Fluidoterapia reflexiva: desde la fisiología a la práctica clínica / Reflexive fluid therapy: From physiology to clinical practice

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

Protein nanocondensates: the next frontier.

Over the past decade, myriads of studies have highlighted the central role of protein condensation in subcellular compartmentalization and spatiotemporal organization of biological processes. Conceptually, protein condensation stands at the highest level in protein structure hierarchy, accounting for the assembly of bodies ranging from thousands to billions of molecules and for densities ranging from dense liquids to solid materials. In size, protein condensates range from nanocondensates of hundreds of nanometers (mesoscopic clusters) to phase-separated micron-sized condensates. In this review, we focus on protein nanocondensation, a process that can occur in subsaturated solutions and can nucleate dense liquid phases, crystals, amorphous aggregates, and fibers. We discuss the nanocondensation of proteins in the light of general physical principles and examine the biophysical properties of several outstanding examples of nanocondensation. We conclude that protein nanocondensation cannot be fully explained by the conceptual framework of micron-scale biomolecular condensation. The evolution of nanocondensates through changes in density and order is currently under intense investigation, and this should lead to the development of a general theoretical framework, capable of encompassing the full range of sizes and densities found in protein condensates.

Rutin: Family Farming Products' Extraction Sources, Industrial Applications and Current Trends in Biological Activity Protection.

In vitro and in vivo studies have demonstrated the bioactivity of rutin, a dietary flavonol naturally found in several plant species. Despite widespread knowledge of its numerous health benefits, such as anti-inflammatory, antidiabetic, hepatoprotective and cardiovascular effects, industrial use of rutin is still limited due to its low solubility in aqueous media, the characteristic bitter and astringent taste of phenolic compounds and its susceptibility to degradation during processing. To expand its applications and preserve its biological activity, novel encapsulation systems have been developed. This review presents updated research on the extraction sources and methodologies of rutin from fruit and vegetable products commonly found in a regular diet and grown using family farming approaches. Additionally, this review covers quantitative analysis techniques, encapsulation methods utilizing nanoparticles, colloidal and heterodisperse systems, as well as industrial applications of rutin.

Structural phases of classical 2D clusters with competing two-body and three-body interactions.

In modeling systems of interacting particles, many-body terms beyond pairwise interactions are often overlooked. Nevertheless, in certain scenarios, even small contributions from three-body or higher-order terms can disrupt significant changes in their collective behavior. Here we investigate the effects of three-body interactions on the structure and stability of 2D, harmonically confined clusters. We consider clusters with three distinct pairwise interactions:logr,1/r, ande-κr/r, thus covering a wide range of condensed and soft matter systems, such as vortices in mesoscopic superconductors, charged colloids, and dusty plasma. In each case, we evaluate the energetics and normal mode spectra of equilibrium and metastable configurations as the intensity of an attractive, Gaussian three-body potential is varied. We demonstrate that, above a threshold value of the three-body energy strength, the cluster shrinks and eventually becomes self-sustained, that is, it remains cohesive after the confinement potential is shut down. Depending on the strengths of the two-body and three-body interaction terms, this compaction can be continuous or abrupt. The latter case is characterized by a discontinuous jump in the particle density and coexsitence of the compact and non-compact phases as metastable states, as in a first-order phase transition. For some values of the particle number, the compaction is preceded by one or more structural changes, resulting in configurations not usually seen in purely pairwise-additive clusters.

Effect of an Albumin Infusion Treatment Protocol on Delayed Cerebral Ischemia and Relevant Outcomes in Patients with Subarachnoid Hemorrhage.

BACKGROUND: An institutional management protocol for patients with subarachnoid hemorrhage (SAH) based on initial cardiac assessment, permissiveness of negative fluid balances, and use of a continuous albumin infusion as the main fluid therapy for the first 5 days of the intensive care unit (ICU) stay was implemented at our hospital in 2014. It aimed at achieving and maintaining euvolemia and hemodynamic stability to prevent ischemic events and complications in the ICU by reducing periods of hypovolemia or hemodynamic instability. This study aimed at assessing the effect of the implemented management protocol on the incidence of delayed cerebral ischemia (DCI), mortality, and other relevant outcomes in patients with SAH during ICU stay. METHODS: We conducted a quasi-experimental study with historical controls based on electronic medical records of adults with SAH admitted to the ICU at a tertiary care university hospital in Cali, Colombia. The patients treated between 2011 and 2014 were the control group, and those treated between 2014 and 2018 were the intervention group. We collected baseline clinical characteristics, cointerventions, occurrence of DCI, vital status after 6 months, neurological status after 6 months, hydroelectrolytic imbalances, and other SAH complication. Multivariable and sensitivity analyses that controlled for confounding and considered the presence of competing risks were used to adequately estimate the effects of the management protocol. The study was approved by our institutional ethics review board before study start. RESULTS: One hundred eighty-nine patients were included for analysis. The management protocol was associated with a reduced incidence of DCI (hazard ratio 0.52 [95% confidence interval 0.33-0.83] from multivariable subdistribution hazards model) and hyponatremia (relative risk 0.55 [95% confidence interval 0.37-0.80]). The management protocol was not associated with higher hospital or long-term mortality, nor with a higher occurrence of other unfavorable outcomes (pulmonary edema, rebleeding, hydrocephalus, hypernatremia, pneumonia). The intervention group also had lower daily and cumulative administered fluids compared with historic controls (p < 0.0001). CONCLUSIONS: A management protocol based on hemodynamically oriented fluid therapy in combination with a continuous albumin infusion as the main fluid during the first 5 days of the ICU stay appears beneficial for patients with SAH because it was associated with reduced incidence of DCI and hyponatremia. Proposed mechanisms include improved hemodynamic stability that allows euvolemia and reduces the risk of ischemia, among others.

Realization of the Brazil-nut effect in charged colloids without external driving.

Sedimentation is a ubiquitous phenomenon across many fields of science, such as geology, astrophysics, and soft matter. Sometimes, sedimentation leads to unusual phenomena, such as the Brazil-nut effect, where heavier (granular) particles reside on top of lighter particles after shaking. We show experimentally that a Brazil-nut effect can be realized in a binary colloidal system of long-range repulsive charged particles driven purely by Brownian motion and electrostatics without the need for activity. Using theory, we argue that not only the mass-per-charge for the heavier particles needs to be smaller than the mass-per-charge for the lighter particles but also that at high overall density, the system can be trapped in a long-lived metastable state, which prevents the occurrence of the equilibrium Brazil-nut effect. Therefore, we envision that our work provides valuable insights into the physics of strongly interacting systems, such as partially glassy and crystalline structures. Finally, our theory, which quantitatively agrees with the experimental data, predicts that the shapes of sedimentation density profiles of multicomponent charged colloids are greatly altered when the particles are charge-regulating with more than one ion species involved. Hence, we hypothesize that sedimentation experiments can aid in revealing the type of ion adsorption processes that determine the particle charge and possibly the value of the corresponding equilibrium constants.

The Electronic Origin of the Zeta Potential is Supported by the Redox Mechanism on an Aqueous Dispersion of Exfoliated Graphite.

Herein we have proposed that a redox mechanism can produce surface charges and negative zeta potential on an aqueous graphite dispersion. Graphite was kept in contact with a concentrated ammonia aqueous solution, washed, and exfoliated in water, resulting in a dispersion with lyophobic nature. Ammonia treatment did not provide functional groups or nitrogen doping to graphite. Moreover, this material was washed twice before sonication to remove most hydroxide. Therefore, neither functional groups, nitrogen atoms, nor hydroxide excess is responsible for the zeta potential. Kelvin probe force microscopy has shown that the ammonia-treated and exfoliated graphite has higher Fermi level than the water-treated material, indicating that the contact between ammonia and graphite promotes redox reactions that provide electrons to graphite. These electrons raise the Fermi level of graphite and generate the negative zeta potential, consequently, they account for the colloidal stability.

Colloidal delivery of vitamin E into solid lipid nanoparticles as a potential complement for the adverse effects of anemia treatment.

Vitamin E (VitE) is one of the most important antioxidants and plays a key role in decreasing the inflammatory effects of oxidative stress caused by recurrent doses of iron administration in anemia treatment. However, VitE is poorly soluble in aqueous environments. Here, VitE encapsulation into solid lipid nanoparticles (SLN) composed of myristil myristate to improve its bioavailability was proposed. A 99.9 ± 0.1% encapsulation efficiency with a drug/lipid ratio of 500 µg/mg and 478 higher VitE solubility was obtained. The antioxidant properties of VitE after encapsulation were maintained. SLN-VitE showed a 228.2 nm mean diameter with low polidispersitivity (0.335), and negative Z potential (ζ ≈ -9.0 mV). The SLN were well-dispersed, displayed spherical and homogeneous morphology by TEM. A controlled release of VitE from SLN was found. The XRD and FTIR analyses revealed the presence of a nanostructured architecture of SLN after VitE incorporation. We probed the safety of SLN-VitE after contact with three in vitro cell models: erythrocytes, lymphocytes and HepG2 cells. The cell viability in presence of SLN, SLN-VitE, and their combinations with iron was not affected. The comet assay demonstrated that the DNA damage caused by iron administration was decrease in presence of SLN-VitE.

Self-assembly in binary mixtures of spherical colloids.

Colloidal suspensions of monodisperse spherical particles have been extensively studied since one of the main advantages of these systems is their similarity to atomic ones. This property has been used successfully in basic science to understand the equilibrium and non-equilibrium behavior of model colloids and to correlate them with their atomic counterparts. In contrast, suspensions used in technological processes are usually more complex. Nevertheless, for their effective applications, it is crucial to understand their properties, such as the microstructure, dynamics, and flow behavior, as well as the mechanisms underlying their self-organization. The first step towards this knowledge is switching from monodisperse suspensions to moderately complex ones, namely binary mixtures. Therefore, the present review aims to summarize the current knowledge about the phase behavior of binary mixtures of spherical colloids with different inter-particle interactions, such as nearly hard spheres, electrostatic repulsion/attraction, depletion attraction, and attraction due to DNA hybridization. A comparison of experimental work with theoretical predictions is described for binary suspensions studied in three and two dimensions. Several open questions are outlined in the conclusions.

Protein conformation and biomolecular condensates.

Protein conformation and cell compartmentalization are fundamental concepts and subjects of vast scientific endeavors. In the last two decades, we have witnessed exciting advances that unveiled the conjunction of these concepts. An avalanche of studies highlighted the central role of biomolecular condensates in membraneless subcellular compartmentalization that permits the spatiotemporal organization and regulation of myriads of simultaneous biochemical reactions and macromolecular interactions. These studies have also shown that biomolecular condensation, driven by multivalent intermolecular interactions, is mediated by order-disorder transitions of protein conformation and by protein domain architecture. Conceptually, protein condensation is a distinct level in protein conformational landscape in which collective folding of large collections of molecules takes place. Biomolecular condensates arise by the physical process of phase separation and comprise a variety of bodies ranging from membraneless organelles to liquid condensates to solid-like conglomerates, spanning lengths from mesoscopic clusters (nanometers) to micrometer-sized objects. In this review, we summarize and discuss recent work on the assembly, composition, conformation, material properties, thermodynamics, regulation, and functions of these bodies. We also review the conceptual framework for future studies on the conformational dynamics of condensed proteins in the regulation of cellular processes.

Protein coronas coating polymer-stabilized silver nanocolloids attenuate cytotoxicity with minor effects on antimicrobial performance.

Silver nanoparticles are versatile platforms with a variety of applications in the biomedical field. In this framework, their presence in biological media inevitably leads to the interaction with proteins thus conducting to the formation of biomolecular coronas. This feature alters the identity of the nanomaterial and may affect many biological events. These considerations motivated the investigation of protein adsorption onto the surface of polymer-stabilized AgNPs. The metallic colloids were coated by polyethyleneimine (PEI), polyvinylpyrrolidone (PVP), and poly(2-vinyl pyridine)-b-poly(ethylene oxide) (PEO-b-P2VP), and nanoparticle-protein interaction was probed by using a library of analytical techniques. The experimental data revealed a higher extent of protein adsorption at the surface of AgNPs@PVP whereas PEO-b-P2VP coating conducted to the least amount. The main component of the protein coronas was evidenced to be bovine serum albumin (BSA), which is indeed the protein at the highest abundancy in the model biological media. We have further demonstrated reduced cytotoxicity of the silver colloids coated by biomolecular coronas as compared to the pristine counterparts. Nevertheless, the protein coatings did not notably reduce the antimicrobial performance of the polymer-stabilized AgNPs. Accordingly, although the protein-repelling property is frequently targeted towards longer in vivo circulation of nanoparticles, we herein underline that protein coatings, which are commonly treated as artifacts to be avoided, may indeed enhance the biological performance of nanomaterials. These findings are expected to be highly relevant in the design of polymer-stabilized metallic colloids intended to be used in healthcare.

Surface-Enhanced Raman and Surface-Enhanced fluorescence of charged dyes based on alginate silver nanoparticles and its calcium alginate hydrogel beads.

This study shows a new SERS (Surface-enhanced Raman Scattering) and SEF (Surface-enhanced Fluorescence) platform approach, in which substrates were constructed from the silver nanoparticles stabilized by alginate polymer (AgALG) and encapsulated in hydrogel calcium alginate beads (AgALGbead). In this regard, the electrostatic repulsion or attraction concerning the charged dyes and the carboxylate groups of the alginate could define the distances between the probe molecules and metallic nanoparticles to determine the SERS or SEF effect. In this sense, the anionic dye named New Indocyanine Green (IR-820) and the cationic dye Rhodamine 6G (Rh6G) were selected to discuss the alginate's ability to quench or enhance the fluorescence and the Raman dyes signals. Furthermore, the SEF effect using the IR-820 dye can be detected for the near-infrared emission (S1 â†’ S0) using the 532 and 633 nm laser lines as well at the visible region (S2 â†’ S0) applying the excitation at 532 nm in the AgALGbead substrates. Nevertheless, the cationic dye provides the Surface-enhanced Resonance Raman Scattering (SERRS) effect and quenching of the fluorescence for the same AgALGbeads substrate at 532 nm laser line.

Thermodynamic Signatures of Structural Transitions and Dissociation of Charged Colloidal Clusters: A Parallel Tempering Monte Carlo Study.

Computational simulation of colloidal systems make use of empirical interaction potentials that are founded in well-established theory. In this work, we have performed parallel tempering Monte Carlo (PTMC) simulations to calculate heat capacity and to assess structural transitions, which may occur in charged colloidal clusters whose effective interactions are described by a sum of pair potentials with attractive short-range and repulsive long-range components. Previous studies on these systems have shown that the global minimum structure varies from spherical-type shapes for small-size clusters to Bernal spiral and "beaded-necklace" shapes at intermediate and larger sizes, respectively. In order to study both structural transitions and dissociation, we have organized the structures appearing in the PTMC calculations by three sets according to their energy: (i) low-energy structures, including the global minimum; (ii) intermediate-energy "beaded-necklace" motifs; (iii) high-energy linear and branched structures that characterize the dissociative clusters. We observe that, depending on the cluster, either peaks or shoulders on the heat-capacity curve constitute thermodynamics signatures of dissociation and structural transitions. The dissociation occurs at T=0.20 for all studied clusters and it is characterized by the appearance of a significant number of linear structures, while the structural transitions corresponding to unrolling the Bernal spiral are quite dependent on the size of the colloidal system.

Influence of a Non-Ionic Surfactant in the Microstructure and Rheology of a Pickering Emulsion Stabilized by Cellulose Nanofibrils.

Emulsion stabilization is a broad and relevant field with applications in oil, polymer and food industries. In recent years, the use of solid particles to stabilize emulsions or Pickering emulsions have been studied for their kinetic and physical properties. Nanomaterials derived from natural sources are an interesting alternative for this application. Cellulose nanofibrils (CNFs) have been widely explored as a Pickering emulsifier with potential food applications, however, in some cases the presence of surfactants is unavoidable, and the literature is devoid of an evaluation of the effect of a non-ionic food-grade surfactant, such as polysorbate 80, in the stabilization of a vegetable oil by CNFs. To better assess the possible interactions between CNFs and this surfactant emulsions containing coconut oil, an emerging and broadly used oil, were processed with and without polysorbate 80 and evaluated in their qualitative stability, morphological and physical properties. Fluorescence microscopy, dynamic light scattering and rheology were used for this assessment. Results indicate in absence of the surfactant, emulsion stability increased at higher CNFs content, creaming was observed at 0.15 and 0.3 wt.% of CNFs, while it was not evidenced when 0.7 wt.% was used. After the addition of surfactant, the droplets are covered by the surfactant, resulting in particles with a smaller diameter, entrapped in the cellulosic structure. Rheology indicates a lower network stiffness after adding polysorbate 80.

A Low Energy Approach for the Preparation of Nano-Emulsions with a High Citral-Content Essential Oil.

Pectis elongata is found in the northern and northeastern regions of Brazil. It is considered a lemongrass due to its citric scent. The remarkable citral content and the wide antimicrobial properties and bioactive features of this terpene make this essential oil (EO) eligible for several industrial purposes, especially in cosmetics and phytotherapics. However, to address the problems regarding citral solubility, nano-emulsification is considered a promising strategy thanks to its improved dispersability. Thus, in this paper we propose a low-energy approach for the development of citral-based nano-emulsions prepared with P. elongata EO. The plant was hydrodistillated to produce the EO, which was characterized with a gas chromatograph coupled to mass spectrometry. The nano-emulsion prepared by a non-heated water titrating (low-energy) method was composed of 5% (w/w) EO, 5% (w/w) non-ionic surfactants and 90% (w/w) deionized water and was analyzed by dynamic light scattering. Levels of citral of around 90% (neral:geranial-4:5) were detected in the EO and no major alteration in the ratio of citral was observed after the nano-emulsification. The nano-emulsion was stable until the 14th day (size around 115 nm and polydispersity index around 0.2) and no major alteration in droplet size was observed within 30 days of storage. Understanding the droplet size distribution as a function of time and correlating it to concepts of compositional ripening, as opposing forces to the conventional Ostwald ripening destabilization mechanism, may open interesting approaches for further industrial application of novel, low-energy, ecofriendly approaches to high citral essential oil-based nano-emulsions based on lemongrass plants.

Nonequilibrium Dynamics of a Magnetic Nanocapsule in a Nematic Liquid Crystal.

Colloidal particles in nematic liquid crystals show a beautiful variety of complex phenomena with promising applications. Their dynamical behaviour is determined by topology and interactions with the liquid crystal and external fields. Here, a nematic magnetic nanocapsule reoriented periodically by time-varying magnetic fields is studied using numerical simulations. The approach combines Molecular Dynamics to resolve solute-solvent interactions and Nematic Multiparticle Collision Dynamics to incorporate nematohydrodynamic fields and fluctuations. A Saturn ring defect resulting from homeotropic anchoring conditions surrounds the capsule and rotates together with it. Magnetically induced rotations of the capsule can produce transformations of this topological defect, which changes from a disclination curve to a defect structure extending over the surface of the capsule. Transformations occur for large magnetic fields. At moderate fields, elastic torques prevent changes of the topological defect by tilting the capsule out from the rotation plane of the magnetic field.

Gelation of amphiphilic janus particles in an apolar medium.

HYPOTHESIS: The anisotropic nature of colloidal particles results in orientation-dependent interactions that organize the particles into peculiar structures different from those formed by isotropic colloids. Particles with a hydrophilic hemisphere are expected to assemble in hydrophobic solvents due to the contribution of hydrophobic interactions as observed for molecular amphiphiles. EXPERIMENTS: Asymmetrically decorated silica-based Janus particles are dispersed in an apolar solvent, chloroform, and their structure and dynamics are studied by light scattering and compared with computer simulations. FINDINGS: Gelation of amphiphilic Janus particles with asymmetric surface decoration is observed in a hydrophobic medium. The influence of particle asymmetry on gel structure and dynamics is discussed. Unlike particles with long-range repulsive interactions in water, these systems rapidly form rather compact structures that are nevertheless more ramified than those made of isotropic hydrophobic particles. Comparison with computer simulations allows visualization of the gel and reveals a contribution of asymmetric short-range attractions and cross-term repulsions to the net effective interaction potential.

Nanoemulsions: Using emulsifiers from natural sources replacing synthetic ones-A review.

In recent years, substantial consideration within the food industry has been aimed at the development of food-grade nanoemulsions (NE) as promising systems for encapsulating, stabilizing, and delivering bioactive compounds. Although numerous studies have revealed the critical potential of NE, there are still several challenges to overcome them. These include the extensive amounts of synthetic emulsifiers needed for NE formulation, which can potentially be toxic for human health. The interest in safety, and natural emulsifiers have stimulated food manufacturers to develop "label-friendly" formulations by replacing synthetic emulsifiers with natural alternatives. This review represents a critical and comprehensive summary of the application of natural emulsifiers as potential substitutes for synthetic emulsifiers in NE production, with particular emphasis on the newly identified natural emulsifiers. Some recent reports showed the excellent emulsifying properties of various natural emulsifier extracted from natural resources, to produce NE, and therefore, might be generalized for further industrial applications. Future trends are encouraged to identify novel natural emulsifiers from industrial food by-products that may demonstrate highly effective emulsifiers.

Fluids in ARDS: more pros than cons.

In acute respiratory distress syndrome (ARDS), increased pulmonary vascular permeability makes the lung vulnerable to edema. The use of conservative as compared to liberal fluid strategies may increase the number of ventilator-free days and survival, as well as reduce organ dysfunction. Monitoring the effects of fluid administration is of the utmost importance; dynamic indexes, such as stroke volume and pulse pressure variations, outperform static ones, such as the central venous pressure. The passive leg raise and end-expiratory occlusion tests are recommended for guiding fluid management decisions. The type of intravenous fluids should also be taken into consideration: crystalloids, colloids, and human albumin have all been used for fluid resuscitation. Recent studies have also shown differences in outcome between balanced and non-balanced intravenous solutions. In preclinical studies, infusion of albumin promotes maintenance of the glycocalyx layer, reduces inflammation, and improves alveolar-capillary membrane permeability. Fluids in ARDS must be administered cautiously, considering hemodynamic and perfusion status, oncotic and hydrostatic pressures, ARDS severity, fluid type, volume and infusion rate, and cardiac and renal function. Of note, no guideline to date has recommended a specific fluid composition for use in ARDS; most physicians currently follow recommendations for sepsis.

Equilibrium clustering of colloidal particles at an oil/water interface due to competing long-range interactions.

HYPOTHESIS: Colloids at fluid interfaces organize according to inter-particle interactions. The main contributions to an effective interaction potential are expected to be electrostatic dipole-dipole repulsion and capillary attraction due to fluid interface deformation. When these interactions are weak, a secondary minimum in the particle pair interaction potential is expected. EXPERIMENTS: Clean bare silica particles were deposited at an oil/water interface and their organization as well as dynamics were observed under a light microscope and analyzed in terms of radial distribution function and mean squared displacement. FINDINGS: Weak long-range competing interactions between colloids at an oil/water interface result in cluster formation. The clusters have a liquid-like structure and grow with increasing particle packing fraction. System 'ergodicity' suggests near-equilibrium assembly, which is confirmed by free particle dynamics outside the clusters. The interplay between dipole-dipole repulsion and capillary attraction responsible for the cluster formation is reflected in a secondary minimum of the effective interaction potential predicted theoretically but inaccessible experimentally from collective particle properties prior to this work.