Changes in chloremia, secondary to hydric reanimation during the first 24 hours, increases hospital stay and complications in patients with acute pancreatitis / Cambios en la cloremia secundaria a la reanimación hídrica, en las primeras 24 horas, incrementa la estancia hospitalaria y las complicaciones en los pacientes con pancreatitis aguda

Abstract Acute pancreatitis (AP) requires first-line treatment with intensive fluid resuscitation. Hydroelectrolyte changes secondary to this management could be related to an increase in hospital stay, complications, and mortality. The objective of this study was to correlate the increase in serum chlorine (> 8mEq / L) during the first 24 hours (ISC) with a longer hospital stay, complications and mortality in patients with AP. A total of 110 patients with AP admitted to the emergency room were included. Fluid management and serum chlorine were recorded on admission and after 24 hours; duration of hospital stay, complications and mortality, were also registered. 37 patients had ISC (age 56.4 ± 18.4 years; 51% women), there were no differences in age, sex or type of fluid management with patients without ISC. In bivariate analysis, ISC was associated with severe AP (30% vs 12%, p = 0.02), higher APACHE II score at admission (8 [6-15] vs 6 [4-9] points, p = 0.006), and longer hospital stay (9 [7-12] vs 7 [5-10] days, p = 0.03). The overall mortality and complications rate were 16% and 25%, respectively, with no differences between the groups (24% vs. 12%, p = 0.1 and 35% vs. 19%, p = 0.06). After multivariate adjustment, independent predictors of hospital stay were ISC> 8 mEq / L (p = 0.01) and APACHE II scores at 24 hours (p = 0.02). We conclude that ISC is associated with a longer hospital stay in patients with AP from a second-level hospital care population.

Resumen La pancreatitis aguda (PA) requiere tratamiento de primera línea con reanimación hídrica intensiva. Los cambios hidroelectrolíticos secundarios a este manejo podrían relacionarse a un incremento en la estancia hospitalaria, complicaciones y mortalidad. El objetivo de este estudio fue correlacionar el incremento de cloro sérico (>8mEq/L) en las primeras 24hrs (ICS), con una mayor estancia hospitalaria, complicaciones y mortalidad en pacientes con PA. Se incluyeron 110 pacientes con PA ingresados a urgencias, se registró el manejo hídrico y cloro sérico al ingreso y 24 horas después, la estancia hospitalaria, complicaciones y mortalidad. 37 pacientes tuvieron ICS (edad 56,4 ± 18,4 años; 51% mujeres) no hubo diferencias en edad, sexo o tipo de manejo hídrico en pacientes sin ISC. En el análisis bivariado, el ICS se asoció a PA grave (30% vs 12%, p = 0,02), mayor puntuación APACHE II al ingreso (8 [6-15] vs 6 [4-9] puntos, p = 0,006) y estancia hospitalaria más prolongada (9 [7-12] frente a 7 [5-10] días, p = 0,03). La tasa global de mortalidad y complicaciones fueron del 16% y el 25%, respectivamente, sin diferencias entre grupos (24% vs 12%, p = 0,1 y 35% vs 19%, p = 0,06). Después del ajuste multivariado, los predictores independientes de la estancia hospitalaria fueron ICS> 8 mEq/L (p = 0,01) y las puntuaciones APACHE II a las 24 horas (p = 0,02). Concluimos que el ICS se asocia a mayor estancia hospitalaria en pacientes con PA de una población de segundo nivel de atención hospitalaria.

Early hemodynamic profile after aortic valve replacement - a comparison between three mechanical valves

Abstract Introduction: There are scarce data comparing different mechanical valves in the aortic position. The objective of this study was to compare the early hemodynamic changes after aortic valve replacement between ATS, Bicarbon, and On-X mechanical valves. Methods: We included 99 patients who underwent aortic valve replacement with mechanical valves between 2017 and 2019. Three types of mechanical valves were used, On-X valve (n=45), ATS AP360 (n=32), and Bicarbon (n=22). The mean prosthetic valve gradient was measured postoperatively and after six months. Results: Preoperative data were comparable between groups, and there were no differences in preoperative echocardiographic data. Pre-discharge echocardiography showed no difference between groups in the ejection fraction (P=0.748), end-systolic (P=0.764) and end-diastolic (P=0.723) diameters, left ventricular mass index (P=0.348), aortic prosthetic mean pressure gradient (P=0.454), and indexed aortic prosthetic orifice area (P=0.576). There was no difference in the postoperative aortic prosthetic mean pressure gradient between groups when stratified by valve size. The changes in the aortic prosthetic mean pressure gradient of the intraoperative period, at pre-discharge, and at six months were comparable between the three prostheses (P=0.08). Multivariable regression analysis revealed that female gender (beta coefficient -0.242, P=0.027), body surface area (beta coefficient 0.334, P<0.001), and aortic prosthetic size (beta coefficient -0.547, P<0.001), but not the prosthesis type, were independent predictors of postoperative aortic prosthetic mean pressure gradient. Conclusion: The three bileaflet mechanical aortic prostheses (On-X, Bicarbon, and ATS) provide satisfactory early hemodynamics, which are comparable between the three valve types and among different valve sizes.

Isotonic saline nasal irrigation in clinical practice: a literature review / O uso da ducha nasal com solução salina na prática clínica: uma revisão da literatura

Abstract Introduction: Nasal instillation of saline solution has been used as part of the treatment of patients with upper respiratory tract diseases. Despite its use for a number of years, factors such as the amount of saline solution to be used, degree of salinity, method and frequency of application have yet to be fully explained. Objective: Review the reported outcomes of saline nasal irrigation in adults with allergic rhinitis, acute or chronic sinusitis and after functional endoscopic sinus surgery (FESS), and provide evidence to assist physiotherapists in decision making in clinical practice. Methods: A search was conducted of the Pubmed and Cochrane Library databases between 2007 and 2014. A combination of the following descriptors was used as a search strategy: nasal irrigation, nasal lavage, rhinitis, sinusitis, saline, saline solution. Results: Eight clinical trials were included, analyzed according to participant diagnosis. Conclusion: The evidence found was heterogeneous, but contributed to elucidating uncertainties regarding the use of nasal lavage in the clinical practice of physical therapy, such as the protocols used.

Resumo Introdução: A instilação nasal de solução salina tem sido utilizada como parte do tratamento de pacientes com doenças do trato respiratório superior. Apesar de ser utilizada há vários anos, fatores como: quantidade da solução a ser instilada, grau de salinidade, modo e frequência de aplicação ainda não foram totalmente elucidados. Objetivo: Revisar os desfechos evidenciados no uso da irrigação nasal salina em adultos com rinite alérgica, sinusite aguda ou crônica e em pós-operatório de cirurgia endoscópica dos seios da face (CES) além de fornecer evidências para a tomada de decisões do fisioterapeuta na sua prática clínica. Métodos: Realizou--se uma busca nas bases de dados Pubmed e Cochrane Library no período compreendido entre 2007 e 2014. Foi utilizada como estratégia a combinação dos seguintes descritores: nasal irrigation, nasal lavage, rhinits, sinusitis, saline, saline solution. Resultados: Foram incluídos oito ensaios clínicos, analisados de acordo com o diagnóstico dos participantes. Conclusão: As evidências encontradas mostraram-se heterogêneas, mas contribuíram para elucidar alguns pontos obscuros na prática clínica da fisioterapia com relação ao uso da ducha nasal, como por exemplo, os protocolos utilizados.

Solução salina versus solução de heparina na perviedade do cateter venoso periférico na terapia venosa intermitente: revisão sistemática / Saline solution versus heparin in the patency of the venous peripheral catheter in the intermittent venous therapy: a systematic review

O uso do cateter venoso periférico intermitente em pacientes hospitalizados pode lhes trazer grandes benefícios, proporcionando maior liberdade com a higiene pessoal, alimentação, deambulação, além melhorias para a equipe de enfermagem com redução das rotinas diárias. No entanto, obstrução do cateter é algo que vem na contramão de uma assistência adequada, causando desconforto para o paciente e aumento do trabalho de enfermagem. Para evitar tal evento e garantir a perviedade do cateter intravascular, deve-se realizar o flushing com solução salina ou solução de heparina, após a administração de medicamentos ou em horários programados de acordo com o protocolo interno das instituições de saúde. Nesse contexto, surge o questionamento de qual é a melhor solução para manter a perviedade do cateter venoso periférico intermitente. Este estudo trata-se de uma revisão sistemática da literatura, com o objetivo de avaliar a efetividade do uso da solução salina comparada à solução de heparina na manutenção da perviedade dos cateteres venosos periféricos. Foi realizada a busca nas bases de dados eletrônicas Cinahl, Cochrane Central, Embase, Lilacs, Pubmed e Web of Science. Das 372 referências identificadas, 12 estudos foram selecionados após a análise de título e resumo para serem lidos na íntegra, sendo que 04 constituíram a amostra final. A extração e análise dos dados foram realizadas por dois revisores independentes e as divergências entre eles foram solucionadas por um terceiro revisor. Os 04 estudos foram publicados no período de 1995 a 2015. Ao todo, foram investigados 975 dispositivos endovenosos mantidos com uma das soluções estudadas em 420 participantes. Os estudos testaram a solução de heparina em dosagens que variaram de 10UI/mL a 100UI/mL versus a solução salina e investigaram as complicações relacionadas ao cateter venoso periférico em uso intermitente, sendo uma delas a obstrução do cateter a qual denominamos como ausência e/ou diminuição da perviedade do cateter venoso, que pode ser evitada com o flushing de forma adequada. As intervenções foram testadas em diferentes populações e não foram concordantes em suas conclusões; dois estudos recomendaram a solução de heparina, um estudo, a solução salina, e um recomenda o uso das duas soluções. Os quatro estudos discutem que as duas soluções são seguras e eficazes para a manutenção da perviedade do cateter venoso periférico. Porém, os autores afirmam que o tamanho da amostra não é suficiente para generalizar os resultados para todos os pacientes hospitalizados. Assim, essa revisão sistemática sugere a necessidade de que novos ensaios clínicos randomizados sejam realizados e que as instituições de saúde devem fomentar as investigações clínicas para validar uma assistência de enfermagem alicerçada em práticas seguras e de qualidade

The using of intermittent peripheral venous catheter in a hospitalized patient can bring to them important benefits, providing more freedom concerning to the personal hygiene, feeding, ambulation, and a lot of another improvements for the nursing team, reducing the daily routines. However, catheter obstruction it is something that disturb an appropriate assistence, provoking discomfort to the patient and increasing the need of job of the nursing team. To avoid this fact and to ensure the patency of the intervascular catheter, must to do the flushing process with saline solution or hepamin, after the application of drugs or in pre established time according to the protocol of procedure of the health institutions. In this regard, it emerges the questioning about what is the best solution to keep the patency of the intermittent peripheral venous catheter. This research is a systematic review about the litetature on this subject, and it aims to evaluate the effectiveness of the using of the saline solution in comparison to the heparin in the maintenance of the patency of the peripheral venous catheter. It has been done a research in the electronic databases Cinahl, Cochrane Central, Embase, Lilacs, Pubmed and Web of Science. An amount of 372 references was identified, but just 12 research were selected after the analysis of their titles and abstracts to be fully read. In the end, 04 of them were picked as definitive samples.The data collect and the anlysis were done by two independent reviewers, and the divergences between them were solved by a third reviewer. The 04 research were publicized in the 1995 to 2015 period. Altogheter, were searched 975 intravenous devices, keeping them with one of the studied solutions in 420 patients. Th estudies tried the heparin in dosages that vary from 10UI/mL to 100UI/mL versus the saline solution and investigated the complications related to the peripheral venous catheter in a intermittent using. One of these complications was the catheter obstruction, wich were designated as lack or the decrease of the patency of the venous catheter, that can be avoided with an appropriate flushing process. The interventions were tried in different populations, and they were not concordant in their conclusions. Two research recommended the heparin, one, the saline solution, and one of them recommend to use both. The four research affirm that the heparin and the saline solution are safety and effective for the maintenance of the patency of the peripheral venous catheter. However, the authors say point out that the quantity of the simple is not enough to to generalize the results regarding to all hospitalized patients. Thus, this systematic review suggest the necessity of new randomized clinical testings. In addition, the health institutions must promote clinical research in order to validate a solid nursing assistance based on safety and appropriated practices

Fluidoterapia para la prevención de hipotensión arterial secundaria a anestesia espinal en operación cesárea: ¿Tenemos todas las respuestas? / Fluid therapy preventing arterial hypotension after spinal anesthesia for cesarean section: do we have all the answers?

Spinal anesthesia is the technique of choice for patients undergoing cesarean section. One of the most common adverse effects of this technique is arterial hypotension, which if severe, can result in serious maternal and fetal injury or death. Different alternatives exist to prevent and treat hypotension associated to spinal anesthesia; one of them is fluid therapy. The objective of this review is to evaluate the currently available evidence for different fluid therapy alternatives and assess their effectiveness. Nowadays, it does not seem advisable to use preload with crystalloids as evidence suggests its ineffectiveness. As for the other three alternatives (preload with colloids, coload with crystalloids and coload with colloids) there is no superiority among them and neither of them seems effective enough to be used as monotherapy. Due to its safety and ease of use, coload with crystalloids associated to alpha agonist vasopressor therapy seems to be the best management strategy. Further studies should aim at the best way to administer fluids in order to optimize vasopressor therapy.

La técnica anestésica de elección para operación cesárea es la anestesia subaracnoídea. Uno de los principales efectos adversos de esta técnica es la hipotensión arterial, que puede llegar a ocasionar graves complicaciones. Existen diversas alternativas para la prevención y manejo de la hipotensión arterial; una de ellas la fluidoterapia. El objetivo de esta revisión es evaluar la evidencia reciente disponible para las distintas alternativas de fluidoterapia y evaluar su efectividad. Actualmente no parece recomendable el utilizar precarga con cristaloides para la prevención de hipotensión arterial. En cuanto a las otras tres alternativas(precarga con coloides, cocarga con cristaloides o cocarga coloides) ninguna parece ser más efectiva que las otras previniendo hipotensión arterial y ninguna sería efectiva como monoterapia. Por su disponibilidad y seguridad de uso, al día de hoy la cocarga con cristaloides asociada a terapia vasopresora alfa agonista parece ser la mejor alternativa. Estudios futuros debieran apuntar a encontrar la forma de infusión que optimize la terapia con vasopresores.

Cristaloides balanceados para ressuscitação do choque séptico / Balanced crystalloids for septic shock resuscitation

RESUMO A administração de fluidos em tempo adequado é crucial para a manutenção da perfusão tissular nos pacientes com choque séptico. Entretanto, a questão da escolha do fluido a ser utilizado para ressuscitação no choque séptico ainda é um assunto em debate. É crescente o corpo de evidência que sugere que o tipo, a quantidade e o momento da administração de fluidos durante a evolução da sepse podem afetar os desfechos do paciente. Os cristaloides têm sido recomendados como fluidos a serem administrados em primeira linha na ressuscitação do choque. No entanto, à luz da natureza inconclusiva da literatura disponível, não se podem fazer recomendações definitivas quanto à solução cristaloide mais apropriada. A ressuscitação de pacientes críticos sépticos e não sépticos com cristaloides não balanceados, principalmente a solução salina a 0,9%, tem sido associada a uma maior incidência de desordens do equilíbrio ácido-base e a distúrbios eletrolíticos, além de poder se associar à maior incidência de lesão renal aguda, à maior necessidade de terapia de substituição renal e à mortalidade. Foi proposto o uso de soluções cristaloides balanceadas como uma alternativa às soluções de cristaloides não balanceados, para mitigar seus efeitos deletérios. Entretanto, a segurança e a eficácia dos cristaloides balanceados para ressuscitação do choque séptico necessitam ser mais bem exploradas em estudos clínicos bem delineados, randomizados e controlados, multicêntricos e pragmáticos.

ABSTRACT Timely fluid administration is crucial to maintain tissue perfusion in septic shock patients. However, the question concerning which fluid should be used for septic shock resuscitation remains a matter of debate. A growing body of evidence suggests that the type, amount and timing of fluid administration during the course of sepsis may affect patient outcomes. Crystalloids have been recommended as the first-line fluids for septic shock resuscitation. Nevertheless, given the inconclusive nature of the available literature, no definitive recommendations about the most appropriate crystalloid solution can be made. Resuscitation of septic and non-septic critically ill patients with unbalanced crystalloids, mainly 0.9% saline, has been associated with a higher incidence of acid-base balance and electrolyte disorders and might be associated with a higher incidence of acute kidney injury. This can result in greater demand for renal replacement therapy and increased mortality. Balanced crystalloids have been proposed as an alternative to unbalanced solutions in order to mitigate their detrimental effects. Nevertheless, the safety and effectiveness of balanced crystalloids for septic shock resuscitation need to be further addressed in a well-designed, multicenter, pragmatic, randomized controlled trial.

Calculation of the Residual Blood Volume after Acute, Non-Ongoing Hemorrhage Using Serial Hematocrit Measurements and the Volume of Isotonic Fluid Infused: Theoretical Hypothesis Generating Study

Fluid resuscitation, hemostasis, and transfusion is essential in care of hemorrhagic shock. Although estimation of the residual blood volume is crucial, the standard measuring methods are impractical or unsafe. Vital signs, central venous or pulmonary artery pressures are inaccurate. We hypothesized that the residual blood volume for acute, non-ongoing hemorrhage was calculable using serial hematocrit measurements and the volume of isotonic solution infused. Blood volume is the sum of volumes of red blood cells and plasma. For acute, non-ongoing hemorrhage, red blood cell volume would not change. A certain portion of the isotonic fluid would increase plasma volume. Mathematically, we suggest that the residual blood volume after acute, non-ongoing hemorrhage might be calculated as 0·25N/[(Hct1/Hct2)-1], where Hct1 and Hct2 are the initial and subsequent hematocrits, respectively, and N is the volume of isotonic solution infused. In vivo validation and modification is needed before clinical application of this model.

Comparison of two maintenance electrolyte solutions in children in the postoperative appendectomy period: a randomized, controlled trial / Comparação de duas soluções para manutenção hidroeletrolítica no pós-operatório de apendicectomia em crianças: um estudo controlado e randomizado

ABSTRACT OBJECTIVE: To compare two electrolyte maintenance solutions in the postoperative period in children undergoing appendectomy, in relation to the occurrence of hyponatremia and water retention. METHODS: A randomized clinical study involving 50 pediatric patients undergoing appendectomy, who were randomized to receive 2,000 mL/m2/day of isotonic (Na 150 mEq/L or 0.9% NaCl) or hypotonic (Na 30 mEq/L NaCl or 0.18%) solution. Electrolytes, glucose, urea, and creatinine were measured at baseline, 24 h, and 48 h after surgery. Volume infused, diuresis, weight, and water balance were analyzed. RESULTS: Twenty-four patients had initial hyponatremia; in this group, 13 received hypotonic solution. Seventeen patients remained hyponatremic 48 h after surgery, of whom ten had received hypotonic solution. In both groups, sodium levels increased at 24 h (137.4 ± 2.2 and 137.0 ± 2.7 mmol/L), with no significant difference between them (p = 0.593). Sodium levels 48 h after surgery were 136.6 ± 2.7 and 136.2 ± 2.3 mmol/L in isotonic and hypotonic groups, respectively, with no significant difference. The infused volume and urine output did not differ between groups during the study. The water balance was higher in the period before surgery in patients who received hypotonic solution (p = 0.021). CONCLUSIONS: In the post-appendectomy period, the use of hypotonic solution (30 mEq/L, 0.18%) did not increase the risk of hyponatremia when compared to isotonic saline. The use of isotonic solution (150 mEq/L, 0.9%) did not favor hypernatremia in these patients. Children who received hypotonic solution showed higher cumulative fluid balance in the preoperative period.

RESUMO OBJETIVO: Comparar duas soluções de manutenção hidroeletrolítica no período pós-operatório (PO) de crianças submetidas à apendicectomia quanto à ocorrência de hiponatremia e retenção hídrica. MÉTODOS: Estudo clínico randomizado que envolveu 50 pacientes pediátricos submetidos à apendicectomia, randomizados para receber 2.000 ml/m2/dia de solução isotônica (Na 150 mEq/L ou NaCl 0,9%) ou hipotônica (Na 30mEq/L ou NaCl 0,18%). Eletrólitos, glicose, ureia e creatinina foram mensurados no início do estudo, 24 e 48 horas após a cirurgia. Foram analisados volume infundido, diurese, peso e balanço hídrico. RESULTADOS: Apresentaram hiponatremia inicial 24 pacientes. Desses, 13 receberam solução hipotônica. Dezessete pacientes permaneceram hiponatrêmicas 48 horas após a cirurgia, 10 haviam recebido solução hipotônica. Nos dois grupos os níveis de sódio aumentaram na 24ª hora PO (137,4 ± 2,2 e 137,0 ± 2,7) e não houve diferença entre eles (p = 0,593). Níveis de sódio 48 h após a cirurgia foram 136,6 ± 2,7 e 136,2 ± 2,3 no grupo isotônico e hipotônico respectivamente sem diferença significativa. Os volumes infundidos e a diurese não diferiram entre os grupos durante o estudo. O balanço hídrico foi maior no período anterior à cirurgia no grupo de pacientes que receberam solução hipotônica (p = 0,021). CONCLUSÕES: No período pós-apendicectomia, o uso da solução hipotônica não aumentou o risco de hiponatremia quando comparado com uma solução salina isotônica. O uso da solução isotônica não favoreceu a hipernatremia nesses pacientes. Crianças que receberam solução hipotônica apresentaram maior balanço hídrico cumulativo no período pré-operatório.

Spectrum CT with Isotonic Mannitol Gastrointestinal Hypotonic Radiography in the Staging of Rectal Carcinoma / 中国医学影像学杂志

Purpose To evaluate the diagnostic efficiency of spectral CT imaging combined with oral isotonic mannitol gastrointestinal hypotonic radiography in the diagnosis of preoperative T and N staging of rectal carcinoma. Materials and Methods Forty-seven patients with rectal cancer confirmed by surgery and pathology were included in this study, all the subjects underwent oral isotonic mannitol gastrointestinal hypotonic radiography prior to CT scan, then abdominal and pelvic plain and double-phase contrast-enhanced CT scan in the spectral imaging mode was performed, the optimal contrast-to-noise ratio imaging were got by the spectrum analysis software, then T-stage was evaluated and compared with pathological T-stage; N-stage was evaluated using both traditional method and the spectral curve method, and compared with pathological N-stage. Results ① All the 47 patients were able to successfully complete the examination and the rectal filling and lesion display were satisfactory; ② the best diagnostic accuracy of T-stage by the monochromatic images was 83.0% (39/47), which had a general correlation with pathologic results (Kappa=0.713, P<0.001); ③ the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of N-stage by the traditional method were 78.72%, 80.95%, 76.92%, 73.91% and 83.33%, respectively, which had a general correlation with pathologic results (Kappa=0.574, P<0.001); the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of N-stage by the Spectral curve method were 89.13%, 75.00%, 100.00%, 100.00% and 83.87%, respectively, which had a fair correlation with pathologic results (Kappa=0.772, P<0.001). Spectral curve method had higher Youden index for N-stage evaluation than traditional method (0.64 vs. 0.58). Conclusion Oral isotonic mannitol gastrointestinal hypotonic radiography can provide a good rectal background, and it is a safe and reliable method for rectal examination, when combined with spectrum CT imaging, it is able to display the detail of lesions and identity the homology of lymph nodes, which might help to make more accurate preoperative T, N staging of rectal carcinoma.

Effects of pyruvate Ringer's solution on erythrocyte deformation function in patients undergoing cardiopulmonary bypass in vitro / 中华麻醉学杂志

Objective To evaluate the effects of pyruvate Ringer' s solution on erythrocyte deformation function in the patients undergoing cardiopulmonary bypass (CPB) in vitro.Methods Thirteen patients of both sexes,aged 25-64 yr,of ASA physical status Ⅱ or Ⅲ (NAHY Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement under CPB were enrolled in the study.At 10 and 60 min of CPB (T1,2) and 60 min after termination of CPB (T3),blood samples 18 ml were drawn from the radial artery and each patient's blood sample was equally divided into 6 parts (3 ml per part).The blood samples were divided into 3 groups (n =13 each):control group (group C),lactated Ringer's solution group (group R),and pyruvate Ringer's solution group (group P).In C,R and P groups,normal saline 1 ml,lactated Ringer's solution 1 ml,and pyruvate Ringer's solution 1 ml were added,respectively,and then the erythrocytes were incubated for 60 min at 37 ℃.At 30 and 60 min of incubation,the erythrocyte rigidity index (ERI) and erythrocyte deformation index (EDI) were detected.Results Compared with C and R groups,the ERI was significantly decreased at 30 and 60 min of incubation at T1,the EDI was decreased at 30 min of incubation at T1,2,and no significant change was found in ERI at T2,3 or in EDI at T3 in group P.There was no significant difference in ERI and EDI at different time points of incubation within groups.Conclusion Pyruvate Ringer's solution can enhance erythrocyte deformation function in the patients undergoing CPB.

Efeitos da desobstrução rinofaríngea retrógada isolada e associada à instilação de soro fisiológico (0,9NACL), sobre as propriedades do muco nasal, a celularidade e as citocinas em lavado nasal e sintomas nasais de motociclistas profissionais expostos à poluição da cidade de Belo Horizonte / Effects of isolated clearance rhinopharyngeal retrograde and clearance rhinopharyngeal retrograde associated with the irrigation of isotonic saline solution (0.9NaCl) on the nasal mucus properties, celularity, and in nasal lavage and the nasal symptoms in professional motorcyclists exposed to air pollutions in the city of Belo Horizonte, Brazil

Introdução: A desobstrução rinofaríngea retrógrada (DRR) é uma técnica de fisioterapia respiratória aplicada em lactentes para desobstrução de vias aéreas superiores, podendo, inclusive, ser associada à irrigação nasal com salina isotônica para remoção de muco viscoso aderido às paredes das vias aéreas. Objetivo: Caracterizar o perfil de motociclistas profissionais expostos à poluição urbana no que se refere a transporte mucociliar nasal (TMCN), inflamação das vias aéreas superiores e sintomas nasais, e comparar o efeito da DRR isolada e associada à instilação de salina isotônica (DRR+S) nesta população. Métodos: Vinte e quatro voluntários divididos aleatoriamente em dois grupos (DRR e DRR+S) submeteram-se a 15 dias consecutivos de tratamento. A avaliação basal e a pós-intervenção constituíram-se da análise do teste de trânsito da sacarina, da celularidade total e diferencial do lavado nasal e dos sintomas de vias aéreas superiores por meio do questionário SNOT-20, bem como do estudo da exposição pessoal à poluição do ar, por meio da análise da concentração do NO2 de amostradores passivos. O TMCN foi avaliado pelo teste ANOVA não paramétrico com medidas repetidas e o SNOT-20 pelo teste Mann-Whitney. As correlações entre a concentração de NO2 e os desfechos das vias aéreas superiores foram testadas por meio do coeficiente de correlação de Spearman. Resultados: Os grupos apresentaram dados clínicos e demográficos semelhantes. O TMCN apresentou-se alterado em 25% dos voluntários e 100% deles apresentavam sintomas de vias aéreas superiores. Após os tratamentos, os sintomas de vias aéreas e o TMCN evidenciaram melhora significativa, apesar do aumento no número de macrófagos e células ciliadas do lavado nasal. Não houve correlação entre o NO2 e o TMCN, tampouco em relação aos sintomas de vias aéreas superiores. CONCLUSÃO: Técnicas não farmacológicas, simples e de baixo custo são efetivas para recuperar o TMCN alterado e melhorar os sintomas de vias aéreas...

Introduction: Rhinopharyngeal Retrograde Clearance (RRC) is a respiratory therapy technique applied to infants with upper airway obstruction that may also be associated with nasal irrigation with isotonic saline for removal of viscous mucus adhered to the walls of the airways. OBJECTIVE: Characterize the profile of professional motorcycles exposed to urban pollution in relation to the nasal mucociliary transport (NMCT), inflammation of the upper airways and nasal symptoms and compare the effect of DRR alone and associated with instillation of isotonic saline (RCC + S). Methods: Twenty-four volunteers were randomly divided into two groups (RCC and RCC + S) and were submitted to 15 consecutive days of treatment. The baseline and post-intervention consisted of analysis of the transit saccharin test, the total and differential cellularity nasal lavage, and symptoms of upper airway through the SNOT-20, as well as the study of personal exposure to air pollution, by analyzing the concentration of diffuse nitrogen dioxide monitoring system. The NMCT was evaluated with ANOVA for repeated measures and the SNOT-20 with the Mann-Whitney test. The correlations between the concentration of NO2 and the upper airway outcomes were tested using the Spearman correlation coefficient. Results: The groups showed similar demographic and clinical data. The NMCT was abnormal in 25% of the volunteers and 100% of the volunteers had symptoms of upper airways. After treatment the upper airway symptoms and the NMCT showed significant improvement despite the increase in the number of macrophages and ciliated cells on the nasal lavage. No correlation was observed between dioxide nitrogen and TMCN and with the symptoms of the upper airways. Conclusion: Nonpharmacological, simple and inexpensive techniques are effective to treat abnormal NMCT and improve symptoms of upper airway in nonsmoking adults...

Há risco de êmbolos durante a infusão com o uso de aquecedores com linhas de aquecimento de sangue e líquidos? / Is there risk of emboli during Infusion with Line type blood-liquid warmers? / ¿Existen riesgos de émbolos durante la infusión con el uso de calentadores con líneas de calentamiento de sangre y líquidos?

JUSTIFICATIVA E OBJETIVOS: Os aquecedores de sangue e de líquidos que aquecem em linha são amplamente usados por causa do baixo custo, do uso prático e porque não dependem de equipamentos. Nosso objetivo foi investigar a formação de bolhas em dois aquecedores tipo linha com duas formas de aquecimento diferentes. MATERIAIS E MÉTODOS: Dois grupos foram designados às marcas de aquecedores de sangue e líquidos: S-line e Astoflo®. Com o uso de 10 conjuntos de soro para cada grupo (n = 20), 1.000 mL de solução NaCl a 9% foram infundidos a 350 mL.hora-1 durante uma hora na sala de operação. As seguintes temperaturas foram mensuradas: das partes proximal, intermediária e distal das linhas; do ambiente de ensaio; do líquido usado e do líquido ao atingir a cânula após o aquecimento. O tempo para a formação visível de bolhas foi registrado. Os achados foram estatisticamente comparados com o uso do teste-U de Mann-Whitney. RESULTADOS: Não houve diferença entre os grupos em relação às temperaturas proximal, intermediária e distal das partes das linhas; do ambiente do estudo; do líquido usado e do líquido ao atingir a cânula (p > 0,05). Bolhas foram observadas nos dois aquecedores e o tempo para a formação de bolhas foi semelhante nos dois grupos de estudo (p = 0,143). CONCLUSÕES: No cenário experimental, criamos condições semelhantes ao nosso ambiente clínico. Ambos os tipos de aquecedores forneceram níveis de aquecimento semelhantes e formaram bolhas visíveis. Considerando que uma pequena quantidade de êmbolos pode ser fatal em bebês e crianças, a formação de bolhas deve ser seriamente considerada em caso de êmbolos e estudos adicionais devem ser feitos para determinar a quantidade, as razões e os conteúdos da formação de bolhas.

INTRODUCTION: Line type blood-liquid warmers are used widely due to their low expense, practical use and nondependence on sets. We aimed to investigate the relationship of bubbles in line type warmers with two different warming properties. MATERIALS AND METHODS: Two groups were designed with S-line and Astoflo® brand blood-liquid warmers. By using 10 medisets for each group (n = 20), we infused 1,000 mL 0.9% NaCl solutions at 350 mL.hour-1 speed for one hour in the operating room. Temperatures at the proximal, midway and distal parts of lines, temperature of experiment environment, temperature of liquid used and temperature of liquid reaching the cannula after warming were measured. Time to visually observable bubble formation was recorded. We compared findings statistically using the Mann-Whitney U test. RESULTS: There were no differences between the groups with respect to temperatures at the proximal, midway and distal parts of lines, temperature of experiment environment, temperature of liquid used and temperature of liquid reaching the cannula (p > 0.05). Bubbles were observed with both warmers and time to bubble formation was similar in the two study groups (p = 0.143). CONCLUSIONS: In the experimental setting, we have designed conditions similar to our clinical environment. Both types of warmers provided similar warming levels and formed visible bubbles. Considering that low amounts of emboli can be fatal in infants and children, bubble formation should be taken seriously into account for emboli and further studies should be carried out to determine the amount, the reasons and the contents of bubble formation.

JUSTIFICATIVA Y OBJETIVOS: Los calentadores que poseen un calentamiento en línea de sangre y de líquidos son extensamente usados a causa de su bajo coste, del uso práctico y también porque no dependen de equipos. Nuestro objetivo fue investigar la formación de burbujas en dos calentadores de tipo línea con dos formas de calentamiento diferentes. MATERIALES Y M&EACUTE;TODOS: Dos grupos fueron designados a las marcas de calentadores de sangre y líquidos: S-line y Astoflo®. Con el uso de 10 conjuntos de suero para cada grupo (n = 20), 1.000 mL de solución NaCl al 9% se infundieron a 350 mL.hora-1 durante una hora en quirófano. Las siguientes temperaturas fueron mensuradas: de las partes proximal, intermedia y distal de las líneas; del ambiente de ensayo; del líquido usado y del líquido al alcanzar la bránula después del calentamiento. El tiempo para la formación visible de burbujas fue registrado. Los hallazgos fueron estadísticamente comparados con el uso del test-U de Mann-Whitney. RESULTADOS: No hubo diferencias entre los grupos con relación a las temperaturas proximal, intermedia y distal de las partes de las líneas; del ambiente del estudio; del líquido usado y del líquido al alcanzar la bránula (p > 0,05). Burbujas se observaron en los dos calentadores y el tiempo para la formación de burbujas fue similar en los dos grupos de estudio (p = 0,143). CONCLUSIONES: Dentro del escenario experimental, creamos condiciones parecidas a nuestro ambiente clínico. Ambos tipos de calentadores suministraron niveles de calentamiento parecidos y formaron burbujas visibles. Considerando que una pequeña cantidad de émbolos puede ser fatal en bebés y en niños, la formación de burbujas debe ser seriamente considerada en caso de émbolos y estudios adicionales deben ser realizados para determinar la cantidad, las razones y los contenidos de la formación de burbujas.

Diferenca de ions fortes na urina como determinante importante das alteracoes na concentracao plasmatica de cloreto em pacientes no pos-operatorio / Urinary strong ion difference is a major determinant of plasma chloride concentration changes in postoperative patients

OBJETIVO: Demonstrar que alterações na concentração plasmática de cloreto ([Cl-]plasma) durante o período pós-operatório são amplamente dependentes da diferença de íons fortes urinária ([SID]urina=[Na+] urina+[K+] urina -[Cl-]urina) e não de diferenças na terapia hídrica. MÉTODOS: Foram realizadas mensurações na admissão à unidade de terapia intensiva e 24 horas mais tarde em um total de 148 pacientes pós-operatórios. Os pacientes foram designados para um de três grupos segundo a alteração na concentração plasmática de cloreto após 24 horas: [Cl-]plasma aumentada (n=39), [Cl-]plasma diminuída (n=56) ou [Cl-]plasma inalterada (n=53). RESULTADOS: Quando da admissão, o grupo com [Cl-]plasma aumentada tinha [Cl-]plasma mais baixa (105±5 versus 109±4 e 106±3mmol/L; p<0,05), um ânion gap plasmático ([AG]plasma) mais alto e um íon gap forte mais alto. Após 24 horas, o grupo com [Cl-]plasma aumentada mostrou [Cl-]plasma mais alta (111±4 versus 104±4 e 107±3mmol/L; p<0,05) e nível plasmático mais baixo de [AG]plasma e íon gap forte. O volume e íon gap forte dos fluidos administrados foram similares entre os grupos, exceto que os [SID]urina eram mais altos (38±37 versus 18±22 e 23±18mmol/L; p<0,05) no grupo com [Cl-]plasma aumentada na avaliação após 24 horas. Uma análise de regressão linear múltipla demonstrou que a [Cl-]plasma na admissão e [SID]urina eram preditores independentes de variação na [Cl-]plasma 24 horas mais tarde. CONCLUSÕES: Alterações na [Cl-]plasma durante o primeiro dia pós-operatório foram amplamente relacionadas com [SID]urina e [Cl-]plasma na admissão, e não às características ...

OBJECTIVE: To show that alterations in the plasma chloride concentration ([Cl-]plasma) during the postoperative period are largely dependent on the urinary strong ion difference ([SID]urine=[Na+]urine+[K+]urine-[Cl-]urine) and not on differences in fluid therapy. METHODS: Measurements were performed at intensive care unit admission and 24 hours later in a total of 148 postoperative patients. Patients were assigned into one of three groups according to the change in [Cl-]plasma at the 24 hours time point: increased [Cl-]plasma (n=39), decreased [Cl-]plasma (n=56) or unchanged [Cl-]plasma (n=53). RESULTS: On admission, the increased [Cl-]plasma group had a lower [Cl-]plasma (105±5 versus 109±4 and 106±3mmol/L, p<0.05), a higher plasma anion gap concentration ([AG]plasma) and a higher strong ion gap concentration ([SIG]). After 24 hours, the increased [Cl-]plasma group showed a higher [Cl-]plasma (111±4 versus 104±4 and 107±3mmol/L, p<0.05) and lower [AG]plasma and [SIG]. The volume and [SID] of administered fluids were similar between groups except that the [SID]urine was higher (38±37 versus 18±22 and 23±18mmol/L, p<0.05) in the increased [Cl-]plasma group at the 24 hours time point. A multiple linear regression analysis showed that the [Cl-]plasma on admission and [SID]urine were independent predictors of the variation in [Cl-]plasma 24 hours later. CONCLUSIONS: Changes in [Cl-]plasma during the first postoperative day were largely related to [SID]urine and [Cl-]plasma on admission and not to the characteristics of the infused fluids. Therefore, decreasing [SID]urine could be a major mechanism for preventing the development of salineinduced hyperchloremia. .

Efeito da administração de solução salina na estabilidade da circulação durante a indução de anestesia geral com propofol em estudo randômico e controlado de procedimentos ginecológicos / Effect of normal saline administration on circulation stability during general anesthesia induction with propofol in gynecological procedures - randomised-controlled study / Efecto de la administración de solución salina normal en la estabilidad de la circulación durante la inducción de anestesia general con propofol en estudio aleatorio y controlado de procedimientos ginecológicos

JUSTIFICATIVA E OBJETIVO: Comparar o efeito da administração profilática de solução salina normal com o efeito hipotensor de propofol em pacientes do sexo feminino programadas para procedimentos ginecológicos. MÉTODO: Foram randomicamente alocadas em dois grupos 69 pacientes, ASA I-II. O Grupo 1 recebeu 5 mL.kg-1 de solução salina a 0,9% 10 minutos antes da indução e o Grupo 2 não recebeu nada (controle). A anestesia foi induzida com propofol e fentanil e depois mantida com propofol e remifentanil. As variáveis hemodinâmicas foram mensuradas pré- e pós-indução da anestesia geral. RESULTADOS: Após a indução, ambos os grupos apresentaram queda significativa da pressão arterial média (p < 0,001) e redução também significativa da frequência cardíaca (p < 0,02 no grupo de estudo e p < 0,001 no grupo de controle). A pressão arterial média pré-indução teve uma queda de mais de 25% em 35% dos pacientes do grupo controle em comparação com apenas 17% dos pacientes que receberam a solução salina (p < 0,04). CONCLUSÃO: A administração profilática de solução salina pode diminuir a porcentagem de pacientes que apresentam queda significativa da pressão arterial após a indução de propofol em anestesia geral.

BACKGROUND AND OBJECTIVE: To compare the effect of prophylactic administration of normal saline against the hypotensive effect of propofol in female patients booked for gynecological procedures. METHOD: Sixty nine ASA (I, II) patients were randomly allocated into two groups, group 1 received 5 mL.kg-1 of 0.9% normal saline 10 minutes before induction, whereas group 2 received nothing (control). Anesthesia was induced with propofol and fentanyl then maintained with propofol and remifentanil. We measured hemodynamic variables pre and post general anesthesia induction. RESULTS: Both groups had significant drops in post induction mean arterial blood pressure (P < 0.001). Also both groups had significant drops in post induction heart rate ((P < 0.02 in sample group and P < 0.001 in control group), and 35% of patients in the control group had more than 25% drop in the pre induction mean arterial blood pressure, compared with only 17% of patients in the saline group (P < 0.04). CONCLUSION: The prophylactic administration of normal saline could decrease the percentage of patients who had a significant drop in their blood pressure after propofol induction of general anesthesia.

JUSTIFICATIVA Y OBJETIVO: Comparar el efecto de la administración profiláctica de solución salina normal con el efecto hipotensor de propofol en pacientes del sexo femenino programadas para procedimientos ginecológicos. MÉTODO: Sesenta y nueve pacientes con ASA I-II fueron ubicados aleatoriamente en dos grupos. El Grupo 1 recibió 5 mL.kg-1 de solución salina al 0,9% 10 minutos antes de la inducción y el Grupo 2 no recibió nada. La anestesia fue inducida con propofol y fentanilo y después se mantuvo con propofol y remifentanilo. Las variables hemodinámicas fueron mensuradas antes y después de la inducción de la anestesia general. RESULTADOS: Después de la inducción, ambos grupos presentaron una caída significativa de la presión arterial promedio (p < 0,001) y una reducción también significativa de la frecuencia cardíaca (p < 0,02 en el grupo de estudio y p < 0,001 en el grupo de control). La presión arterial promedio pre inducción tuvo una caída de más del 25% en 35% de los pacientes del grupo control en comparación con solamente un 17% de los pacientes que recibieron la solución salina (p < 0,04). CONCLUSIÓN: La administración profiláctica de la solución salina normal puede disminuir el porcentaje de pacientes que presentan una caída significativa de la presión arterial después de la inducción de propofol en la anestesia general.

Volume mediano efetivo de cristaloides na prevenção de hipotensão arterial em pacientes submetidas à cesariana com raquianestesia / The median effective volume of crystalloid in preventing hypotension in patients undergoing cesarean delivery with spinal anesthesia / Volumen mediano efectivo de cristaloides en la prevención de hipotensión arterial en pacientes sometidas a la cesárea con raquianestesia

JUSTIFICATIVA E OBJETIVOS: A hipotensão materna associada à raquianestesia no parto cesáreo é a complicação mais frequente e problemática, com sérios riscos para a mãe e comprometimento do bem-estar neonatal. Nesse contexto, o volume efetivo de cristaloides por via intravenosa como uma estratégia de prevensão ainda não foi estimado. MÉTODOS: Oitenta e cinco parturientes com estado físico ASA I/II submetidas à cesariana seletiva foram selecionadas e 67 mulheres elegíveis foram designadas para receber uma pré-carga de cristaloides com 2 mL de bupivacaína hiperbárica a 0,5% (10 mg) mais 50 µg de morfina. O volume de cristaloides foi determinado por um método sequencial up-and-down. Os cristaloides foram infundidos a uma taxa de 100 a 150 mL.min-1 antes da anestesia espinal. O volume inicial de cristaloides foi de 5 mL.kg-1. Os dados do efeito do volume foram ajustados para o modelo sigmoidal de máxima eficácia e a mediana do volume efetivo (VE50) e seu intervalo de confiança (IC) de 95% foram calculados usando a estimativa de máxima verossimilhança e a regressão logística de Firth corrigida. RESULTADOS: Sessenta e sete parturientes completaram o estudo e foram analisadas. Vinte e oito pacientes (41,8%) desenvolveram hipotensão, com queda da pressão arterial sistólica (PAS) superior a 20% do valor basal. O VE50 de cristaloides foi de 12,6 mL.kg-1 (IC 95%, 11,6 a 14,8 mL.kg-1). Com a correção de Firth, a probabilidade conjunta do volume efetivo de cristaloides a 13 mL.kg-1 foi de 50,2% (IC 95%, 30,0% a 83,1%). CONCLUSÕES: O VE50 estimado da pré-carga de cristaloides necessário para prevenir a hipotensão induzida por anestesia espinhal em parto cesáreo é de 13 mL.kg-1 (valor aproximado). Porém, a profilaxia ou terapia com vasoconstritores também deve ser preparada e administrada no momento oportuno.

BACKGROUND AND OBJECTIVES: Spinal anesthesia-associated maternal hypotension in Cesarean delivery is the most frequent and troublesome complication, posing serious risks to mothers and compromising neonatal well-being. The effective volume of intravenous crystalloid as the preventive strategy in this context has not been estimated. METHODS: Eighty-five parturients with ASA physical status I/II undergoing elective Cesarean delivery were screened and 67 eligible women were assigned to receive pre-spinal crystalloid loading. Hyperbaric 0.5% bupivacaine 2 mL (10 mg) plus morphine 50 µg was given to all patients. The volume of crystalloid was determined by an up-and-down sequential method. The crystalloid was infused at a rate of 100-150 mL.min-1 prior to the spinal anesthetic injection. The initial volume of crystalloid was 5 mL.kg-1. Volume-effect data were fitted to a sigmoidal maximum efficacy model and the median effective volume (EV50) and corresponding 95% confidence interval (95% CI) were estimated using maximum likelihood estimation and logistic regression with Firth's correction. RESULTS: A total of 67 subjects completed the study and were analyzed. Twenty-eight (41.8%) patients developed hypotension with their systolic blood pressure (SBP) decreasing > 20% of baseline. The EV50 of crystalloid were 12.6 mL.kg-1 (95% CI, 11.6 to 14.8 mL.kg-1). With Firth's correction, the pooled probability of an effective preventive volume of crystalloid at 13 mL.kg-1 was 50.2% (95% CI, 30% to 83.1%). CONCLUSIONS: The estimated EV50 of the preloaded crystalloid required to prevent spinal anesthesia-induced hypotension in a Cesarean section is, approximately, 13 mL.kg-1. However, prophylactic or therapeutic vasoconstrictors should also be prepared and administered at an appropriate time.

JUSTIFICATIVA Y OBJETIVOS: La hipotensión materna asociada a la raquianestesia en el parto por cesárea es la complicación más común y problemática, acarreando serios riesgos para la madre y para el compromiso del bienestar neonatal. En ese contexto, el volumen efectivo de cristaloides por vía intravenosa como una estrategia de prevención todavía no ha sido estimado. MÉTODOS: Fueron elegidas ochenta y cinco parturientes con estado físico ASA I/II sometidas a la cesárea selectiva, y 67 mujeres elegibles fueron designadas para recibir una precarga de cristaloides con 2 mL de bupivacaína hiperbárica al 0,5% (10 mg) más 50 µg de morfina. El volumen de cristaloides quedó determinado por un método secuencial up-and-down. Los cristaloides fueron administrados a una tasa de 100 a 150 mL.min-1 antes de la anestesia espinal. El volumen inicial de cristaloides fue de 5 mL.kg-1. Los datos del efecto del volumen se ajustaron para el modelo sigmoidal de máxima eficacia y la mediana del volumen efectivo (VE50). El intervalo de confianza (IC) de 95% fue calculado usando la estimación de máxima verosimilitud y la regresión logística de Firth para la corrección. RESULTADOS: Sesenta y siete parturientes completaron el estudio y fueron analizadas. Veinte y ocho pacientes (41,8%) desarrollaron hipotensión, con una caída de presión arterial sistólica (PAS) superior al 20% del valor basal. El VE50 de cristaloides fue de 12,6 mL.kg-1 (IC 95%, 11,6 a 14,8 mL.kg-1). Con la corrección de Firth, la probabilidad conjunta del volumen efectivo de cristaloides a 13 mL.kg-1 fue de 50,2% (IC 95%, 30,0% a 83,1%). CONCLUSIONES: El VE50 estimado de la precarga de cristaloides necesario para prevenir la hipotensión inducida por anestesia espinal en el parto por cesárea es de 13 mL.kg-1 (valor aproximado). Sin embargo, la profilaxis o terapia con vasoconstrictores también debe ser preparada y administrada en el momento oportuno.

Effect of different methods of volumetherapy on tissue oxygenation in elderly patients undergoing radical operation for gastrointestinal tumor / 中华麻醉学杂志

Objective To investigate the effect of different methods of volume therapy on tissue oxygenation in elderly patients undergoing radical operation for gastrointestinal tumor.Methods Sixty ASA Ⅱ or Ⅲ patients,aged ＞ 65 yr,weighing 42 -85 kg,undergoing elective radical operation for gastrointestinal tumor,were randomized into 3 groups ( n =20 each):lactated Ringer' s solution (LR) group ( group Ⅰ ),LR + 0.6 ％ hydroxyethyl starch (HES) 130/0.4 (2 ∶ 1 ) group ( group Ⅱ ) and LR + 0.6 ％ HES 130/0.4 ( 1 ∶1 ) group ( group Ⅲ ).Anesthesia was induced with propofol,vecuronium and fentanyl and maintained with sevoflurane,remifentanil and vecuronium.The patients were mechanically ventilated after tracheal intubation.PETCO2 was maintained at 30-35 mm Hg.Transcutaneous partial pressure of oxygen (TcPO2) and transcutaneous partial pressure of carbon dioxide (TcPCO2) were measured within 5 min before fluid infusion (To ),25-30 min after beginning of fluid infusion (T1),within 5 min before skin incision (T2),within 5 min after skin incision (T3 ),within the first hour after beginning of surgery (T4),within the second hour after beginning of surgery (T5 ) and within 5 min before the end of surgery (T6 ).The average value within each time period was obtained.Blood gas analysis was performed simultaneously and PaO2 and PaCO2 were recorded.The fluid infused,urine volume,blood loss and requirement for norepinephrine,RBC and plasma were recorded during operation.The time when the patients passed the flatus,duration of stay in ICU and postoperative complications were recorded.Results There was no significant difference in TcPO2,TcPCO2,PaO2,PaCO2,the time when the patients passed the flatus,duration of stay in ICU and the incidence of postoperative complications among the three groups ( P ＞ 0.05).TcPO2 and PaO2 were significantly higher at T2-6 in the three groups and TcPCO2 was significantly lower at T3 in group Ⅲ than those at To and T1 ( P＜ 0.05 or 0.01).TcPCO2 was significantly lower at T3 than at T2 in the three groups (P ＜ 0.05).Compared with group Ⅰ,the requirement for norepinephrine was significantly lower ( P ＜ 0.05),and no significant change was found in the fluid infused,urine volume,blood loss and requirement for RBC and plasma in groups Ⅱ and Ⅲ ( P＞0.05).Conclusion When LR,LR+0.6％ HES 130/0.4 (2∶1) or LR + 0.6％ HES 130/0.4 (1∶1) is used for volume therapy,tissue oxygenation is improved,however,LR + 0.6％ HES 130/0.4 (2∶1) or LR + 0.6％ HES 130/0.4 (1∶1 ) is better in maintaining circulatory stability than LR infused alone and is more suitable for elderly patients undergoing radical operation for gastrointestinal tumor.

Solução salina isotônica como fluidoterapia de manutenção intravenosa para prevenir hiponatremia adquirida em crianças hospitalizadas / Isotonic saline solution as maintenance intravenous fluid therapy to prevent acquired hyponatremia in hospitalized children

OBJETIVOS: Avaliar se o uso de soluções salinas hipotônicas como fluidoterapia de manutenção em crianças hospitalizadas aumenta o risco de hiponatremia, se a administração de fluidos isotônicos é capaz de proteger contra a hiponatremia adquirida e se as soluções isotônicas aumentam os riscos de efeitos deletérios como hipernatremia ou sobrecarga hídrica. FONTES DOS DADOS: Realizou-se uma pesquisa bibliográfica nas bases de dados PubMed (01/01/1969 a 13/07/2011), Embase (1989 a 2011) e Cochrane Library (1989 a 2011). Adicionalmente, referências foram incluídas dos estudos selecionados. SÍNTESE DOS DADOS: Crianças hospitalizadas têm riscos potenciais para hiponatremia, e o uso de soluções salinas hipotônicas é o principal fator de risco para esse agravo. As soluções salinas isotônicas têm mostrado efeito protetor para hiponatremia e, até o momento, sem efeitos deletérios significativos, como sobrecarga hídrica, hipernatremia ou flebites. CONCLUSÕES: As evidências indicam que a tradicional recomendação de Holliday & Segar quanto à fluidoterapia de manutenção para crianças doentes e hospitalizadas merece ser reconsiderada em virtude das evidências sobre os efeitos adversos dela advindos, assim como dos melhores resultados obtidos com o emprego das soluções isotônicas.

OBJECTIVES: This review aims to evaluate if the use of hypotonic saline solutions as maintenance intravenous fluid therapy in hospitalized children increases the risk of hyponatremia, if the administration of isotonic fluids is able to protect against acquired hyponatremia and if the isotonic solutions increase the risks of deleterious effects such as hypernatremia or fluid overload. SOURCES: We researched the relevant literature on the PubMed (Jan 01 1969 to Jul 13 2011), EMBASE (1989 to 2011) and Cochrane Library (1989 to 2011) databases. Furthermore, references of selected studies were included. SUMMARY OF THE FINDINGS: Hospitalized children are potentially at risk of developing hyponatremia and the use of hypotonic saline solutions is the main risk factor for this disease. Isotonic saline solutions have shown a protective effect against hyponatremia, and, so far, there have been no significant deleterious effects such as fluid overload, hypernatremia or phlebitis. CONCLUSIONS: The evidence found indicates that the traditional recommendation of Holliday and Segar to use maintenance fluid therapy for sick and hospitalized children deserves to be reconsidered due to the adverse effects found to arise from it, apart from the better results obtained by using isotonic solutions.

Análise comparativa da reposição volêmica com solução isotônica e solução hipertônica em ratos com sepse / A comparative analysis of isotonic versus hypertonic solution volume replacement in septic rats

OBJETIVO: Há controvérsias sobre o melhor fluído a ser utilizado na reposição volêmica no tratamento da sepse. O objetivo do estudo foi comparar a reposição volêmica com solução salina isotônica à 0,9 por cento ou com solução salina hipertônica à 7,5 por cento , em ratos com sepse induzida pela ligadura e punção do ceco. MÉTODOS: Estudo experimental com 30 ratos Wistar, divididos em três grupos: controle (GC, n=10), solução isotônica (GSI, n=10) e solução hipertônica (GSH, n=10). Em todos os grupos foi realizada a ligadura e punção do ceco, sendo avaliadas, após 15 horas, a freqüência respiratória, pressão arterial média, fluxos sanguíneos hepático e renal, peso e coleta de sangue para dosagem de TNF-α. No grupo solução isotônica e grupo solução hipertônica houve reposição volêmica 60 minutos antes com solução salina a 0,9 por cento e solução salina a 7,5 por cento, respectivamente. RESULTADOS: Ocorreram dois óbitos na amostra total. Houve diferença significativa do peso médio dos ratos após 15 horas de sepse (p=0,018), principalmente se comparados GSI e GSH (p=0,003). O fluxo sanguíneo renal também apresentou diferenças significativas entre os grupos GC e GSH (p=0,002), e GC e GSI (p=0,008), mas sem significância entre GSI e GSH. A melhora da PAM com o uso de SSH não foi constatada (p=0,054). As demais variáveis não apresentaram significância para o estudo. CONCLUSÕES: Embora não tenham sido evidenciadas melhorias na pressão arterial média, bem como no fluxo hepático e TNF-α, ratos submetidos à sepse por ligadura e punção do ceco, após 15 horas, apresentaram aumento significativo do fluxo sanguíneo renal independente do uso de solução salina isotônica à 0,9 por cento ou hipertônica à 7,5 por cento.

PURPOSE: Sepsis severity and mortality risk require aggressive therapy which includes hemodynamic support. The best fluid for volume replacement, however, is controversial. This study aimed to compare 0.9 percent isotonic saline solution versus 7.5 percent hypertonic saline solution as volume replacement fluid in sepsis induced by cecum ligation plus puncture rats. METHODS: This experimental trial included 30 rats divided into three groups: Control group (CG, n = 10), isotonic (ISG, n = 10) and hypertonic solution (HSG, n = 10). Fifteen hours after cecum ligation and puncture, all animals underwent respiratory rate, mean arterial pressure, renal and hepatic blood flow and weight evaluation, plus blood collection for TNF-α measurement. The ISG and HSG treatment groups received volume replacement 60 minutes before the procedure with either 0.9 percent or 7.5 percent saline solution, respectively. RESULTS: Two animals died. Significant differences were found for the animals' mean weight after 15 hours (p=0.018), particularly relevant when ISG and HSG are compared (p=0.003). Renal blood flow was also significantly different for the CG versus HSG (p=0.002) and CG versus ISG (p=0.008), but not significantly different for ISG versus HSG. No mean arterial pressure improvement was found for HSG (0.054). Other variables were not significant. CONCLUSIONS: Although no mean blood pressure, hepatic flow or TNF-α improvements were detected, the rats with sepsis 15 hours after cecum ligation and puncture showed significantly increased renal blood flow which was 0.9 percent isotonic saline solution or of 7.5 percent hypertonic solution use independent.

Effect of lactated crystalloid solution on arterial blood lactate concentration during orthotopic liver transplantation / 中华麻醉学杂志

Objective To compare the effects of three different crystalloid solutions on arterial blood lactate concentration and acid-base balance during orthotopic liver transplantation (OLT) without veno-venous bypass. Methods Ninety ASA Ⅱ-Ⅳ patients with end-stage liver disease of both sexes (78 males, 12 females) aged 16-67 yrs weighing 45-87 kg undergoing OLT were randomly allocated to one of 3 groups ( n = 30 each): group Ⅰ received normal saline (NS); group Ⅱ received lactated Ringer's solution (LR) and group Ⅲ acetated Ringer's solution (Plasma A, Baxter) (PA). The crystalloid was infused at a rate of 6-8 ml?kg-1?h-1. Colloid, albumin, RBC and whole blood were infused based on BP, CVP and Hb concentration. The arterial pH, BE and lactate concentration were measured before anesthesia (T0 baseline) , before cross-clamping of the portal vein (T1) at 30 min and the end of anhepatic phase (T2,T3) , 5 and 30 min after unclamping of the portal vein (T4,T5) and at the end of surgery (T6). Results There was no significant difference in the amount of crystalloid, colloid and blood products infused during operation among the 3 groups. Arterial pH decreased significantly at T1 (immediately before anhepatic phase) as compared to the baseline value at T0 and the low pH was maintained until the end of operation. BE was significantly decreased during anhepatic phase (at T2 and T3 ) . The blood lactate was increasing during operation and was 3 times that of baseline value at the end of operation. However there was no significant difference in arterial pH, BE and lactate concentration among the 3 groups.Conclusion In OLT without venovenous bypass, blood lactate increases progressively but the lactated Ringer's solution does not have any effect on the blood lactate concentration.