ABSTRACT
Severe diabetic ketoacidosis is one of the complications with the highest mortality rate in diabetes mellitus, regardless of its form of presentation. It progresses rapidly, which is why early recognition and treatment are crucial interventions to influence its prognosis. Treatment is urgent and relies on key pillars such as hydration, correction of insulin deficiency, and electrolyte balance control. While these measures begin to take effect, we must also provide supportive measures, including oxygen therapy, which has a clear goal but no established indication. The objective of this narrative is to review the pathophysiological principles that explain the use of high-flow nasal cannula (HFNC) as part of supportive treatment in patients with DKA, extrapolating the benefits this device has demonstrated in various respiratory pathologies, using arguments based on the pathophysiological changes of this disease, which will be analyzed below.
La cetoacidosis diabética grave es una de las complicaciones con mayor tasa de mortalidad de la diabetes mellitus en cualquiera de sus formas de presentación, es de rápido rápida progresión y es por lo que el reconocerlo y el tratarlo precozmente, son intervenciones cruciales para influir en su pronóstico. El tratamiento es urgente y tiene pilares fundamentales, como lo son la hidratación, la corrección del déficit de insulina y el control hidroelectrolítico. Mientras estas medidas comienzan a hacer efecto, tenemos que proporcionar algunas medidas de soporte, entre ellas está la oxigenoterapia, la cual tiene un objetivo claro, pero no una indicación establecida. El objetivo de esta narrativa es revisar los principios fisiopatológicos que expliquen el uso de la cánula nasal de alto flujo (CNAF) como parte del tratamiento de soporte en pacientes con CAD, extrapolando los beneficios que este dispositivo ha demostrado en las distintas patologías respiratorias, utilizando argumentos basados en los cambios fisiopatológicos de esta enfermedad, los cuales se analizaran a continuación.
Subject(s)
Humans , Male , Young Adult , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/diagnosis , Respiratory Insufficiency , Acidosis , Diabetic Ketoacidosis/physiopathology , Diabetic Ketoacidosis/therapy , Fluid Therapy/methods , CannulaABSTRACT
Introducción. La fluidoterapia es una intervención ampliamente usada en la práctica clínica. No obstante, su aplicación no está exenta de riesgos y demanda una evaluación cuidadosa de la tolerancia del paciente y su respuesta al volumen. La práctica empírica de la reanimación con líquidos puede ser potencialmente letal. El propósito de esta revisión fue proporcionar una visión general de los principios fisiológicos y terapéuticos para la administración de líquidos intravenosos en pacientes críticamente enfermos, abordando poblaciones especiales, como los pacientes quirúrgicos, sépticos y politraumatizados. Métodos. Se hizo una revisión narrativa a partir de artículos publicados en PUBMED, ScienceDirect y LILACS, entre 2001 y 2023. Para la búsqueda se emplearon los términos MESH fluid therapy, crystalloid solutions y colloids. Resultados. Se encontraron 371 artículos, de los cuales se seleccionaron los estudios clínicos aleatorizados, las revisiones narrativas, las revisiones sistemáticas y los metaanálisis que analizaron el rol de los cristaloides y coloides. Se incluyeron manuscritos publicados en fechas por fuera del rango de búsqueda, que se consideraron relevantes para la descripción de la fisiopatología y los fundamentos del uso de líquidos endovenosos. Conclusión. La reanimación reflexiva se fundamenta en un entendimiento holístico de la fisiología y la individualización de la fluidoterapia. El uso liberal de líquidos endovenosos tiene potenciales efectos nocivos y las estrategias de reanimación deben ser guiadas por medidas dinámicas y estáticas individuales, que proporcionan un panorama seguro para el manejo de los líquidos.
Introduction. Fluid therapy is an intervention widely used in clinical practice. However, its application is not without risks and requires a careful evaluation of patient's tolerance and response to volume. The empirical practice of fluid resuscitation can be potentially lethal. The purpose of this review was to provide an overview of the physiological and therapeutic principles for the administration of intravenous fluids in critically ill patients, addressing special populations, such as surgical, septic, and trauma patients. Methods. A narrative review was carried out based on articles published in PUBMED, ScienceDirect, and LILACS between 2001 and 2023. MESH terms fluid therapy, crystalloid solutions, and colloids were employed. Results. A total of 371 articles were found, of which randomized clinical trials studies, narrative reviews, systematic reviews, and meta-analyses that analyzed the role of crystalloids and colloids were selected. Manuscripts published on dates outside the search range, which were considered relevant for the description of the pathophysiology and the rationale for the use of intravenous fluids, were included. Conclusion. Reflective resuscitation is based on a holistic understanding of physiology and individualization of fluid therapy. The liberal use of intravenous fluids has potential harmful effects and resuscitation strategies should be guided by individual dynamic and static measures, which provide a safe framework for fluid management
Subject(s)
Humans , Extracellular Fluid , Fluid Therapy , Colloids , Glycocalyx , Crystalloid SolutionsABSTRACT
La rabdomiólisis es un "síndrome" clínico y de datos de laboratorio, con destrucción del músculo esquelético. Puede ser ocasionado por diversos factores: lesión muscular; ingesta de medicamentos y tóxicos, o aumento de la actividad muscular y herencia. La presentación del cuadro es muy variable, desde casos asintomáticos hasta los de mayor severidad, incluida la muerte. Las complicaciones pueden ser: insuficiencia renal aguda, trastornos en la conducción eléctrica cardíaca, fallo multisistémico, coagulación intravascular diseminada y alteraciones del medio interno. La evolución depende de la precocidad del diagnóstico y el tratamiento adecuado. También el seguimiento posterior y el reinicio del ejercicio progresivo podrá evitar recidivas. (AU)
Rhabdomyolysis is a clinical and laboratory "syndrome" involving the destruction of skeletal muscle. It can be caused by several factors: muscle injury, drug and toxic ingestion, or increased muscle activity and heredity. The presentation is very variable, ranging from asymptomatic cases to those of greater severity, including death. Complications may include acute renal failure, cardiac conduction disturbances, multisystem failure, disseminated intravascular coagulation, and changes in the internal environment. Outcome depends on early diagnosis and appropriate treatment. Subsequent follow-up resumption of progressive exercise may also prevent recurrences. (AU)
Subject(s)
Humans , Male , Young Adult , Rhabdomyolysis/diagnosis , Rhabdomyolysis/therapy , Musculoskeletal Diseases/complications , Rhabdomyolysis/etiology , Exercise , Early Diagnosis , Fluid TherapyABSTRACT
Objetivos gerais: construir um protótipo semi-funcional do dispositivo de hidratação subcutânea e avaliar a sua usabilidade. Objetivos específicos: avaliar a eficácia do protótipo do dispositivo de hidratação subcutânea; medir a satisfação do enfermeiro em relação ao protótipo do dispositivo de hidratação subcutânea e verificar a intenção de uso do protótipo do dispositivo de hidratação subcutânea. Método: estudo de natureza descritiva e exploratória, com abordagem qualitativa e quantitativa. O estudo parte de um aprimoramento de uma tecnologia em saúde, um modelo de utilidade nacional que possui o intuito de realizar a administração de soro fisiológico no tecido subcutâneo. Os dados foram coletados em quatro etapas sequenciais. A primeira etapa foi a construção do protótipo do dispositivo de hidratação subcutânea, a partir da utilização de dispositivos disponíveis no mercado; a segunda etapa foi um grupo focal com profissionais da área da saúde; a terceira etapa foi a testagem do protótipo em ambiente simulado com os objetivos de realizar a punção subcutânea e a administração de soro fisiológico no tecido subcutâneo com o uso do protótipo do dispositivo de hidratação subcutânea e entrevista semiestruturada; a quarta etapa foi um grupo focal com enfermeiros que realizaram a testagem em ambiente simulado. O estudo seguiu a análise de conteúdo temática. Resultados: por meio das etapas foi possível realizar a prototipagem do dispositivo de hidratação subcutânea e agregar informações e ideias de forma ampla acerca do protótipo; estabelecer os parâmetros de usabilidade do protótipo: eficácia, satisfação e intenção de uso, e captar recomendações para o seu aprimoramento. Conclusão: o processo de prototipagem foi uma estratégia positiva para o aprimoramento do dispositivo de hidratação subcutânea, e a avaliação de usabilidade foi profícua, estabelecendo que o protótipo é eficaz, que satisfaz os enfermeiros e que possui intenção de uso e incorporação em seu ambiente de trabalho.
General objectives: to build a semi-functional prototype of the subcutaneous hydration device and evaluate its usability. Specific objectives: to evaluate the effectiveness of the hydration device and evaluate its usability prototype; to measure nurse satisfaction with the hydration device and evaluate its usability prototype and to assess the intention to use the hydration device and evaluate its usability prototype. Method: a descriptive and exploratory study, with a qualitative and quantitative approach. The study is based on the improvement of a health technology, a national utility model aimed at administering saline solution subcutaneously. Data were collected in four stages (sequentially). The first stage was the construction of the hydration device and evaluate its usability prototype, which used devices available on the market; the second stage was a focus group with healthcare professionals; the third stage was the testing of the prototype in a simulated environment with the objectives of performing subcutaneous puncture and administering saline solution subcutaneously using the hydration device and evaluate its usability prototype and a semi-structured interview; the fourth stage was a focus group with nurses who performed the testing in a simulated environment. The study followed thematic content analysis. Results: through the stages, it was possible to prototype the hydration device and evaluate its usability and gather comprehensive information and ideas about the prototype; establish usability parameters of the prototype: effectiveness, satisfaction, and intention to use, and gather recommendations for its improvement. Conclusion: the prototyping process was a positive strategy for the improvement of the hydration device and evaluate its usability, and the usability assessment was fruitful, establishing that the prototype is effective, satisfies nurses, and has intention of use and incorporation into their work environment.
Objetivos generales: construir un prototipo semifuncional del dispositivo de hidratación subcutánea y evaluar su usabilidad. Objetivos específicos: evaluar la eficacia del prototipo del dispositivo de hidratación subcutánea; medir la satisfacción del enfermero respecto al prototipo del dispositivo de hidratación subcutánea y verificar la intención de uso del prototipo del dispositivo de hidratación subcutánea. Método: estudio de naturaleza descriptiva y exploratoria, con enfoque cualitativo y cuantitativo. El estudio parte de un perfeccionamiento de una tecnología en salud, un modelo de utilidad nacional que tiene como objetivo administrar suero fisiológico en el tejido subcutáneo. Los datos se recopilaron en cuatro etapas (secuencialmente). La primera etapa fue la construcción del prototipo del dispositivo de hidratación subcutánea, que utilizó dispositivos disponibles en el mercado; la segunda etapa fue un grupo focal con profesionales del área de la salud; la tercera etapa fue la prueba del prototipo en un entorno simulado con el objetivo de realizar la punción subcutánea y la administración de suero fisiológico en el tejido subcutáneo con el uso del prototipo del dispositivo de hidratación subcutánea y una entrevista semiestructurada; la cuarta fue un grupo focal con enfermeros que realizaron la prueba en un entorno simulado. El estudio siguió el análisis de contenido temático. Resultados: a través de las etapas fue posible realizar la prototipación del dispositivo de hidratación subcutánea y agregar información e ideas de manera amplia sobre el prototipo; establecer los parámetros de usabilidad del prototipo: eficacia, satisfacción e intención de uso, y obtener recomendaciones para su perfeccionamiento. Conclusión: el proceso de prototipado fue una estrategia positiva para el perfeccionamiento del dispositivo de hidratación subcutánea, y la evaluación de usabilidad fue fructífera, estableciendo que el prototipo es eficaz, que satisface a los enfermeros y que tiene intención de uso e incorporación en su entorno laboral.
Subject(s)
Fluid Therapy , Biomedical Technology , Nursing CareABSTRACT
Introdução: A administração de fluidos é muitas vezes realizada no Acidente Vascular Encefálico isquêmico (AVEi) agudo. Permanecem controvérsias em relação ao efeito de diferentes concentrações de sódio em fluidos administrados após AVEi, bem como seu impacto em órgãos a distância. Nosso objetivo foi comparar os efeitos de quatro tipos de fluidos [solução salina isotônica 0,9% (ISO), solução salina hipotônica 0,45% (HIPO), solução salina hipertônica 1,5% (HIPER) e glicose 5% (GLICO)] nas áreas perilesionais do cérebro, bem como nos pulmões e rins após AVEi. Métodos: 28 ratos Wistar machos (peso 375 ± 23 g) foram submetidos à indução de AVEi por termocoagulação dos vasos piais no córtex sensório-motor primário direito. Após 3h, os animais foram anestesiados e aleatoriamente designados para receber um dos quatro tipos de fluidos, no qual foram infundidos por duas horas. Durante a infusão dos fluidos, os animais foram mecanicamente ventilados de forma protetora. A gasometria arterial e a função pulmonar foram mensuradas ao longo do experimento. Ao final do experimento, os pulmões, o tecido cerebral e os rins foram removidos para análise histológica e de biologia molecular, além da urina e plasma para análise de bioquímica. Resultados: Na histologia pulmonar, o grupo ISO apresentou menor colapso alveolar, comparado ao HIPER (p=0,01) e menor edema, comparado ao HIPO (p=0,007). O grupo ISO apresentou menor expressão de interleucina (IL)-1ß no tecido pulmonar em comparação ao HIPO (p=0,027), enquanto o fator de crescimento endotelial vascular (VEGF) e a aquaporina (AQP)-5 foram mais expressos no grupo ISO, em comparação ao GLICO (p= 0,0151 e p=0,0109, respectivamente). A histoarquitetura cerebral demonstrou aumento de versican e hialuronano no grupo ISO em comparação ao grupo HIPER (p=0,022 e p=0,018, respectivamente). O grupo HIPER apresentou maior expressão de IL-1ß, moleÌcula de adesaÌo celular vascular-1 (VCAM-1) e zônula oclusão (ZO)-1 no cérebro, em comparação ao grupo GLICO (p=0,01, p=0,02, p=0,006, respectivamente). A expressão cerebral de IL-1ß foi maior em ISO e HIPER do que em GLICO (p = 0,01). No rim, os grupos ISO e HIPO induziram menor lesão das bordas em escova, comparados ao HIPER (p=0,007 e p=0,032, respectivamente). A expressão renal de lipocalina associada à gelatinase de neutrófilos (NGAL) foi maior no grupo GLICO, comparado ao grupo HIPO (p=0,007). As concentrações de cloreto nas amostras de sangue diminuíram ao longo do tempo durante os experimentos em ISO, em comparação aos grupos HIPO, HIPER e GLICO (p=0,031, p=0,001 e p=0,021). O grupo HIPO aumentou a creatinina e a osmolaridade urinária, em comparação ao HIPER (p<0,0001 e p=0,0027, respectivamente). Conclusões: O fluido isotônico causa menos lesões cerebrais, pulmonares e renais no AVEi experimental.(AU)
Background: Fluid administration is used many times in acute ischemic stroke (AIS). Controversies remain regarding the effect of different sodium concentrations in fluids administered after AIS as well as their impact on distal organ function. We aimed to compare the effects of four types of fluids [isotonic 0.9% saline (ISO), hypotonic 0.45% saline (HYPO), hypertonic 1.5% saline (HYPER) and glucose 5% (GLUCO)] on the perilesional areas of the brain, as well as on lung, and kidneys after AIS. Methods: AIS was induced in 28 male Wistar rats and, after 3 hours, animals were randomized to receive one of the four types of fluids. Results: In lung histology, ISO group showed less alveolar collapse, compared to HYPER (p=0.01) and less edema, compared to HYPO (p=0.007). ISO group presented lower interleukin (IL)-1ß expression in lung tissue compared to HYPO (p=0.027), whereas vascular endothelial growth factor (VEGF) and aquaporin (AQP)-5 were more pronounced in ISO, compared to GLUCO (p=0.0151 and p=0.0109, respectively). The brain histoarchitecture demonstrated an increase of versican and hyaluronan in ISO group compared to HYPER group (p=0.022 and p=0.018, respectively). HYPER group presented higher IL-1ß, vascular cell adhesion molecule-1 (VCAM-1) and zonula occludens (ZO)-1 expression in brain, compared to GLUCO group (p=0.01, p=0.02, p=0.006, respectively). IL1ßbrain expression was higher in ISO and HYPER than GLUCO (p=0.01). In kidney, ISO and HYPO groups induced less injury of the brush borders, compared to HYPER (p=0.007 and p=0.032, respectively). Neutrophil gelatinase-associated lipocalin (NGAL) renal expression was higher in GLUCO group, compared to HYPO (p=0.007). The chloride concentrations in blood samples decreased over time during experiments in ISO, compared to HYPO, HYPER and GLUCO groups (p=0.031, p=0.001 and p=0.021). HYPO group increased urine creatinine and osmolality, compared to HYPER (p<0.0001 and p=0.0027, respectively).Conclusion: Isotonic fluid causes less brain, lungs, and kidneys injury in experimental AIS.(AU)
Subject(s)
Rats , Respiratory Function Tests , Sodium , Blood Gas Analysis , Brain Injuries , Stroke , Fluid Therapy , Kidney Function Tests , Models, AnimalABSTRACT
Introducción: la enfermedad diarreica aguda (EDA) produce elevada morbimortalidad en la edad pediátrica. Aunque existen directrices para ayudar a los médicos para su manejo, en ocasiones estas no se cumplen. Objetivo: Investigar el manejo ambulatorio de la EDA en menores de 5 años por personal de atención pediátrico venezolano. Métodos: estudio observacional, analítico, de corte transversal. Se realizó una encuesta con aplicación en línea. Se indagó: edad, sexo, lugar de trabajo, tiempo desde la última actualización en manejo de diarrea, indicación de tratamientos farmacológicos y medidas de prevención e higiene. Se evaluó la asociación entre prescripciones farmacológicas y características de los encuestados. Resultados: un total de 221 médicos respondieron la encuesta, 43,0% pediatras, edad promedio 41,9 ± 14,15; 70,1 % femeninos; lugar de trabajo mixto (público y privado) 42,1%; tiempo de actualización 83,3% menos de 5 años; 59,2% consultaba consensos o guías. El 81,4% prescribió sales de rehidratación oral ((sro), leche humana 78,7%, realimentación precoz 43,8%, zinc 23,9%, probióticos 52,9%, antieméticos 65,6%; lavado de manos 93,2%. tener >40 años se asoció con prescribir antieméticos y trabajar en consulta privada, (or= 2,4; 1,4-4,3 y or= 0,5; 0,3-0,9), antiácidos e inhibidores de la secreción gástrica (or= 2,6; 1,3-4,9 y or= 0,4; 0,2-0,7; respectivamente), mientras los probióticos (or=1,4: 0,7-2,9) y zinc (or= 1,8; 1,0-3,0) con guardias en instituciones públicas (or= 1,9; 95%: 1,0-3,4). Conclusión: nuestro estudio respalda la necesidad de una mayor evaluación y estrategias de implementación de las pautas ESPGHAN/FLSPGHAN /SVPP(AU)
Introduction: Acute diarrheal disease (ADD) produces high morbidity and mortality in pediatric age. Although guidelines for appropriate management are available, these are not always followed. Objective: to investigate the outpatient management of ADD in children under 5 years of age by venezuelan pediatric care personnel. methods: observational, analytical, cross-sectional study. A survey was carried out with an online application. The following data were registered: age, sex, workplace, time since the last update in management of diarrhea, indication for pharmacological treatments and prevention/hygiene measures. The association between pharmacological prescriptions and characteristics of the respondents was evaluated. Results: A total of 221 doctors responded the survey: 43.0% pediatricians, average age 41.9 ± 14.15; 70.1% female; mixed workplace (public and private) 42.1%; time since the last update 83.3 %, less than 5 years. 59.2% consulted consensus or guideliness. 81.4% prescribed oral rehydration salts (ORS), human milk 78.7%, early refeeding 43.8%, zinc 23.9%, probiotics 52.9%, antiemetics 65.6%, hand washing 93.2%. being >40 years old was associated with prescribing antiemetics and working in private practice, (or= 2.4; 1.4-4.3 and or= 0.5; 0.3-0.9), antacids and gastric secretion inhibitors (or= 2.6; 1.3-4.9 and or= 0.4; 0.2-0.7; respectively), while probiotics (or=1.4: 0. 7-2.9) and zinc (or= 1.8; 1.0-3.0) with night shifts in public institutions (or= 1.9; 95%: 1.0-3.4). Conclusion: our study supports the need for further evaluation and implementation strategies of the ESPGHAN/FLSPGHAN /SVPP guidelines(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Outpatients , Indicators of Morbidity and Mortality , Dysentery/mortality , Hand Disinfection , Cross-Sectional Studies , Surveys and Questionnaires , Fluid Therapy , Pediatricians , AntidiarrhealsABSTRACT
Estimado editor: Los albores del año 2020 le depararon a la humanidad una terrible sorpresa: se reportaban los primeros casos de la posteriormente famosa COVID-19, una enfermedad, cuyo estrepitoso avance la convirtió en una pandemia declarada el 11 de marzo de 2020.1 Desde entonces, muchas han sido las estrategias destinadas a paliar sus efectos deletéreos. Ciertamente, fueron apareciendo esperanzadoras medidas sanitarias, unas con mayor éxito o acogida que otras, pero sin el suficiente respaldo científico como para avalar su uso y convertirse en la estrategia ideal. De ellas, algunas ya validadas para el tratamiento de pacientes críticos, como lo son la ventilación-oxigenoterapia (V), la infusión de líquidos-fluidoterapia (I) y la pronación (P), también fueron parte del intento. A ellas serán dedicadas estas líneas de reflexión...(AU)
Subject(s)
Humans , Male , Female , Oxygen Inhalation Therapy/methods , Pronation , Fluid Therapy/methods , COVID-19/epidemiologyABSTRACT
La técnica anestésica de elección para operación cesárea es la anestesia subaracnoidea. La hipotensión el efecto adverso más frecuente de esta técnica anestésica y está relacionada con efectos deletéreos maternos y fetales que puede llegar a ocasionar graves complicaciones. Por esta razón es importante conocer las complicaciones y la aproximación terapéutica de la hipotensión materna, para disminuir la morbilidad y mortalidad del binomio materno-fetal. Las medidas para disminuir la hipotensión materna posterior al bloqueo subaracnoideo, tanto en el número de casos como en severidad de la misma son varias, pero la carga de fluidos se ha convertido en la piedra angular en la profilaxis de la hipotensión. 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 en sus diferentes modalidades (precarga con coloides o cristaloides, cocarga con coloides o cristaloides), ninguna parece ser totalmente efectiva como monoterapia. El enfoque para la prevención y el tratamiento de la hipotensión debe ser multimodal. 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...(AU)
Subject(s)
Humans , Female , Pregnancy , Fluid Therapy , Cesarean Section/methods , Anesthesia/methodsABSTRACT
Contexto e Objetivo: Ingestão de água com espessante diminui a aspiração para vias aéreas em pacientes com disfagia orofaríngea, entretanto pode causar dificuldade na ingestão. Nosso objetivo foi avaliar, em pessoas saudáveis, a influência da obesidade, idade e sexo na ingestão de água espessada. Desenho e local: Estudo transversal realizado em amostra de conveniência na Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Método: Ingestão de água sem e com espessante foi avaliada em 75 indivíduos saudáveis (42 mulheres) com idades entre 18 e 62 anos, pelo teste de ingestão de água, com os voluntários ingerindo 100 ml de água na temperatura ambiente, sem e com 2,4 g de espessante alimentar. Foram medidos o tempo para ingerir todo o volume, o número de deglutições, e calculados o fluxo de ingestão e o volume em cada deglutição, com os voluntários indicando a sensação e a dificuldade na ingestão. Resultados: Com espessante, o fluxo de ingestão e o volume em cada deglutição foram menores, e houve maior dificuldade e pior sensação durante a ingestão. Obesidade e idade não influenciaram a ingestão. As mulheres tiveram menor fluxo de ingestão que os homens. Discussão: A utilização de água espessada em pacientes com disfagia pode ter dificuldades que comprometem a hidratação. Alteração do sabor e temperatura do líquido podem facilitar a ingestão. Conclusão: A ingestão de água em pessoas saudáveis tem influência da consistência e do sexo dos indivíduos, sem influência de idade ou obesidade.
Subject(s)
Deglutition Disorders , Deglutition , Dehydration , Drinking , Fluid TherapyABSTRACT
Objective: Evaluate the effects of alternative therapy on the hematological profiles of different families of captive snakes. Methodology: Captive snakes at NUROF-UFC were submitted to a clinical and hematological evaluation before and after applying an alternative treatment, including systematic sunbathing and hydration by soaking bathes twice a week for five weeks. The biometric, clinical, and hematological data were compared by multivariate analysis of variance and investigated for possible causal relationships by general linear models. Results: A significant difference was observed between erythrograms and global leukograms in the three families of snakes evaluated before and after treatment. The significant reduction in the heterophil: lymphocyte ratio in the Family Colubridae after treatment was noteworthy. Discussion: The results were most likely due to stress level reduction by improving thermoregulation and conversion of vitamin D during sunbathing, oral rehydration and refreshing in soaking baths, and general metabolic rates due to physical exercise. Conclusion: The results confirm the initial hypothesis, assuming that a simple but systematic treatment that included sunlight exposure and immersion hydration was efficient in reducing stress rates.
Objetivo: Avaliar a influência de banhos de sol e de imersão em água nos perfis hematológicos de serpentes cativas, antes e após a aplicação deste tratamento alternativo. Metodologia: Serpentes cativas no NUROF-UFC foram submetidas à avaliação clínica e hematológica, depois submetidas ao tratamento alternativo por cinco semanas, sendo novamente avaliadas após. Os dados obtidos foram submetidos à análise estatística multivariada (NPMANOVA e GLM) para investigação de possíveis relações causais entre o tratamento e os perfis hematológicos. Resultados: Foi observada diferença significativa entre os eritrogramas e leucogramas nas três famílias de serpentes avaliadas antes e após o tratamento. Ressalta-se a redução significativa na razão heterófilos:linfócitos na Família Colubridae após o tratamento. Discussão: A diferença estatística deveu-se provavelmente à redução nos níveis de estresse, possibilitada por aquecimento e aumento de conversão da vitamina D durante a exposição solar; reidratação oral e refrescância nos banhos de imersão, e ao recondicionamento pelo exercício físico. Conclusão: Os resultados confirmaram a hipótese inicial, admitindo que um tratamento alternativo, simples mas aplicado sistematicamente, que incluiu exposição à luz solar e hidratação por imersão em água foi eficiente em reduzir as taxas de estresse em serpentes cativas.
Subject(s)
Hematology , Reptiles , Snakes , Sunbathing , Fluid TherapyABSTRACT
Critical care ultrasound has many operational advantages such as visualization, reproducibility, noninvasiveness, and real-time dynamic monitoring, and is now widely used in the treatment process of various clinical diseases. Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. On the basis of active anti-infection, early administration of fluid resuscitation to maintain organ tissue perfusion and individualized adjustment of volume management is the core of improving patient prognosis and reducing mortality. Currently, there are many shortcomings in the commonly used clinical physical examination and static parameters to assess volume status. Critical care ultrasound has many advantages in volume management of sepsis due to its diversified advantages, which promoted the development of critical care medicine. This article presents a review of critical care ultrasound in volume management in sepsis, aiming to highlight the value and limitations of the application of critical care ultrasound in volume management in sepsis.
Subject(s)
Humans , Reproducibility of Results , Sepsis/therapy , Critical Care , Fluid TherapyABSTRACT
BACKGROUND@#After major liver resection, the volume status of patients is still undetermined. However, few concerns have been raised about postoperative fluid management. We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection (LLR) with or without inferior vena cava (IVC) respiratory variability-directed fluid therapy in the anesthesia intensive care unit (AICU).@*METHODS@#This randomized controlled clinical trial enrolled 70 patients undergoing LLR. The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU, while the standard practice of fluid management was used for the control group. The primary outcome was the time to flatus after surgery. The secondary outcomes included other indicators of gut function recovery after surgery, postoperative length of hospital stay (LOS), liver and kidney function, the severity of oxidative stress, and the incidence of severe complications associated with hepatectomy.@*RESULTS@#Compared with patients receiving standard fluid management, patients in the intervention group had a shorter time to anal exhaust after surgery (1.5 ± 0.6 days vs. 2.0 ± 0.8 days) and lower C-reactive protein activity (21.4 [95% confidence interval (CI): 11.9-36.7] mg/L vs. 44.8 [95%CI: 26.9-63.1] mg/L) 24 h after surgery. There were no significant differences in the time to defecation, serum concentrations of D -lactic acid, malondialdehyde, renal function, and frequency of severe postoperative complications as well as the LOS between the groups.@*CONCLUSION@#Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR.@*TRIAL REGISTRATION@#ChiCTR-INR-17013093.
Subject(s)
Humans , Hepatectomy , Vena Cava, Inferior/surgery , Liver , Laparoscopy , Fluid TherapyABSTRACT
BACKGROUND@#Early fluid resuscitation is one of the fundamental treatments for acute pancreatitis (AP), but there is no consensus on the optimal fluid rate. This systematic review and meta-analysis aimed to compare the efficacy and safety of aggressive vs. controlled fluid resuscitation (CFR) in AP.@*METHODS@#The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science databases were searched up to September 30, 2022, for randomized controlled trials (RCTs) comparing aggressive with controlled rates of early fluid resuscitation in AP patients without organ failure on admission. The following keywords were used in the search strategy: "pancreatitis," "fluid therapy,""fluid resuscitation,"and "randomized controlled trial." There was no language restriction. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the certainty of evidence. Trial sequential analysis (TSA) was used to control the risk of random errors and assess the conclusions.@*RESULTS@#A total of five RCTs, involving 481 participants, were included in this study. For primary outcomes, there was no significant difference in the development of severe AP (relative risk [RR]: 1.87, 95% confidence interval [CI] 0.95-3.68; P = 0.07; n = 437; moderate quality of evidence) or hypovolemia (RR: 0.98, 95% CI: 0.32-2.97; P = 0.97; n = 437; moderate quality of evidence) between the aggressive and CFR groups. A significantly higher risk of fluid overload (RR: 3.25, 95% CI: 1.53-6.93; P <0.01; n = 249; low quality of evidence) was observed in the aggressive fluid resuscitation (AFR) group than the controlled group. Additionally, the risk of intensive care unit admission ( P = 0.02) and the length of hospital stay ( P <0.01) as partial secondary outcomes were higher in the AFR group. TSA suggested that more studies were required to draw precise conclusions.@*CONCLUSION@#For AP patients without organ failure on admission, CFR may be superior to AFR with respect to both efficacy and safety outcomes.@*REGISTRATION@#PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; CRD 42022363945.
Subject(s)
Humans , Randomized Controlled Trials as Topic , Fluid Therapy , Hypovolemia , Pancreatitis/therapyABSTRACT
Objective Although goal-directed fluid therapy (GDFT) has been proven to be effective in reducing the incidence of postoperative complications, the underlying mechanisms remain unknown. The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications. We further tested the role of this mediation effect using mean arterial pressure, a hemodynamic indicator. Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis. We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications. We conducted mediation analysis using the mediation package in R (version 3.1.2), based on 5,000 bootstrapped samples, adjusting for covariates. Results Among the 300 patients in the study, 40% (120/300) developed postoperative complications within 30 days. GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders (odds ratio: 0.460, 95% CI: 0.278, 0.761; P = 0.003). The total effect of GDFT on postoperative complications was -0.18 (95% CI: -0.28, -0.07; P < 0.01). The average causal mediation effect was -0.08 (95% CI: -0.15, -0.04; P < 0.01). The average direct effect was -0.09 (95% CI: -0.20, 0.03; P = 0.17). The proportion mediated was 49.9% (95% CI: 18.3%, 140.0%). Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications. Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.
Subject(s)
Humans , Blood Pressure , Goals , Postoperative Complications/epidemiology , Hemodynamics , Fluid Therapy/methodsABSTRACT
Objective: To investigate the scientificity and feasibility of the ten-fold rehydration formula for emergency resuscitation of pediatric patients after extensive burns. Methods: A retrospective observational study was conducted. The total burn area of 30%-100% total body surface area (TBSA) and body weight of 6-50 kg in 433 pediatric patients (250 males and 183 females, aged 3 months to 14 years) with extensive burns who met the inclusion criteria and admitted to the burn departments of 72 Class A tertiary hospitals were collected. The 6 319 pairs of simulated data were constructed after pairing each body weight of 6-50 kg (programmed in steps of 0.5 kg) and each total burn area of 30%-100% TBSA (programmed in steps of 1%TBSA). They were put into three accepted pediatric rehydration formulae, namely the commonly used domestic pediatric rehydration formula for burn patients (hereinafter referred to as the domestic rehydration formula), the Galveston formula, and the Cincinnati formula, and the two rehydration formulae for pediatric emergency, namely the simplified resuscitation formula for emergency care of patients with extensive burns proposed by the World Health Organization's Technical Working Group on Burns (TWGB, hereinafter referred to as the TWGB formula) and the pediatric ten-fold rehydration formula proposed by the author of this article--rehydration rate (mL/h)=body weight (kg) × 10 (mL·kg-1·h-1) to calculate the rehydration rate within 8 h post injury (hereinafter referred to as the rehydration rate). The range of the results of the 3 accepted pediatric rehydration formulae ±20% were regarded as the reasonable rehydration rate, and the accuracy rates of rehydration rate calculated using the two pediatric emergency rehydration formulae were compared. Using the maximum burn areas (55% and 85% TBSA) corresponding to the reasonable rehydration rate calculated by the pediatric ten-fold rehydration formula at the body weight of 6 and 50 kg respectively, the total burn area of 30% to 100% TBSA was divided into 3 segments and the accuracy rates of the rehydration rate calculated using the 2 pediatric emergency rehydration formulae in each segment were compared. When neither of the rehydration rates calculated by the 2 pediatric emergency rehydration formulae was reasonable, the differences between the two rehydration rates were compared. The distribution of 433 pediatric patients in the 3 previous total burn area segments was counted and the accuracy rates of the rehydration rate calculated using the 2 pediatric emergency rehydration formulae were calculated and compared. Data were statistically analyzed with McNemar test. Results: Substitution of 6 319 pairs of simulated data showed that the accuracy rates of the rehydration rates calculated by the pediatric ten-fold rehydration formula was 73.92% (4 671/6 319), which was significantly higher than 4.02% (254/6 319) of the TWGB formula (χ2=6 490.88,P<0.05). When the total burn area was 30%-55% and 56%-85% TBSA, the accuracy rates of the rehydration rates calculated by the pediatric ten-fold rehydration formula were 100% (2 314/2 314) and 88.28% (2 357/2 670), respectively, which were significantly higher than 10.98% (254/2 314) and 0 (0/2 670) of the TWGB formula (with χ2 values of 3 712.49 and 4 227.97, respectively, P<0.05); when the total burn area was 86%-100% TBSA, the accuracy rates of the rehydration rates calculated by the pediatric ten-fold rehydration formula and the TWGB formula were 0 (0/1 335). When the rehydration rates calculated by the 2 pediatric emergency rehydration formulae were unreasonable, the rehydration rates calculated by the pediatric ten-fold rehydration formula were all higher than those of the TWGB formula. There were 93.07% (403/433), 5.77% (25/433), and 1.15% (5/433) patients in the 433 pediatric patients had total burn area of 30%-55%, 56%-85%, and 86%-100% TBSA, respectively, and the accuracy rate of the rehydration rate calculated using the pediatric ten-fold rehydration formula was 97.69% (423/433), which was significantly higher than 0 (0/433) of the TWGB formula (χ2=826.90, P<0.05). Conclusions: The application of the pediatric ten-fold rehydration formula to estimate the rehydration rate of pediatric patients after extensive burns is more accurate and convenient, superior to the TWGB formula, suitable for application by front-line healthcare workers that are not specialized in burns in pre-admission rescue of pediatric patients with extensive burns, and is worthy of promotion.
Subject(s)
Male , Female , Humans , Child , Burns/therapy , Hospitalization , Resuscitation , Fluid Therapy/methods , Body Surface Area , Retrospective StudiesABSTRACT
La esofagitis necrotizante aguda es un trastorno poco común que puede ser causa de hemorragia digestiva alta. Predomina en el sexo masculino en la sexta década de la vida. El diagnóstico es endoscópico y muestra una mucosa esofágica de apariencia negra que afecta al esófago distal en toda su circunferencia y se detiene abruptamente en la unión gastroesofágica. Clínicamente suele presentarse con hematemesis y melenas, shock hipovolémico por sangrado masivo, siendo otras manifestaciones el dolor epigástrico, molestia retroesternal y disfagia. Se vincula a pacientes con antecedentes de enfermedad cardiovascular, alcoholismo, diabetes mellitus, desnutrición, hernia hiatal, estenosis gastroduodenal, cáncer, así como pacientes en shock, traumatizados, sometidos a cirugía mayor e inmunosuprimidos. El tratamiento se basa en fluidoterapia, inhibidores de la bomba de protones y suspensión de la vía oral, siendo controvertido el uso de antibioticoterapia. Su pronóstico es malo y dependerá de la gravedad de la enfermedad esofágica y del terreno del paciente, con una mortalidad de hasta el 36 %. Presentamos el caso clínico de un paciente de 81 años, hipertenso, que presenta hematemesis, confirmándose en la endoscopía una esofagitis necrotizante aguda, que evoluciona favorablemente con tratamiento médico.
Acute necrotizing esophagitis is a rare disorder that can cause upper gastrointestinal bleeding. It predominates in males in the sixth decade of life. The diagnosis is endoscopic and shows a black-appearing esophageal mucosa that affects the entire circumference of the distal esophagus and stops abruptly at the gastroesophageal junction. Usually, patients present with hematemesis and melena, with other manifestations such as epigastric pain, retrosternal discomfort, dysphagia, and hypovolemic shock. Almost all patients reported comorbidities: cardiovascular disease, alcoholism, diabetes mellitus, malnutrition, hiatal hernia, gastroduodenal stenosis, and malignant neoplasia; is related as well to patients with shock, trauma, undergoing major surgery, and immunosuppression. The treatment is based on fluid reposition, proton pump inhibitors and suspension of the oral route, the use of antibiotic therapy being controversial. Its prognosis is poor and will depend on the severity of the esophageal disease and the patient comorbidities, with a mortality rate up to 36 %. Case: A 81-year-old male patient with hypertension, who presented hematemesis, confirmed by endoscopy as acute necrotizing esophagitis, whose evolution was favorable with medical treatment.
A esofagite necrosante aguda é uma doença rara que pode causar hemorragia digestiva alta. Predomina no sexo masculino na sexta década de vida. O diagnóstico é endoscópico e mostra uma mucosa esofágica circunferencial difusa com aspecto preto que envolve quase universalmente o esôfago distal e para abruptamente na junção gastroesofágica. Clinicamente, geralmente se apresenta com hematêmese e melena, com outras manifestações sendo dor epigástrica, desconforto retroesternal, disfagia e choque hipovolêmico. Está relacionado a pacientes com histórico de doenças cardiovasculares, alcoolismo, diabetes mellitus, desnutrição, hérnia hiatal, estenose gastroduodenal e neoplasia maligna, bem como pacientes em choque, trauma, cirurgia de grande porte e imunossupressão. O tratamento é a medicação dietética higiênica baseada em fluidoterapia, inibidores da bomba de prótons e suspensão da via oral, sendo o uso de antibioticoterapia controverso. Seu prognóstico é ruim e dependerá da gravidade da doença esofágica e do terreno do paciente, com mortalidade de até 36 %. Apresentamos o caso clínico de um paciente hipertenso de 81 anos que apresentou hematêmese, confirmada por endoscopia como esofagite necrosante aguda, que evoluiu favoravelmente com tratamento higiênico-dietético e medicamentoso.
Subject(s)
Humans , Male , Aged, 80 and over , Esophagitis/drug therapy , Esophagitis/diagnostic imaging , Proton Pump Inhibitors/therapeutic use , Fluid Therapy , Hematemesis/etiology , Acute Disease , Endoscopy, Gastrointestinal , Treatment Outcome , Esophagitis/complications , Octogenarians , Necrosis/etiologyABSTRACT
El aporte de fluidos constituye un elemento central en la atención del paciente pediátrico hospitalizado, existiendo aún controversias acerca de cuál es la composición óptima, la dosis adecuada y la mejor estrategia para administrar los mismos. El propósito de este artículo de actualización es brindar al médico que se desempeña en las diferentes áreas de la internación pediátrica, conceptos y enfoques terapéuticos que lo ayuden en la asistencia de los pacientes que por diversos motivos requieren la administración de fluidos endovenosos. La recomendación de utilizar cristaloides en la reanimación es casi uniforme. Se observa una clara tendencia al uso de soluciones isotónicas balanceadas para la reposición del déficit previo y el aporte de fluidos de mantenimiento. En relación a la dosis y a la estrategia, es generalizada la recomendación de un enfoque más restrictivo en el aporte de volumen, aún en los pacientes con shock, donde es necesario lograr un balance entre una resucitación efectiva y el riesgo de sobrecarga de fluidos. Respecto a la administración de albúmina al 20% en el paciente crítico con hipoalbuminemia, la evidencia existente es escasa y no permite formular recomendaciones. Sin embargo, es frecuente su uso en la práctica asistencial
Intravenous fluids administration is a central element in the care of hospitalized pediatric patients, and there are still controversies about what is the optimal composition, the appropriate dose, and the best strategy for their administration. The purpose of this narrative review is to provide the physicians who works in the different areas of pediatric hospitalization, concepts and therapeutic approaches that help them in the care of patients who for diverse reasons require administration of intravenous fluids. The recommendation to use crystalloids in resuscitation is almost uniform. There is a clear trend towards the use of balanced isotonic solutions to replace the previous deficit and the supply of maintenance fluids. In relation to the dose and strategy, the recommendation of a more restrictive approach in volume administration is generalized, even in patients with shock, where it is necessary to strike a balance between effective resuscitation and the risk of fluid overload. Regarding the administration of 20% albumin in critically ill patients with hypoalbuminemia, the existing evidence is scarce and does not allow recommendations to be formulated. However, it is frequently used in healthcare practice
Subject(s)
Humans , Child , Critical Care , Fluid Therapy , Shock/therapy , Electrolytes/administration & dosage , Hypotonic Solutions/administration & dosage , Isotonic Solutions/administration & dosageABSTRACT
Abstract Background Pancreaticoduodenectomy is associated with high morbidity. Many preoperative variables are risk factors for postoperative complications, but they are primarily non-modifiable. It is not clear whether an intraoperative goal-directed fluid regimen might be associated with fewer postoperative surgical complications compared to current conservative, non-goal-directed fluid practices. We hypothesize that the use of Systolic Volume Variation (SVV)-guided intraoperative fluid administration might be beneficial. Methods Data from 223 patients who underwent pancreaticoduodenectomy in our institution between 2015 and 2019 were reviewed. Patients were classified into two groups based on the use of intraoperative use of SVV to guide the administration of fluids. The decision to use SVV or not was made by the attending anesthesiologist. Subjects were classified into SVV-guided intraoperative fluid therapy (SVV group) and non-SVV-guided intraoperative fluid therapy (non-SVV group). Uni and multivariate regression analyses were conducted to determine if SVV-guided fluid therapy was significantly associated with a lower incidence of postoperative surgical complications, such as Postoperative Pancreatic Fistula (POPF), Delayed Gastric Emptying (DGE), among others, after adjusting for confounders. Results Baseline, demographic, and intraoperative characteristics were similar between SVV and non-SVV groups. In the multivariate analysis, the use of SVV guidance was significantly associated with fewer postoperative surgical complications (OR = 0.48; 95% CI 0.25-0.91; p= 0.025), even after adjusting for significant covariates, such as perioperative use of epidural, pancreatic gland parenchyma texture, and diameter of the pancreatic duct. Conclusions VV-guided intraoperative fluid administration might be associated with fewer postoperative surgical complications after pancreaticoduodenectomy.