. Perioperative and postoperative univariate predictors of MACCE at 30-day follow-up were: total amount of fluids (during 24 hours) over 4000 mL, any red blood cell (RBC) infusion, treatment in the intensive care unit (ICU), tracheostomy, and microvascular reconstruction surgery. Median time from operation to MACCE was 3 days. Patients receiving >4000 mL of fluids had MACCE more often compared with those receiving <4000 mL (10.8% vs 2.4%; p < .001, respectively). Moreover, every RBC unit transfused or every liter of fluid administered over 4000 mL/24h increased the risk of MACCE 18% per unit/liter, respectively. Patients with head and neck cancer receiving excessive intravenous fluid administration perioperatively and postoperatively are at high risk for cardiac complications, especially heart failure. © 2016 Wiley Periodicals, Inc. Head Neck 39: 37-41, 2017.

A Prospective Randomized Study Comparing Manual and Wall Suction in the Performance of Bronchoalveolar Lavage

Background: Bronchoalveolar lavage (BAL) may be performed using a hand-held syringe or wall suction. Objectives: The aim was to study BAL volume and diagnostic yields based on BAL technique. Methods: A total of 220 consecutive patients undergoing BAL at our center were included. Manual aspiration was performed in 115 patients (group 1), and wall suction (<50 mm Hg of negative pressure) was used in 105 patients (group 2). All bronchoscopies were performed under conscious sedation applying topical anesthesia with lidocaine. Three 50-ml sterile saline aliquots were instilled in all patients. Results: The mean total amount of fluid recovered was 67 ± 20 ml in group 1 and 55 ± 22 ml in group 2 (p < 0.001). More patients in the manual aspiration group met American Thoracic Society criteria (recovery of ≥30% of instilled fluid) for an optimal BAL (81 vs. 59%; p < 0.001). The quantity of recovered fluid was also related to BAL location (p < 0.001) and radiologic findings (p = 0.002). Forty-eight (22%) BALs were diagnostic (23 in group 1 and 25 in group 2), including 37 positive bacterial cultures, 6 positive stains for Pneumocystis, and 5 cases of malignancy. No statistically significant difference in diagnostic yield was observed between the two groups. A BAL diagnosis was more likely in patients with certain radiologic (p = 0.033) and endoscopic findings (p = 0.001). When taking into account all bronchoscopic techniques performed during the procedure (e.g. biopsies, brushing, etc.), bronchoscopy was diagnostic in 37% of patients. Conclusions: Manual aspiration is superior to wall suction during BAL yielding a larger quantity of aspirate. Diagnostic yields are similar for both techniques.

The electrical resistance of the lungs, intercostal muscles, and kidneys in hypertensive ISIAH rats

A comparative study of the bioelectrical impedance of normotensive and hypertensive animal tissues was carried out. It was found that the electrical resistance of kidneys, lungs, and intercostal muscles in rats with arterial hypertension (ISIAH strain) was significantly lower than in normotensive Wistar rats, which indicates that the volume of circulating blood and the total amount of fluid were increased in animals with arterial hypertension. The fact that the resistance of the conducting medium is decreased in arterial hypertension should be taken into account in the analysis of cardioelectric potentials on the body surface and electrocardiograms in conventional leads, as well as for the purposes of the development of heterogeneous torso models and for verification of recovery algorithms for electrical properties of chest tissues.

New Formula (22/17) for Calculation of the Total Amount of Intravenous Fluids Given for Pediatric &amp; Neonatal Surgical Operations Weighing up to 20 Kg or 5 Years Age

Introduction: A new formula(RH) for calculation of intra operative fluids given in neonatal & pediatric life threatening surgical operations from 1 kg – 2o kg body weight (or 1 day – 5 yrs age) was explained in this study. Aim of the Study : To find a simple , correct, & easily applicable formula to avoid any unwanted dangerous faults in calculation of fluid requirements in all types of neonatal& pediatric surgical operations from 1 kg – 20 kg body weight (or 1 day – 5 years age) especially for juniors or early post graduated doctors dealing with these age group (or weights). Patients: (5000 Patients) including neonates, infants & pediatric age group presented to CWTH/Medical city/Baghdad for different types of surgical operations were enrolled in this study divided to 3 groups (Group A) Life threatening and emergency conditions 2300 patients, (Group B) Major& super major elective operations 700 patients & (Group C) Different types of minor to moderate elective surgical operations 2000 patients. Methods: In this new formula intra operative fluid requirements calculated as: a) *Pre existing deficit (Fasting): 20 ml/kg this amount is divided over 3 hours: ½ the amount given in the 1st hour of operation and ¼ the amount is given for each the 2nd& 3rd hours of operations. b) *Maintenance fluid requirements: 4 ml/kg/hr for all weights up to 20 kg. c) *3rd Space replacement: 8 ml/kg/hr for major& super major operations & 4 ml/kg/hr for minor operations. Results: By comparison of this new formula with most of other references and other anesthesia text books fluid formulas regarding this aspect the results is that the difference in the total amounts of fluid requirements per hour was minute and regarded as negligible difference. Conclusion: *This new(RH) formula has been used for years(2005-2015) in neonatal & pediatric anesthetic department in CWTH/ Baghdad Medical City for 5000 neonates, infants & pediatric patients without any complications. a. This new formula is correct, safer, simpler & easily applicable than other formulas. b. The most important point in this new formula, is that it can be summarized by just 2 numbers (22- 17), 22ml/kg for the 1st hr. & 17 ml for the 2nd& 3rd hrs of operation time for major operation.

Analysis of risk factor of hyperlactacidemia after gastrointestinal surgery: a clinical data analysis of 216 patients

To investigate the risk factors that cause arterial blood lactate (Lac) elevation in patients after gastrointestinal operation. The data of 216 patients who had undergone gastrointestinal operation, and transferred to intensive care unit (ICU) of Ningxia Medical University General Hospital from November 2013 to November 2014 were retrospectively analyzed. According to the initial level of blood Lac after operation, the patients were divided into two groups: high Lac group (Lac > 2 mmol/L, n = 100) and normal Lac group (Lac ≤ 2 mmol/L, n = 116). The baseline data of two groups were recorded as follows: (1) baseline data: gender, age, preoperative acute physiology and chronic health evaluation II (APACHE II ) score, previous diseases, initial Lac level after operation; (2) preoperative risk factors: 24-hour total amount of fluid, and the amount of colloid for resuscitation; (3) intraoperative risk factors: the proportion of emergency operation, operation time, site of operation, usage of antibacterial drug, the highest and lowest mean arterial pressure and its difference (MAPmax, MAPmin, A MAP), total amount of fluid and colloid for resuscitation. The risk factors of increasing Lac post gastrointestinal operation was evaluated using multiple linear regression analysis. (1) There were no significant differences in baseline data such as gender, age, preoperative APACHE II score and previous diseases between the two groups (all P > 0.05). Initial Lac-level in high Lac group was significantly higher than that of normal Lac group (mmol/L: 5.1 ± 3.6 vs. 1.3 ± 0.4, t = 10.584, P = 0.000). (2) There were no significant differences in 24-hour amount of fluid and colloid for resuscitation before operation, and intraoperative MAPmax between two groups. Compared with normal Lac group, intraoperative A MAP [ mmHg (1 mmHg = 0.133 kPa): 35.8 ± 14.4 vs. 28.7 ± 13.7, t = 3.727, P = 0.000], the proportion of emergency operations (19.0% vs. 9.5%, χ² = 9.869, P = 0.007), intraoperative transfusion volume [mL: 4 500 (3 500, 5 800) vs. 3,700 (2,812, 5,075), Z = -3.244, P = 0.001], intraoperative colloid volume [mL: 1,000 (1,000, 1,900) vs. 1,000 (1,000, 1,787 ), Z = -2.347, P = 0.019], and operation time (minutes: 222.0 ± 91.5 vs. 187.0 ± 75.9, t = 3.026, P = 0.003) in high Lac group were significantly increased, and the levels of intraoperative MAPmin (mmHg: 68.7 ± 11.6 vs. 75.9 ± 10.6, t = -4.716, P = 0.000) and intraoperative antibiotics usage (62.0% vs. 86.2%, χ² = 18.318, P = 0.000) were significantly decreased. (3) The patients undergoing operation of esophagus, stomach, duodenal and intestine, and colon accounted for 6.9%, 22.7%, 16.7%, and 53.7%, respectively, their Lac was 2.8 (1.6, 5.4), 2.3 (1.2, 5.8), 2.5 (1.5, 5.2), 1.7 (1.1, 2.9) mmol/L, respectively, indicating that surgical site had an influence on the occurrence of postoperative hyperlactacidemia (χ² = 11.032, P = 0.012). (4) It was showed by multiple linear regression analysis that the operation site (t = -2.725, P = 0.007), MAPmin (t = -4.533, P = 0.000), non-antibiotics usage during operation (t = 2.441, P = 0.016) were the risk factors of Lac increase in patients after gastrointestinal operation. (5) The incidence of postoperative incipient procalcitonin (PCT) increase (PCT > 0.5 g/L) in patients and usage of antibiotics was significantly lower than that in patients who did not receive antibiotics during operation [17.89% (17/95) vs. 67.74% (21/31), χ² = 27.572, P = 0.000]. The surgical site showed an influence on the occurrence of hyperlactacidemia in patients after gastrointestinal operation, and the lowest occurrence rate was found in the colonic operation. In patients suffering from gastrointestinal operation, antibiotics should be routinely used to improve MAP. Excessive preoperative and intraoperative fluid infusion cannot reduce the occurrence of hyperlactacidemia.

Centhaquin improves survival in a swine model of hemorrhagic shock

BackgroundHemorrhage is a frequent event in hospital and prehospital settings. The aim of the present study was to investigate whether centhaquin improves 24-h survival and reduces the total volume of required fluids in an established model of swine hemorrhagic shock. Material and methodsTwenty-five pigs were instrumented and subjected to hemorrhagic shock. The animals were randomly allocated in two experimental groups, the control (vehicle) (n = 10) and the centhaquin groups (0.015 mg/kg, n = 10); all animals received lactated Ringer solution in the resuscitation phase until their mean arterial pressure reached 90% of the baseline. A sham group (n = 5) was added a posteriori to mimic the hemodynamic profile of the centhaquin group. ResultsA statistically significant difference was observed in the time required for the three groups to reach their target mean aortic pressure, 36.88 ± 3.26 min for the control group versus 9.40 ± 1.01 min for the sham group and 7.10 ± 0.97 min for the centhaquin group (P < 0.001). The total amount of fluids in the control and the sham groups was significantly higher when compared with that of the centhaquin-treated animals (P < 0.001). All 10 animals in the centhaquin group survived for 24 h, whereas only three animals survived in the control group and one animal in the sham group (P = 0.002). ConclusionsCenthaquin 0.015 mg/kg administered in the fluid resuscitation phase resulted in lower volume of fluids and better survival compared with control and sham-operated animals.

Continuous renal replacement therapy and negative fluid balance improves renal function and prognosis of patients with acute kidney injury in sepsis

To investigate the influence of fluid balance and model of renal replacement therapy (RRT) on renal function and prognosis of patients suffering from septic acute kidney injury (AKI). A retrospective cohort analysis of 117 septic AKI patients who had undergone RRT between January 2009 and December 2014 was performed in the Second Affiliated Hospital of Nanjing Medical University. The patients were divided into positive fluid balance group (n = 52) and negative fluid balance group (n = 65) according to the total amount of fluid calculated from the difference between fluid administered and fluid lost during the first 1 week of RRT. The incidence of renal recovery and death of the patients by 60 days as the endpoint events were taken to judge the prognosis of two groups. RRT strategies included continuous renal replacement therapy (CRRT) and intermittent renal replacement therapy (IRRT). Multiple factors including estimated glomerular filtration rate (eGFR), sequential organ failure assessment (SOFA) score, RRT model, the accumulation of fluid before initiation of RRT, and negative fluid balance during RRT were analyzed for outcome predictors by Cox proportional hazards model. There were no differences between two groups regarding clinical characteristics. The percentage of receiving CRRT in the negative fluid balance group was slightly higher than that of the positive fluid balance group (52.31% vs. 36.54%, χ² = 2.899, P = 0.089). With Kaplan-Meier survival curves, it was shown that the patients of negative fluid balance group had a higher rate of recovery of renal function (χ² = 4.803, P = 0.028) and significantly lower mortality rate (χ² = 9.505, P = 0.002). The rate of recovery of renal function by 60 days was higher in the negative fluid balance group than that in the positive fluid balance group (47.69% vs. 28.85%, χ² = 3.991, P = 0.046), while the mortality rate was significantly lowered in the negative fluid balance group compared with that of the positive fluid balance group (40.00% vs. 67.31%, χ² = 4.378, P = 0.036). Cox multivariate regression was used for excluding confounding factors. After adjusting for the clinically relevant variables, RRT negative fluid balance was significantly associated with recovery of renal function [ hazard ratios (HR) = 2.440, 95% confidence intervals (95%CI) = 1.089-5.464, P = 0.030] and mortality (HR = 0.443, 95%CI = 0.238-0.822, P = 0.010]. Higher eGFR before RRT and CRRT were independent favorable factors for recovery of renal function (HR = 1.014, 95%CI = 1.003-1.026, P = 0.012; HR = 3.138, 95%CI = 1.765-7.461, P = 0.002), and higher SOFA score was associated with a significantly higher risk of death (HR = 1.115, 95%CI = 1.057-1.177, P < 0.001). Once the patients with septic AKI showed the signs of fluid overload, timely RRT and effective removal of excessive liquid may reverse the adverse prognosis. RRT with negative fluid balance is beneficial for the recovery of renal function, and reduce the mortality in patients with septic AKI, and CRRT model is a good choice.

Risk factors for development of intraoperative hypothermia in patients undergoing thoracic surgery

Objective To identify the risk factors for the development of intraoperative hypothermia in the patients undergoing thoracic surgery. Methods One hundred twenty patients of both sexes, aged 23-83 yr, weighing 43-92 kg, of ASA physical statusⅠorⅡ, scheduled for elective thoracic surgery, who had an expected surgical duration of more than 2 h, with the core body temperature of 36.0-37.5 ℃, were included.After admission to the operating room, the core body temperature was measured.Intraoperative nasopharyngeal temperature of lower than 36 ℃ was defined as hypothermia.The patients were randomly divided into hypothermia group or non-hypothermia group according to whether or not intraoperative hypothermia occurred.Factors including the patient characteristics, the total amount of fluid infused(including the volume of blood transfused), duration and way of anesthesia and duration and type of surgery were recorded.The risk factors associated with intraoperative hypothermia were identified by logistic regression analysis. Results A total of 94 patients developed hypothermia during surgery, and the incidence of hypothermia was 78.3%.The lowest body temperature was 33.6 ℃.There was significant difference between the two groups in age, duration of surgery, the total amount of fluid infused, and the body temperature when patients were admitted to the operating room.Logistic regression analysis revealed that the total amount of fluid infused>2 000 ml(OR=3.499)and low body temperature when patients were admitted to the operating room(OR=0.074)were independent risk factors for intraoperative hypothermia in the patients undergoing thoracic surgery. Conclusion The total amount of intravenous fluid infused>2 000 ml and low body temperature when patients were admitted to the operating room are independent risk factors in the patients undergoing thoracic surgery. Key words: Hypothermia; Risk factors; Thoracic surgical procedures; Intraoperative complications

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.

Effect of the amount of intraoperative fluid administration on postoperative pulmonary complications following anatomic lung resections

Excessive fluid administration during lung resections is a risk for pulmonary injury. We analyzed the effect of intraoperative fluids on postoperative pulmonary complications (PCs). Patients who underwent anatomic pulmonary resections during 2012 to 2013 were included. Age, weight, pulmonary function data, smoking (pack-years), the infusion rate and the total amount of intraoperative fluids (including crystalloid, colloid, and blood products), duration of anesthesia, hospital stay, PCs, and mortality were recorded. PCs were defined as acute respiratory distress syndrome, need for intubation, bronchoscopy, atelectasis, pneumonia, prolonged air leak, and failure to expand. Univariate analyses and multivariate logistic regression were performed. A Lowess curve was drawn for intraoperative fluid threshold. In 139 patients, types of resections were segmentectomy-lobectomy (n=69; extended n=37; video-assisted thoracoscopic surgery n=19) and pneumonectomy (n=9; extended n=5). One hundred sixty-one PCs were observed in 76 patients (acute respiratory distress syndrome [n=5], need for intubation [n=9], atelectasis [n=60], need for bronchoscopy [n=19], pneumonia [n=26], prolonged air leak [n=19], and failure to expand [n=23]). Overall mortality was 4.3% (6 out of 139 patients). Mean hospital stay was 8.5 ± 4.8days. Univariate analyses showed that smoking, intraoperative total amount of fluids, crystalloids, blood products, and infusion rate as well as total amount of crystalloids and infusion rate during the postoperative first 48hours were significant for PCs (P=.033, P<.0001, P=.001, P=.03, P<.0001, P=.002, and P<.0001, respectively). In multivariate logistic regression analysis intraoperative infusion rate (P<.0001) and smoking were significant (P=.023). An infusion rate of 6 mL/kg/h was found to be the threshold. The occurrence of postoperative PCs is seen more frequently if the intraoperative infusion rate of fluids exceeds 6 mL/kg/h.

A comprehensive study of clinical biomarkers, use of inotropic medications and fluid resuscitation in newborns with persistent pulmonary hypertension.

Persistent pulmonary hypertension of the newborn (PPHN) is associated with high morbidity and mortality. This study evaluated clinical outcomes in PPHN in relation to echocardiographic (EC) markers, score of neonatal acute physiology, perinatal extension, version II (SNAPPE II) scores, inotropic agent use, and the amount of fluid received as boluses. In this retrospective chart analysis of 98 neonates with PPHN born at >34 weeks' gestation, we compared two cohorts of newborns: those who received inhaled nitric oxide and mechanical ventilation only, and who survived to discharge (Group 1); and those who required extracorporeal membrane oxygenation (ECMO) or who died (Group 2). Of 21 EC parameters assessed, seven were significantly different between Group 1 and Group 2. Eleven (24.4%) newborns in Group 2 had decreased left ventricular (LV) function, compared with three (5.1%) in Group 1 (p = 0.011). Median SNAPPE II scores were significantly higher in Group 2 than in Group 1 (p < 0.001). Newborns in Group 2 also received a significantly higher amount of fluid as boluses during the first 7 days of hospitalization compared with Group 1 (p = 0.018). Following logistic regression analysis, only the difference in total SNAPPE II score retained statistical significance (p < 0.001); however, the total amount of fluid administered as boluses trended higher (p = 0.087) for newborns in Group 2. Our findings show that SNAPPE II scores may help guide counseling for parents of newborns with PPHN regarding the likelihood of death or the need for ECMO. Limiting fluid boluses may improve outcomes in newborns with high SNAPPE II scores and decreased LV function.

A randomized, controlled trial of oral versus intravenous fluids for lowering blood glucose in emergency department patients with hyperglycemia

Blood glucose can be lowered via insulin and/or fluid administration. Insulin, although efficacious, can cause hypoglycemia and hypokalemia. Fluids do not cause hypoglycemia or hypokalemia, but the most effective route of fluid administration has not been well described. This study compared the efficacy and safety of oral versus intravenous fluids for reducing blood glucose in patients with hyperglycemia. We conducted a prospective, nonblinded, randomized, controlled trial. Inclusion criteria were blood glucose > 13.9 mmol/L, age > 18 years, and ability to tolerate oral fluids. Subjects were excluded for critical illness, contraindication to fluids, and/or hyperglycemia therapy prior to enrolment. Subjects were randomized to receive oral bottled water or intravenous normal saline (maximum 2 L) over 2 hours. The primary outcome of interest was a change in blood glucose at 2 hours across treatment arms. The 48 subjects were randomized. Baseline blood glucose levels and total amount of fluid received were similar between the two groups. The mean decrease in blood glucose at 2 hours was similar for both treatment arms: a mean decrease of 3.4 mmol/L (20.2 mmol/L to 16.8 mmol/L) in the oral fluid group versus a mean decrease of 4.0 mmol/L (19.7 mmol/L to 15.7 mmol/L) in the intravenous fluid group. The mean difference between groups was -0.6 mmol/L (95% confidence interval -2.3-1.2; p = 0.51). No adverse events were observed in either group. In this unblinded randomized trial, oral and intravenous fluids were equally efficacious in lowering blood glucose levels in stable hyperglycemic patients and no adverse events were noted. Physicians should be mindful that, although similar, the reduction in blood glucose was modest in both groups.

Na+-K+-2Cl−cotransporter-mediated fluid secretion increases under hypotonic osmolarity in the mouse submandibular salivary gland

Water-handling epithelia are sensitive to the osmotic environment. In this study, the effects of a hypo-osmotic challenge on carbachol (CCh)-induced fluid secretion was investigated using an ex vivo submandibular gland perfusion technique and intracellular pH and Ca(2+) measurements. The osmolality of the perfusion solution was altered to examine the response of the gland to a hypotonic challenge. The flow rate was increased by 34% with a 30% hypotonic solution (225 mosmol/kgH2O), although the Ca(2+) response was unchanged. The lowering of the external Cl(-) by 50% abolished this increase in the 30% hypotonic solution. Furthermore, bumetanide, an inhibitor of the Na(+)-K(+)-2Cl(-) cotransporter (NKCC1), completely inhibited the fluid secretion increase caused by the 30% hypotonic solution, and both the total amount of fluid and the flow rate were identical to those of the isotonic solution. This finding was confirmed by measuring the NKCC1 bumetanide-dependent NH4 (+) transport; Na(+)-K(+)-2Cl(-) transport was upregulated >40% by a 30% hypotonic challenge. Therefore, the increase in CCh-induced fluid secretion in response to hypotonic conditions can be attributed, to a large extent, to the specific activation of the NKCC1.

A spectral theory approach for extreme value analysis in a tandem of fluid queues

We consider a model to evaluate performance of streaming media over an unreliable network. Our model consists of a tandem of two fluid queues. The first fluid queue is a Markov modulated fluid queue that models the network congestion, and the second queue represents the play-out buffer. For this model the distribution of the total amount of fluid in the congestion and play-out buffer corresponds to the distribution of the maximum attained level of the first buffer. We show that, under proper scaling and when we let time go to infinity, the distribution of the total amount of fluid converges to a Gumbel extreme value distribution. From this result, we derive a simple closed-form expression for the initial play-out buffer level that provides a probabilistic guarantee for undisturbed play-out.

Early Factors Associated With Fluid Sequestration and Outcomes of Patients With Acute Pancreatitis

Predicting level of fluid sequestration could help identify patients with acute pancreatitis (AP) who need more or less aggressive fluid resuscitation. We investigated factors associated with level of fluid sequestration in the first 48 hours after hospital admission in patients with AP and effects on outcome. We analyzed data from consecutive adult patients with AP admitted to the Brigham and Women's Hospital in Boston, Massachusetts, from June 2005 to December 2007 (n= 266) orthe Alicante University General Hospital in Spain from September 2010 to December 2012 (n= 137). Level of fluid sequestration in the first 48 hours after hospital admission was calculated by subtracting the total amount of fluid administered and lost in the first 48 hours of hospitalization. Demographic and clinical variables obtained in the emergency department were analyzed to identify factors associated with level of fluid sequestration in the first 48 hours after hospital admission. Outcome assessed included length of hospital stay, acute fluid collection(s), pancreatic necrosis, persistent organ failure, and mortality. The median level of fluid sequestration in the first 48 hours after hospital admission was 3.2 L (1.4-5 L). The simple and multiple linear regression models showed that younger age, alcohol etiology, hematocrit, glucose, and systemic inflammatory response syndrome were significantly associated with increased levels of fluid sequestration in the first 48 hours after hospital admission. Increased level of fluid sequestration in the first 48 hours was significantly associated with longer hospital stays and higher rates of acute fluid collection, pancreatic necrosis, and persistent organ failure. There was a nonsignificant trend toward a higher level of fluid sequestration in the first 48 hours among patients who died. Age, alcoholic etiology of AP, hematocrit, glucose, and presence of systemic inflammatory response syndrome in the emergency department were independent predictors of increased levels of fluid sequestration in the first 48 hours after hospital admission. These patients have higher risks of local and systemic complications and longer hospital stays.

Single-incision thoracoscopic surgery of pleural effusions for diagnosis and treatment

Several procedures such as video-assisted thoracoscopic surgery (VATS) are used to make a definite diagnosis in recurrent pleural effusions so that appropriate treatment can be arranged. Single-incision thoracoscopic surgery (SITS) is the most appropriate procedure that can be used for this purpose. The contribution of SITS to diagnosis and treatment is evaluated in this study that we conducted using a single thoracoport in patients with pleural effusion. Nineteen consecutive patients with pleural effusion that was recurrent or refractory to medical treatment were included in the study to be diagnosed and treated with SITS. Thoracentesis was performed and pleural fluid samples obtained in all patients before the procedure. Pleural effusion drainage was performed from the 11-mm single skin incision by using a 10.5-mm single thoracoport, and biopsy or talc pleurodesis was performed in the same session when needed. The median age of the patients was 56.68 ± 3.05 years and there were 11 males and 8 females. The total amount of fluid drained by SITS was 1,436 ± 227 mL and the surgery lasted 81.05 ± 5.36 min. In addition, partial decortication and/or deloculation were performed in six patients and talc pleurodesis in nine patients. Fifteen patients were diagnosed with benign and four patients with malignant pleural effusion by thoracentesis, while nine patients were diagnosed with benign and ten patients with malignant pleural effusion by SITS. We therefore had six cases diagnosed as benign with thoracentesis who were diagnosed with malignant disease after SITS. SITS presents both diagnosis and treatment options together for pleural effusions. We believe SITS should be preferred to conventional three-port VATS to minimize the spread of infection and tumor cells to the chest wall in infectious and malignant diseases.

G53 Current Practise Relating to Fluid Bolus Administration in Critically Ill Children

AimTo establish the frequency, amount and the diagnostic reasons for fluid bolus administration in children referred to a paediatric intensive care (PIC) retrieval serviceMethods Retrospective case notes review of all...

Case Scenario: Hemodynamic Management of Postoperative Acute Kidney Injury

Case Scenario: Hemodynamic Management of Postoperative Acute Kidney Injury

The Concept of Titration can be Transposed to Fluid Management. But does is Change the Volumes? Randomised Trial on Pleth Variability Index During Fast-Track Colonic Surgery

The concept of drug titration emerged recently for intraoperative fluid administration during Fast-Track colonic surgery to avoid hypovolemia as well as excessive crystalloid administration. The Pleth Variability Index (PVI) is an oximeter-derived parameter. It allows a continuous monitoring of the respiratory variation of the perfusion index. To investigate if applying the concept of fluid titration with PVI-guided colloid administration conjointly with restricted crystalloids administration changes the amount of fluid administered. DESIGN, SETTINGS AND PATIENTS: Twenty one ASA 2 patients scheduled for Fast-Track colonic surgery were randomized in two groups: the PVI-guided the fluid management group and the the control group. After the induction of general anesthesia, the PVI group received a 10 mL.kg- 1.h-1 infusion of crystalloid during the first hour, reduced to 2 mL.kg-1.h-1 thereafter. Colloids 250 mL were administered if necessary to maintain a PVI value of 10 to 13%. In the control group, a 10 mL.kg-1.h-1 infusion of crystalloid during the first hour was followed by a 5 mL.kg-1.h-1 infusion. Boluses of 250 mL of colloids were administered if required to maintain the mean arterial pressure above 65 mmHg. Intraoperative crystalloids infused volume were significantly lower in the PVI group (925+/-262 mL vs 1129+/- 160 mL; P=0.04). In contrast, the infused amounts of colloids was higher in the PVI group (725+/-521 mL vs 250+/-224 mL; P=0.01). Interestingly, total fluid amount infused intra- ant postoperatively were similar between the groups (1650+/- 807 mL vs 1379+/-186 mL; P=0.21). PVI-guided fluid management in Fast-Track colonic surgery is not necessarily associated with different total volume infused.

Sudden syncopal attack after postobstructed diuresis under combined spinal epidural anesthesia

Micturition is clinically well-known as a factor that may cause hypotension, bradycardia, and if severe, syncope. However, the mechanism of syncope during micturition is not completely understood. Vasodilatation, bradycardia, and reflex car diovascular depression are all called by various terms including vasovagal syncope, Bazold-Jarisch reflex, and neurocardiogenic syncope [1]. The neurally-mediated syncope includes true and situational syncope that can take place in various situations such as blood loss, cough, sneeze, micturition and lifting up a heavy load. A case of a 71 year-old man under combined spinal epidural anesthesia for total knee replacement, in which the operation were performed without knowing that a Foley catheter installed had been obstructed, and severe bradycardia, hypotension, and loss of consciousness occurred immediately after moving the pa tient to the recovery room following micturition were described. The patient had a history of syncope. Preoperative cardiac test was normal. At the operation room, heart rate and blood pressure were 70 /min and 170/90 mmHg. Beginning with the sufficient administration of fluid, the regional anesthesia was performed and the sensory block was verified up to the T4 der matome. A forced air warmer was used to maintain the body temperature. At the end of operation, 8 ml of 0.15% levobupivacaine was injected through the epidural catheter, and then a mixture of anesthetics was continuously injected. Intraoperative systolic blood pressure were ranged from 110 to 190 mmHg, diastolic pressure 65 to 105 mmHg, heart rate 52 to 70 /min, and estimated blood loss was approximately 500 ml. Although the total amount of fluid was approximately 1,000 ml, no urine out put was observed. Just before leaving the operation room, it was found that the tip of the Foley catheter was obstructed. When the catheter was opened, about 700 ml of urine was discharged. At that time, the vital signs were normal and consciousness clear. Finding that the sensory block level had come down to the T12 dermatome, the patient was moved to the recovery room. Immediately after arriving at the recovery room, the heart rate was drastically reduced from 70 /min to 30 /min or below, the blood pressure was 50/30 mmHg, and consciousness was lost. Promptly, 0.5 mg of atropine sulfate and 10 mg of ephedrine were administered, and the patient-controlled epidural anal gesia (PCEA) was stopped. Following the treatment, the heart rate recovered to 60 /min and the blood pressure to 110/80 mmHg, and subsequently, the consciousness of the patient was recovered. While the patient remained in the recovery room, no abnormal findings were observed. Micturition syncope was con firmed that head-tilt test done after the operation was positive. The main causes of consciousness loss when awakening from anesthesia include metabolic anomalies such as hypoglycemia, hyponatremia, hypoxia and severe cardiovascular collapse. However, based on the fact that the patient had no findings of cardiac abnormalities, the patient in this case might have experienced reflex micturition syncope. Micturition syncope is one type of situational syncope that occurs due to neural mediation, and usually occurs in healthy men after alcohol hyperingestion [2]. Sumiyoshi et al. [2] mentioned sleeping under warm blankets and administration of a vasodilator can be factors that cause a reduction in the peripheral arterial blood resistance in the lower extremities and reported that the Valsalva maneuver is a factor