<strong>Introduction:</strong> The reported incidence of AKI with COVID-19 varies from 0.5% to 22%. Several mechanisms were postulated as a cause of AKI in patients infected with COVID-19. The appropriate ...<strong>Introduction:</strong> The reported incidence of AKI with COVID-19 varies from 0.5% to 22%. Several mechanisms were postulated as a cause of AKI in patients infected with COVID-19. The appropriate management of AKI in patients with COVID-19 remains unclear at this time. One point of absolute importance, is the consideration of volume status. Given the paucity of knowledge with regards to the role of different strategies for fluid management during an episode of AKI in patients with COVID-19, this retrospective study aims to compare renal outcome and overall prognosis in patients who received conservative versus liberal fluid management. <strong>Methods:</strong> This is a single-center retrospective observational cohort study at a community hospital in Westchester County, NY. All adult patients who tested positive for the COVID-19 infection by PCR testing of a nasopharyngeal swab and were hospitalized from March 22, 2020 to May 25, 2020 are eligible. Among those identified with AKI, patients were divided into two groups: conservative fluid administration versus liberal fluid administration. <strong>Results:</strong> Of the 136 patients, 84 (61.76%) were admitted to the ICU, with 60% of patients under the conservative fluid strategy and 40% receiving liberal fluid management. On the other hand, 52 (38.23%) patients were admitted on the medical floors, with more patients (67.31%) receiving liberal fluid management. <strong>Discussion:</strong> In our cohort of 136 patients with COVID-19 respiratory illness and AKI, there was a significant difference in renal outcome, in terms of improvement of renal function in patients receiving liberal fluid management (55.07%) versus conservative fluid management (16.41%, p ≤ 0.001), with more patients in the liberal group having lower peak creatinine before levels improved. This, as well, was associated with improvement in oxygenation, characterized by improvement in respiratory status, facilitating weaning of oxygen supplementation (p < 0.001). On the other hand, there was no significant difference between the conservative and liberal groups in terms of undergoing renal replacement therapy. Twenty-one of the 136 patients with AKI required RRT and 19 (90%) of them were admitted to the ICU and mechanically ventilated. On the other hand, there was no statistical difference in mortality rate of patients who underwent renal replacement therapy, regardless of whether they were in the conservative or liberal strategy group. <strong>Conclusion:</strong> Our data report that liberal fluid management in COVID-19 patients with AKI, had better outcomes, in terms of renal function, oxygenation and mortality rate, as compared to patients in the conservative fluid management group. Once patients are started on renal replacement therapy, however, renal and lung outcomes and mortality rate become insignificant between the two groups.展开更多
Liquid directional transport surfaces have the ability to control the movement of liquids in specific directions,making them highly applicable in various fields such as heat transfer,fluid management,microfluidics,and...Liquid directional transport surfaces have the ability to control the movement of liquids in specific directions,making them highly applicable in various fields such as heat transfer,fluid management,microfluidics,and chemical engineering.This review aims to summarize the research progress on liquid directional transport surfaces and spacecraft fluid management devices.Among the different liquid control technologies available,certain surface design methods based on principles of fluid dynamics under microgravity show remarkable potential for space fluid management.Precise fluid management is crucial for the in-orbit operation of spacecraft.Utilizing surface tension effects represents the most direct and effective approach to achieve directional liquid transport in space.The intrinsic flow characteristics of the two-dimensional plane of directional transport surfaces are advantageous for managing fluids in the confined spaces of spacecraft.By analyzing the functional characteristics of these liquid directional transport surfaces,we assess their feasibility for integration into spacecraft fluid management devices.Considering the features of the space environment,this review also provides design guidelines for liquid directional transport surfaces suitable for use in spacecraft fluid management devices,serving as a significant reference for future research.展开更多
Ultrasound has long been an essential tool in nephrology,traditionally used for procedures like vascular access and kidney biopsies.Point-of-care ultrasonography(POCUS),a rapidly evolving bedside technology,is now gai...Ultrasound has long been an essential tool in nephrology,traditionally used for procedures like vascular access and kidney biopsies.Point-of-care ultrasonography(POCUS),a rapidly evolving bedside technology,is now gaining momentum in nephrology by providing real-time imaging to enhance physical examination findings.Unlike comprehensive radiology-performed ultrasound,POCUS focuses on specific clinical questions,providing immediate and actionable insights.This narrative review examines the philosophy behind POCUS,its expanding applications in nephrology,and its impact on patient care,including its role in diagnosing obstructive uropathy,guiding fluid management,and evaluating hemodynamics in cardiorenal syndrome.Additionally,the review addresses barriers to widespread adoption,such as the need for structured training,competency validation,and interdisciplinary cooperation.By integrating POCUS into routine practice,nephrologists can refine diagnostic accuracy,improve patient outcomes,and strengthen the role of bedside medicine.展开更多
Hemodynamic monitoring and optimization improve postoperative outcome during high-risk surgery.However,hemodynamic management practices among Chinese anesthesiologists are largely unknown.This study sought to evaluate...Hemodynamic monitoring and optimization improve postoperative outcome during high-risk surgery.However,hemodynamic management practices among Chinese anesthesiologists are largely unknown.This study sought to evaluate the current intraoperative hemodynamic management practices for high-risk surgery patients in China.From September 2010 to November 2011,we surveyed anesthesiologists working in the operating rooms of 265 hospitals representing 28 Chinese provinces.All questionnaires were distributed to department chairs of anesthesiology or practicing anesthesiologists.Once completed,the 29-item questionnaires were collected and analyzed.Two hundred and 10 questionnaires from 265 hospitals in China were collected.We found that 91.4%of anesthesiologists monitored invasive arterial pressure,82.9%monitored central venous pressure（CVP）,13.3%monitored cardiac output（CO）,10.5%monitored mixed venous saturation,and less than 2%monitored pulse pressure variation（PPV） or systolic pressure variation（SPV） during high-risk surgery.The majority（88%） of anesthesiologists relied on clinical experience as an indicator for volume expansion and more than 80%relied on blood pressure,CVP and urine output.Anesthesiologists in China do not own enough attention on hemodynamic parameters such as PPV,SPV and CO during fluid management in high-risk surgical patients.The lack of CO monitoring may be attributed largely to the limited access to technologies,the cost of the devices and the lack of education on how to use them.There is a need for improving access to these technologies as well as an opportunity to create guidelines and education for hemodynamic optimization in China.展开更多
Acute pancreatitis(AP)and chronic pancreatitis are the third leading gastrointestinal causes for admissions and readmissions to hospitals in the United States.This review of articles published between 2019-2022(Decemb...Acute pancreatitis(AP)and chronic pancreatitis are the third leading gastrointestinal causes for admissions and readmissions to hospitals in the United States.This review of articles published between 2019-2022(December)from international sources identified four categories of crucial new findings:The report includes(1)New genetic pathogenic mutations(TRPV6);expected genetic outcomes in a Northern European population;(2)a new serum diagnostic marker for AP-fatty acid ethyl esters-distinguishing acute pancreatitis associated with alcohol;explanations of the impact of monocytes/macrophages on the inflammatory process that defines their future in diagnosis,staging,and treatment;(3)innovations in timing of per os low-fat,solid food intake immediately on admission;resolution of concepts of aggressive parenteral fluid intake;dramatic shifts to nonoperative from operative treatment of infected pancreatic necrosis.Each modification reduced interventions,complications,and lengths-of-stay;and(4)authoritarian recommendations for medical treatment of chronic pain.These advances offer opportunities to initiate newly proven treatments to enhance outcomes,alter the natural history,and envision the future of two diseases that have no known cure.展开更多
BACKGROUND In patients with respiratory failure,loop diuretics remain the cornerstone of the treatment to maintain fluid balance,but resistance is common.AIM To determine the efficacy and safety of common diuretic com...BACKGROUND In patients with respiratory failure,loop diuretics remain the cornerstone of the treatment to maintain fluid balance,but resistance is common.AIM To determine the efficacy and safety of common diuretic combinations in critically ill patients with respiratory failure.METHODS We searched MEDLINE,Embase,Cochrane Library and PROSPERO for studies reporting the effects of a combination of a loop diuretic with another class of diuretic.A meta-analysis using mean differences(MD)with 95%confidence interval(CI)was performed for the 24-h fluid balance(primary outcome)and the 24-h urine output,while descriptive statistics were used for safety events.RESULTS Nine studies totalling 440 patients from a total of 6510 citations were included.When compared to loop diuretics alone,the addition of a second diuretic is associated with an improved negative fluid balance at 24 h[MD:-1.06 L(95%CI:-1.46;-0.65)],driven by the combination of a thiazide plus furosemide[MD:-1.25 L(95%CI:-1.68;-0.82)],while no difference was observed with the combination of a loop-diuretic plus acetazolamide[MD:-0.40 L(95%CI:-0.96;0.16)]or spironolactone[MD:-0.65 L(95%CI:-1.66;0.36)].Heterogeneity was high and the report of clinical and safety endpoints varied across studies.CONCLUSION Based on limited evidence,the addition of a second diuretic to a loop diuretic may promote diuresis and negative fluid balance in patients with respiratory failure,but only when using a thiazide.Further larger trials to evaluate the safety and efficacy of such interventions in patients with respiratory failure are required.展开更多
Early detection and prompt reversal of sepsis-induced tissue hypoperfusion are key elements while treating pa-tients with septic shock.Fluid administration is widely accepted as the first-line therapy followed by vaso...Early detection and prompt reversal of sepsis-induced tissue hypoperfusion are key elements while treating pa-tients with septic shock.Fluid administration is widely accepted as the first-line therapy followed by vasopressor use in persistently hypotensive patients or in those with insufficient arterial pressure to ensure adequate tissue perfusion.Recent evidence suggests a beneficial effect of combining fluids with vasopressors in the early phase of sepsis.Compared with fluids alone,combining fluids and vasopressors increases mean systemic pressure and venous return and corrects hypotension better.This approach also limits fluid overload,which is an independent factor of poor outcomes in sepsis.It produces less hemodilution than fluids alone.As a consequence of these effects,combined treatment may improve outcomes in septic shock patients.展开更多
Background:While central venous pressure(CVP)measurement is used to guide fluid management for high-risk surgical patients during the perioperative period,its relationship to patient prognosis is unknown.Methods:This ...Background:While central venous pressure(CVP)measurement is used to guide fluid management for high-risk surgical patients during the perioperative period,its relationship to patient prognosis is unknown.Methods:This single-center,retrospective observational study enrolled patients undergoing high-risk surgery from February 1,2014 to November 31,2020,who were admitted to the surgical intensive care unit(ICU)directly after surgery.Patients were divided into the following three groups according to the first CVP measurement(CVP1)after admission to the ICU:low,CVP1<8 mmHg;moderate,8 mmHg≤CVP1≤12 mmHg;and high,CVP1>12 mmHg.Perioperative fluid balance,28-day mortality,length of stay in the ICU,and hospitalization and surgical complications were compared across groups.Results:Of the 775 high-risk surgical patients enrolled in the study,228 were included in the analysis.Median(interquartile range)positive fluid balance during surgery was lowest in the low CVP1 group and highest in the high CVP1 group(low CVP1:770[410,1205]mL;moderate CVP1:1070[685,1500]mL;high CVP1:1570[1008,2000]mL;all P<0.001).The volume of positive fluid balance during the perioperative period was correlated with CVP1(r=0.336,P<0.001).The partial arterial pressure of oxygen(PaO 2)/fraction of inspired oxygen(FiO 2)ratio was significantly lower in the high CVP1 group than in the low and moderate CVP1 groups(low CVP1:400.0[299.5,443.3]mmHg;moderate CVP1:362.5[330.0,434.9]mmHg;high CVP1:335.3[254.0,363.5]mmHg;all P<0.001).The incidence of postoperative acute kidney injury(AKI)was lowest in the moderate CVP1 group(low CVP1:9.2%;moderate CVP1:2.7%;high CVP1:16.0%;P=0.007).The proportion of patients receiving renal replacement therapy was highest in the high CVP1 group(low CVP1:1.5%;moderate CVP1:0.9%;high CVP1:10.0%;P=0.014).Logistic regression analysis showed that intraoperative hypotension and CVP1>12 mmHg were risk factors for AKI within 72 h after surgery(adjusted odds ratio[aOR]=3.875,95%confidence interval[CI]:1.378–10.900,P=0.010 and aOR=1.147,95%CI:1.006–1.309,P=0.041).Conclusions:CVP that is either too high or too low increases the incidence of postoperative AKI.Sequential fluid therapy based on CVP after patients are transferred to the ICU post-surgery does not reduce the risk of organ dysfunction caused by an excessive amount of intraoperative fluid.However,CVP can be used as a safety limit indicator for perioperative fluid management in high-risk surgical patients.展开更多
文摘<strong>Introduction:</strong> The reported incidence of AKI with COVID-19 varies from 0.5% to 22%. Several mechanisms were postulated as a cause of AKI in patients infected with COVID-19. The appropriate management of AKI in patients with COVID-19 remains unclear at this time. One point of absolute importance, is the consideration of volume status. Given the paucity of knowledge with regards to the role of different strategies for fluid management during an episode of AKI in patients with COVID-19, this retrospective study aims to compare renal outcome and overall prognosis in patients who received conservative versus liberal fluid management. <strong>Methods:</strong> This is a single-center retrospective observational cohort study at a community hospital in Westchester County, NY. All adult patients who tested positive for the COVID-19 infection by PCR testing of a nasopharyngeal swab and were hospitalized from March 22, 2020 to May 25, 2020 are eligible. Among those identified with AKI, patients were divided into two groups: conservative fluid administration versus liberal fluid administration. <strong>Results:</strong> Of the 136 patients, 84 (61.76%) were admitted to the ICU, with 60% of patients under the conservative fluid strategy and 40% receiving liberal fluid management. On the other hand, 52 (38.23%) patients were admitted on the medical floors, with more patients (67.31%) receiving liberal fluid management. <strong>Discussion:</strong> In our cohort of 136 patients with COVID-19 respiratory illness and AKI, there was a significant difference in renal outcome, in terms of improvement of renal function in patients receiving liberal fluid management (55.07%) versus conservative fluid management (16.41%, p ≤ 0.001), with more patients in the liberal group having lower peak creatinine before levels improved. This, as well, was associated with improvement in oxygenation, characterized by improvement in respiratory status, facilitating weaning of oxygen supplementation (p < 0.001). On the other hand, there was no significant difference between the conservative and liberal groups in terms of undergoing renal replacement therapy. Twenty-one of the 136 patients with AKI required RRT and 19 (90%) of them were admitted to the ICU and mechanically ventilated. On the other hand, there was no statistical difference in mortality rate of patients who underwent renal replacement therapy, regardless of whether they were in the conservative or liberal strategy group. <strong>Conclusion:</strong> Our data report that liberal fluid management in COVID-19 patients with AKI, had better outcomes, in terms of renal function, oxygenation and mortality rate, as compared to patients in the conservative fluid management group. Once patients are started on renal replacement therapy, however, renal and lung outcomes and mortality rate become insignificant between the two groups.
基金National Key R&D Programof China,Grant/Award Numbers:2022YFF0503500,2023YFB4603700Strategic Priority Research Programof the Chinese Academy of Sciences,Grant/Award Number:XDB0910300。
文摘Liquid directional transport surfaces have the ability to control the movement of liquids in specific directions,making them highly applicable in various fields such as heat transfer,fluid management,microfluidics,and chemical engineering.This review aims to summarize the research progress on liquid directional transport surfaces and spacecraft fluid management devices.Among the different liquid control technologies available,certain surface design methods based on principles of fluid dynamics under microgravity show remarkable potential for space fluid management.Precise fluid management is crucial for the in-orbit operation of spacecraft.Utilizing surface tension effects represents the most direct and effective approach to achieve directional liquid transport in space.The intrinsic flow characteristics of the two-dimensional plane of directional transport surfaces are advantageous for managing fluids in the confined spaces of spacecraft.By analyzing the functional characteristics of these liquid directional transport surfaces,we assess their feasibility for integration into spacecraft fluid management devices.Considering the features of the space environment,this review also provides design guidelines for liquid directional transport surfaces suitable for use in spacecraft fluid management devices,serving as a significant reference for future research.
文摘Ultrasound has long been an essential tool in nephrology,traditionally used for procedures like vascular access and kidney biopsies.Point-of-care ultrasonography(POCUS),a rapidly evolving bedside technology,is now gaining momentum in nephrology by providing real-time imaging to enhance physical examination findings.Unlike comprehensive radiology-performed ultrasound,POCUS focuses on specific clinical questions,providing immediate and actionable insights.This narrative review examines the philosophy behind POCUS,its expanding applications in nephrology,and its impact on patient care,including its role in diagnosing obstructive uropathy,guiding fluid management,and evaluating hemodynamics in cardiorenal syndrome.Additionally,the review addresses barriers to widespread adoption,such as the need for structured training,competency validation,and interdisciplinary cooperation.By integrating POCUS into routine practice,nephrologists can refine diagnostic accuracy,improve patient outcomes,and strengthen the role of bedside medicine.
文摘Hemodynamic monitoring and optimization improve postoperative outcome during high-risk surgery.However,hemodynamic management practices among Chinese anesthesiologists are largely unknown.This study sought to evaluate the current intraoperative hemodynamic management practices for high-risk surgery patients in China.From September 2010 to November 2011,we surveyed anesthesiologists working in the operating rooms of 265 hospitals representing 28 Chinese provinces.All questionnaires were distributed to department chairs of anesthesiology or practicing anesthesiologists.Once completed,the 29-item questionnaires were collected and analyzed.Two hundred and 10 questionnaires from 265 hospitals in China were collected.We found that 91.4%of anesthesiologists monitored invasive arterial pressure,82.9%monitored central venous pressure（CVP）,13.3%monitored cardiac output（CO）,10.5%monitored mixed venous saturation,and less than 2%monitored pulse pressure variation（PPV） or systolic pressure variation（SPV） during high-risk surgery.The majority（88%） of anesthesiologists relied on clinical experience as an indicator for volume expansion and more than 80%relied on blood pressure,CVP and urine output.Anesthesiologists in China do not own enough attention on hemodynamic parameters such as PPV,SPV and CO during fluid management in high-risk surgical patients.The lack of CO monitoring may be attributed largely to the limited access to technologies,the cost of the devices and the lack of education on how to use them.There is a need for improving access to these technologies as well as an opportunity to create guidelines and education for hemodynamic optimization in China.
文摘Acute pancreatitis(AP)and chronic pancreatitis are the third leading gastrointestinal causes for admissions and readmissions to hospitals in the United States.This review of articles published between 2019-2022(December)from international sources identified four categories of crucial new findings:The report includes(1)New genetic pathogenic mutations(TRPV6);expected genetic outcomes in a Northern European population;(2)a new serum diagnostic marker for AP-fatty acid ethyl esters-distinguishing acute pancreatitis associated with alcohol;explanations of the impact of monocytes/macrophages on the inflammatory process that defines their future in diagnosis,staging,and treatment;(3)innovations in timing of per os low-fat,solid food intake immediately on admission;resolution of concepts of aggressive parenteral fluid intake;dramatic shifts to nonoperative from operative treatment of infected pancreatic necrosis.Each modification reduced interventions,complications,and lengths-of-stay;and(4)authoritarian recommendations for medical treatment of chronic pain.These advances offer opportunities to initiate newly proven treatments to enhance outcomes,alter the natural history,and envision the future of two diseases that have no known cure.
文摘BACKGROUND In patients with respiratory failure,loop diuretics remain the cornerstone of the treatment to maintain fluid balance,but resistance is common.AIM To determine the efficacy and safety of common diuretic combinations in critically ill patients with respiratory failure.METHODS We searched MEDLINE,Embase,Cochrane Library and PROSPERO for studies reporting the effects of a combination of a loop diuretic with another class of diuretic.A meta-analysis using mean differences(MD)with 95%confidence interval(CI)was performed for the 24-h fluid balance(primary outcome)and the 24-h urine output,while descriptive statistics were used for safety events.RESULTS Nine studies totalling 440 patients from a total of 6510 citations were included.When compared to loop diuretics alone,the addition of a second diuretic is associated with an improved negative fluid balance at 24 h[MD:-1.06 L(95%CI:-1.46;-0.65)],driven by the combination of a thiazide plus furosemide[MD:-1.25 L(95%CI:-1.68;-0.82)],while no difference was observed with the combination of a loop-diuretic plus acetazolamide[MD:-0.40 L(95%CI:-0.96;0.16)]or spironolactone[MD:-0.65 L(95%CI:-1.66;0.36)].Heterogeneity was high and the report of clinical and safety endpoints varied across studies.CONCLUSION Based on limited evidence,the addition of a second diuretic to a loop diuretic may promote diuresis and negative fluid balance in patients with respiratory failure,but only when using a thiazide.Further larger trials to evaluate the safety and efficacy of such interventions in patients with respiratory failure are required.
文摘Early detection and prompt reversal of sepsis-induced tissue hypoperfusion are key elements while treating pa-tients with septic shock.Fluid administration is widely accepted as the first-line therapy followed by vasopressor use in persistently hypotensive patients or in those with insufficient arterial pressure to ensure adequate tissue perfusion.Recent evidence suggests a beneficial effect of combining fluids with vasopressors in the early phase of sepsis.Compared with fluids alone,combining fluids and vasopressors increases mean systemic pressure and venous return and corrects hypotension better.This approach also limits fluid overload,which is an independent factor of poor outcomes in sepsis.It produces less hemodilution than fluids alone.As a consequence of these effects,combined treatment may improve outcomes in septic shock patients.
基金supported by high-level hospital foster grants from Fujian Provincial Hospital,Fujian Province,China[Grant number:(2020)HSJJ14].
文摘Background:While central venous pressure(CVP)measurement is used to guide fluid management for high-risk surgical patients during the perioperative period,its relationship to patient prognosis is unknown.Methods:This single-center,retrospective observational study enrolled patients undergoing high-risk surgery from February 1,2014 to November 31,2020,who were admitted to the surgical intensive care unit(ICU)directly after surgery.Patients were divided into the following three groups according to the first CVP measurement(CVP1)after admission to the ICU:low,CVP1<8 mmHg;moderate,8 mmHg≤CVP1≤12 mmHg;and high,CVP1>12 mmHg.Perioperative fluid balance,28-day mortality,length of stay in the ICU,and hospitalization and surgical complications were compared across groups.Results:Of the 775 high-risk surgical patients enrolled in the study,228 were included in the analysis.Median(interquartile range)positive fluid balance during surgery was lowest in the low CVP1 group and highest in the high CVP1 group(low CVP1:770[410,1205]mL;moderate CVP1:1070[685,1500]mL;high CVP1:1570[1008,2000]mL;all P<0.001).The volume of positive fluid balance during the perioperative period was correlated with CVP1(r=0.336,P<0.001).The partial arterial pressure of oxygen(PaO 2)/fraction of inspired oxygen(FiO 2)ratio was significantly lower in the high CVP1 group than in the low and moderate CVP1 groups(low CVP1:400.0[299.5,443.3]mmHg;moderate CVP1:362.5[330.0,434.9]mmHg;high CVP1:335.3[254.0,363.5]mmHg;all P<0.001).The incidence of postoperative acute kidney injury(AKI)was lowest in the moderate CVP1 group(low CVP1:9.2%;moderate CVP1:2.7%;high CVP1:16.0%;P=0.007).The proportion of patients receiving renal replacement therapy was highest in the high CVP1 group(low CVP1:1.5%;moderate CVP1:0.9%;high CVP1:10.0%;P=0.014).Logistic regression analysis showed that intraoperative hypotension and CVP1>12 mmHg were risk factors for AKI within 72 h after surgery(adjusted odds ratio[aOR]=3.875,95%confidence interval[CI]:1.378–10.900,P=0.010 and aOR=1.147,95%CI:1.006–1.309,P=0.041).Conclusions:CVP that is either too high or too low increases the incidence of postoperative AKI.Sequential fluid therapy based on CVP after patients are transferred to the ICU post-surgery does not reduce the risk of organ dysfunction caused by an excessive amount of intraoperative fluid.However,CVP can be used as a safety limit indicator for perioperative fluid management in high-risk surgical patients.
