Efficacy of Fluid Administration Followed by Lung Sonography in Hemodynamic Assessment in Acute Circulatory Failure in Critically Ill Patients

Background:Early recognition and appropriate treatment of shock have been shown to decrease mortality. Incorporation of bedside ultrasound in patients with undifferentiated shock allows for rapid evaluation ofreversible causes of shock and improves accurate diagnosis in undifferentiated hypotension. The aim of the present study was to evaluate efficacy of fluid administration followed by lung sonography in hemodynamic assessment in acute circulatory failure in critically ill patients.Materials and Methods: This prospective cohort controlled randomized study was carried out on 50 Critically ill Patients who had acute circulatory failure in intensive care unit Tanta university hospital Critically ill patients of either sex aged 21-60 years when mean blood pressure was below 65 mmHg were included. Patients have been uniformly distributed in2 categories, The patients assigned either to the Control Group (group I) or to the FALLS (fluid administration limited by lung sonography) protocol group (group II)Results:Comparison between two groups revealed that, the heart rate showed that heart rate is lower in group II in comparison to group I .Comparison between two groups revealed that, the mean arterial blood pressure changes showed that it is higher in group II in comparison to group I .Comparison between two groups revealed that, the Central venous pressure showed that no significant difference in the base line .Intensive care unit stay in group I rangedbetween 5 –11 days while in group II ranged between 3 –8 days .Survival analysis (Kaplan Mier curve), Mortality at 28 days found in group I mean 21.28 days with SE 1.898 and in group II mean 24 days with SE 1.64 with no significant difference in time but there was significant difference in number of mortalities as discussed before.Conclusion:We conclude from this study that bedside Lung Ultrasound has a good accuracy and superiority in assessment over other traditionally used methods for detecting early signs of pulmonary congestion and thus guides the fluid administration in shock management to decrease complications, mortality and intensive care stay

Preoperative restricted versus liberal fluid administration on perioperative safety for pancreatic surgery: a Meta-analysis / 中华外科杂志

Objective@#To assess the perioperative safety of preoperative restricted fluid administration and liberal fluid administration for pancreatic surgery.@*Methods@#The randomized controlled trials comparing restricted and liberal in pancreatic surgery were collected by searching the databases of PubMed, Embase and the Cochrane Library.Two reviewers independently selected studies according to the inclusion and exclusion criteria, then extracted the data and assessed the quality of included studies.Meta-analysis was performed by RevMan 5.3 software.@*Results@#A total of 4 studies involving 785 patients were finally included, with 396 cases in restricted group and 389 cases in liberal group.Results of Meta-analysis showed that there was no statistically significant difference between the two groups in terms of intraoperative blood loss, postoperative complications, mortality, reoperation in-hospital and length of stay(all P>0.05).@*Conclusion@#With regard to pancreatic surgery, restricted fluid administration do not have outstanding advantages.

Complicaciones hemodinámicas en el posoperatorio inmediato relacionadas con la reposición de volumen intraoperatorio / Hemodynamic complications related to intraoperative volume replacement in the immediate postoperative period

Introducción: la administración de fluidos durante el transoperatorio, tiene como premisa mantener un volumen intravascular adecuado para asegurar un equilibrio hidroelectrolítico y ácido-básico, y optimizar el transporte de oxígeno y la función de los factores de la coagulación. Objetivo: evaluar la relación entre la pauta de administración de fluidos como soluciones de reemplazo en el transoperatorio y la aparición de complicaciones hemodinámicas en el posoperatorio inmediato. Método: se realizó un estudio prospectivo, descriptivo, de corte transversal con una revisión exhaustiva de las historias clínicas a los pacientes que recibieron tratamiento quirúrgico en el Hospital Clínicoquirúrgico "Hermanos Ameijeiras", en el período de enero de 2009 a enero de 2011; y al día siguiente del acto quirúrgico se entrevistaron los anestesiólogos actuantes. Resultados: de una muestra de 42 pacientes, 15 presentaron comportamiento hemodinámico sugerente de demanda de volumen, en las primeras 24 horas de concluida la intervención. La demanda de volumen se relacionó con intervenciones quirúrgicas abdominales y espinales complejas, reposición del volumen con coloides en las pérdidas hemáticas y de volemia en menos del 100 %, y un tiempo quirúrgico mayor de 5 horas. No influyeron los valores de hematocrito, el peso y el por ciento de pérdidas hemáticas. Conclusiones: la estabilidad hemodinámica posoperatoria, en los pacientes a quienes se les realizaron intervenciones con pérdidas hemáticas mayores de 1 000 mL, estuvo influenciada por el porcentaje de sangre perdida y su reposición. Los mejores resultados se obtuvieron cuando la expansión superó las pérdidas y la reposición se realizó con coloides. El tiempo quirúrgico influyó significativamente en la estabilidad hemodinámica.

Introduction: fluid administration during the transoperative period is aimed at maintaining an adequate intravascular volume to ensure appropriate hydroelectrolytic and acid-base balance and optimize oxygen transport and the function of coagulation factors. Objective: evaluate the relationship between the fluid administration regimen based on replacement solutions in the transoperative period and the appearance of hemodynamic complications in the immediate postoperative period. Method: a prospective cross-sectional descriptive study was conducted based on an exhaustive review of the medical records of patients undergoing surgical treatment at Hermanos Ameijeiras Clinical Surgical Hospital from January 2009 to January 2011. Additionally, the anesthesiologists involved were interviewed on the day after each operation. Results: in a sample of 42 patients, 15 showed hemodynamic behavior suggesting volume demand in the 24 hours following surgery. Volume demand was associated with abdominal and complex spinal surgery, colloidal volume replacement in blood losses or volemic losses under 100 %, and a surgical time greater than 5 hours. No influence was exerted by hematocrit values, weight or percentage of blood loss. Conclusions: the postoperative hemodynamic stability of patients undergoing surgical interventions with blood losses above 1 000 mL was influenced by the percentage of blood lost and its replacement. The best results were obtained when the expansion exceeded the losses and when the replacement was conducted with colloids. Surgical time had a significant influence on hemodynamic stability.

A case of common cold syndrome complicated with greater yang and lesser yang disease with complains of abdominal fullness after fluid administration / 日本東洋医学雑誌

We experienced a case with symptoms ranging between greater yang and lesser yang disease after fluid administration. A 62-year-old woman complained of abdominal fullness, systemic feebleness, dull headache and buzzing in the ear. As she had the symptoms of greater yang disease such as chillness, fever and headache, and those of lesser yang disease such as vertigo, bitter taste in the mouth, thirst and fullness beneath the heart, she was diagnosed as having the complication of greater yang and lesser yang disease. As a result, fluid administration was stopped and Shirei-to was administered. The following was found; eliminated systemic feebleness, restored appetite, improved fullness beneath the heart and loss of body weight. Saikokeishi-to was effective for nausea and sense of epigastric pressure. The patient recovered her vitality sufficiently to travel. For cold and pain of legs and loins, Toki-shigyaku-ka-goshuyu-shokyo-to was effective. Fluid administration is usually for alimentation and the treatment of dehydration, however, it should be indicated with caution for common cold syndrome.