AIM: To investigate the effects of 7.5% hypertonic saline on positive fluid balance and negative fluid balance, after radical surgery for gastrointestinal carcinoma. METHODS: Fifty-two patients with gastrointestinal c...AIM: To investigate the effects of 7.5% hypertonic saline on positive fluid balance and negative fluid balance, after radical surgery for gastrointestinal carcinoma. METHODS: Fifty-two patients with gastrointestinal carcinoma undergoing radical surgery were studied. The patients were assigned to receive either Ringer lactate solution following 4 mL/kg of 7.5% hypertonic saline (the experimental group, n = 26) or Ringer lactate solution (the control group, n = 26) during the early postoperative period in SICU. Fluid infusion volumes, urine outputs, fluid balance, body weight change, PaO2/FiO2 ratio, anal exhaust time as well as the incidence of complication and mortality were compared between the two groups. RESULTS: Urine outputs on the operative day and the first postoperative day in experimental group were significantly more than in control group (P<0.000001, P=0.000114). Fluid infusion volumes on the operative day and the first postoperative day were significantly less in experimental group than in control group (P= 0.000042, P= 0.000415). The volumes of the positive fluid balance on the operative day and during the first 48 h after surgery, in experimental group, were significantly less than in control group (P<0.000001). Body weight gain post-surgery was significantly lower in experimental group than in control group (P<0.000001). The body weight fall in experimental group occurred earlier than in control group (P<0.000001). PaO2/FiO2 ratio after surgery was higher in experimental group than in control group (P= 0.000111). The postoperative anal exhaust time in experimental group was earlier than in control group (P= 0.000006). The overall incidence of complications and the incidence of pulmonary infection were lower in experimental group than in control group (P= 0.0175, P= 0.0374). CONCLUSION: 7.5% hypertonic saline has an intense diuretic effect and causes mobilization of the retained fluid, which could reduce fluid infusion volumes and positive fluid balance after radical surgery for gastrointestinal carcinoma, as well as, accelerate the early appearance of negative fluid balance after the surgery, improve the oxygen diffusing capacity of the patients' alveoli, and lower the overall incidence of complications and pulmonary infection after the surgery.展开更多
BACKGROUND:Fluid management is crucial to acute respiratory distress syndrome(ARDS)secondary to sepsis.However,choices of fluid resuscitation strategies and fluid input volumes remain a thorny problem.Our study aimed ...BACKGROUND:Fluid management is crucial to acute respiratory distress syndrome(ARDS)secondary to sepsis.However,choices of fluid resuscitation strategies and fluid input volumes remain a thorny problem.Our study aimed to elucidate the relationship between fluid balance and prognosis of ARDS patients secondary to sepsis.METHODS:Our study included 322 sepsis patients from Ruijin Hospital between 2014 and 2018,and 84 patients were diagnosed as ARDS within 72 hours after onset of sepsis according to Berlin ARDS Defi nition.RESULTS:Among the 322 sepsis patients,84(26.1%)were complicated with ARDS within 72 hours.ARDS patients had a lower oxygenation index(PaO2/FiO2166.4±71.0 vs.255.0±91.2,P<0.05),longer duration of mechanical ventilation(11[6-24]days vs.0[0-0]days,P<0.05)than those without ARDS.Sepsis patients with ARDS showed daily positive net fl uid balance during seven days compared with those without ARDS who showed daily negative net fluid balance since the second day with signifi cant statistical differences.Among the 84 sepsis patients with ARDS,58(69.0%)died.Mean daily fl uid input volumes were much lower in survivors than in non-survivors(43.2±16.7 mL/kg vs.51.0±25.2 mL/kg,P<0.05)while output volumes were much higher in survivors(45.2±19.8 mL/kg vs.40.2±22.7 mL/kg,P<0.05).Using binary logistic regression analysis,we found that the mean daily fl uid balance was independently associated with mortality of sepsis patients complicating with ARDS(P<0.05).CONCLUSIONS:Early negative fluid balance is independently associated with a better prognosis of sepsis patients complicated with ARDS.展开更多
Background Early adequate fluid infusion could prevent organ hypoperfusion after surgery. However,excessive fluid expansion after pediatric cardiac surgery adversely influences multiple organ systems. This retrospecti...Background Early adequate fluid infusion could prevent organ hypoperfusion after surgery. However,excessive fluid expansion after pediatric cardiac surgery adversely influences multiple organ systems. This retrospective,observational study aimedto determine the relationship between the first 24 hours postoperative positive fluid balance and mortality and morbidity in neonates undergoing cardiac surgery. Methods In total,256 neonates who had undergone cardiovascular surgery were enrolled. The baseline characteristics,fluid input,output,and clinical outcomes were obtained. Fluid balance was calculated as(total fluid in total fluid out). Cox proportionalhazards regressions were used to analyze the relationship between early positive fluid balance and postoperative mortality. Results No difference was observed between the positive fluid balance group and negative fluid balance group in terms of age,weight,height,RACHS-1 score,cardiopulmonary bypass time,and aortic crossclamp time. Positive fluid balance group patients were more likely to have a higher rate of male(P=0.01),more peritoneal drainage after surgery(P=0.015),higher maximum vasoactive-inotropicscore(P<0.001)than those with negative fluid balance. There was no difference in the duration of mechanical ventilation and hospital length of stay after surgery between two groups(P=0.296 and 0.38,respectively).Predictors of in-hospital mortality from multivariate analyses were cardiopulmonary bypass time(HR 1.01,95%CI 1.002-1.021,P=0.013),chest drainage(HR 1.01,95%CI 1.000-1.011,P=0.045),and positive fluid balance(HR 7.85,95%CI 1.395-44.159,P=0.019). Conclusions Early postoperative positive fluid balance is associated with higher mortality in neonates following cardiopulmonary bypass cardiac surgery. However,postoperative positive fluid balance is not associated with increased duration of mechanical ventilation and hospital length of stay.展开更多
Objective:This study aimed to investigate the longitudinal trajectories of cumulative fluid balance(CFB)in intensive care unit(ICU)patients and analyze the relationship between different trajectory groups and the occu...Objective:This study aimed to investigate the longitudinal trajectories of cumulative fluid balance(CFB)in intensive care unit(ICU)patients and analyze the relationship between different trajectory groups and the occurrence of pressure injuries(PIs).Methods:In this retrospective longitudinal study,we obtained health-related data from the Medical Information Mart for Intensive Care IV database,including sociodemographic,disease-related variables,and ICU treatment variables.The daily CFB adjusted for body weight was calculated,and the occurrence of PIs during the ICU stay was recorded.A group-based trajectory model was used to explore the different CFB trajectories.Binary logistic regression was used to analyze the relationship between the CFB trajectory group and PIs.Results:Among the 4,294 included participants,we identified four distinct trajectories of CFB in ICU patients:the rapid accumulation group(12.5%),the slow accumulation group(28.5%),the neutral balance group(41.7%),and the negative decrease group(17.3%).After adjusting for some sociodemographic,disease-related variables,and ICU treatment variables,the rapid accumulation group had an OR of 1.63(95%CI:1.30,2.04)for all stages of PIs and an OR of 1.36(95%CI:1.08,1.72)for stage II or higher PIs compared to the neutral balance group.Conclusions:Four unique trajectories of CFB were identified among patients in the ICU,including rapid accumulation,slow accumulation,neutral balance,and negative decrease.Rapid accumulation independently increased the risk of PIs during ICU stay.展开更多
The effect of intravenous bolus rates on patient outcomes is a complex and crucial aspect of critical care.Fluid challenges are commonly used in critically ill patients to manage their hemodynamic status,but there is ...The effect of intravenous bolus rates on patient outcomes is a complex and crucial aspect of critical care.Fluid challenges are commonly used in critically ill patients to manage their hemodynamic status,but there is limited information available on the specifics of when,how much,and at what rate fluids should be administered during these challenges.The aim of this review is to thoroughly examine the relationship between intravenous bolus rates,fluid-electrolyte balance,and mortality and to analyze key research findings and methodologies to understand these complex dynamics better.Fluid challenges are commonly employed in managing hemodynamic status in this population,yet there is limited information on the optimal timing,volume,and rate of fluid administration.Utilizing a narrative review approach,the analysis identified nine relevant studies that investigate these variables.The findings underscore the importance of a precise and individualized approach in clinical settings,highlighting the need to tailor intravenous bolus rates to each patient's specific needs to maximize outcomes.This review provides valuable insights that can inform and optimize clinical practices in critical care,emphasizing the necessity of meticulous and exact strategies in fluid administration.展开更多
BACKGROUND: Although liver transplantation (LT) has made rapid progress, early pulmonary complications still occur. More attention should be paid to fluid therapy that may be an important factor leading to these compl...BACKGROUND: Although liver transplantation (LT) has made rapid progress, early pulmonary complications still occur. More attention should be paid to fluid therapy that may be an important factor leading to these complications. It is necessary to investigate the correlation between intraoperative and postoperative fluid therapy and early pulmonary complications after LT, then attempt to provide a reasonable fluid therapy in the perioperative period. METHODS: Sixty-two patients who had undergone Ff were enrolled and analyzed retrospectively. Based on early phase prognosis after LT, the 62 patients were divided into a non-pulmonary complication group and a pulmonary complication group. Twenty perioperative variables were analyzed in both groups to screen out several factors causing early pulmonary complications, then the parameters reflecting postoperative recovery were analyzed. RESULTS: The pulmonary complication group had 29 patients (46.77%), 3 (4.84%) of whom died during the perioperative period. Using monofactorial analysis for each variable, the two groups differed in the following variables: preoperative lung function, volume of intraoperative transfusion, volume of intraoperative bleeding, and volume of intraoperative net fluid retention and fluid balance (<=-500 ml) in >= 2 of the first 3 days after operation. Analysis of the relationship between multivariate factors and pulmonary complications after LT by logistic multivariate regression analysis showed that preoperative lung function, volume of intraoperative bleeding, and fluid balance (<=-500 ml) in >=-2 of the first 3 days after operation were influential factors. CONCLUSIONS: It is important to maintain fluid balance during the perioperative period of LT. If the hemodynamics are stable, appropriate negative fluid balance in the first 3 days after operation apparently decreases the incidence of early pulmonary complications after LT. These measures are associated with better postoperative recovery.展开更多
Central venous pressure(CVP)serves as a direct approximation of right atrial pressure and is influenced by factors like total blood volume,venous compliance,cardiac output,and orthostasis.Normal CVP falls within 8-12 ...Central venous pressure(CVP)serves as a direct approximation of right atrial pressure and is influenced by factors like total blood volume,venous compliance,cardiac output,and orthostasis.Normal CVP falls within 8-12 mmHg but varies with volume status and venous compliance.Monitoring and managing disturbances in CVP are vital in patients with circulatory shock or fluid disturbances.Elevated CVP can lead to fluid accumulation in the interstitial space,impairing venous return and reducing cardiac preload.While pulmonary artery catheterization and central venous catheter obtained measurements are considered to be more accurate,they carry risk of complications and their usage has not shown clinical improvement.Ultrasound-based assessment of the internal jugular vein(IJV)offers real-time,non-invasive measurement of static and dynamic parameters for estimating CVP.IJV parameters,including diameter and ratio,has demonstrated good correlation with CVP.Despite significant advancements in non-invasive CVP measurement,a reliable tool is yet to be found.Present methods can offer reasonable guidance in assessing CVP,provided their limitations are acknowledged.展开更多
BACKGROUND The mortality rate from septic shock in patients with hematological malignancies(HMs)remains significantly higher than that in patients without HMs.A longer resuscitation time would definitely be harmful be...BACKGROUND The mortality rate from septic shock in patients with hematological malignancies(HMs)remains significantly higher than that in patients without HMs.A longer resuscitation time would definitely be harmful because of the irreversibly immunocompromised status of the patients.Shortening the resuscitation time through continuous renal replacement therapy(CRRT)with oXiris^(■)would be an attractive strategy in managing such patients.AIM To explore the effects of CRRT and oXiris^(■)in shortening the resuscitation time and modifying the host response by reducing inflammation mediator levels.METHODS Forty-five patients with HM were diagnosed with septic shock and underwent CRRT between 2018 and 2022.Patients were divided into two groups based on the hemofilter used for CRRT(oXiris^(■)group,n=26;M150 group,n=19).We compared the number of days of negative and total fluid balance after 7 d of CRRT between the groups.The heart rate,norepinephrine dose,Sequential Organ Failure Assessment(SOFA)score,and blood lactic acid levels at different time points in the two groups were also compared.Blood levels of inflammatory mediators in the 26 patients in the oXiris^(■)group were measured to further infer the possible mechanism.RESULTS The average total fluid balance after 7 d of CRRT in the oXiris^(■)group was significantly lower than that of patients in the M150 hemofilter group.The SOFA scores of patients after CRRT with oXiris^(■)therapy were significantly lower than those before treatment on day 1(d1),d3 and d7 after CRRT;these parameters were also significantly lower than those of the control group on d7.The lac level after oXiris^(■)therapy was significantly lower than that before treatment on d3 and d7 after CRRT.There were no significant differences in the above parameters between the two groups at the other time points.In the oXiris^(■)group,procalcitonin levels decreased on d7,whereas interleukin-6 and tumor necrosis factor levels decreased significantly on d3 and d7 after treatment.CONCLUSION CRRT with oXiris^(■)hemofilter may improve hemodynamics by reducing inflammatory mediators and playing a role in shortening the resuscitation period and decreasing total fluid balance in the resuscitation phases.展开更多
The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic aci...The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic acid-base bal- ance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume （〉2 L） saline infusion in healthy adults induces hyperohloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload （80 ml/kg） in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger （NHE） and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemody- namics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising 02 delivery to the renal perenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, in- creases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastroin- testinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.展开更多
Understanding the dynamics of phase boundaries in fluids requires quantitative knowledge about the microscale processes at the interface.We consider the sharp-interface motion of the compressible two-component flow an...Understanding the dynamics of phase boundaries in fluids requires quantitative knowledge about the microscale processes at the interface.We consider the sharp-interface motion of the compressible two-component flow and propose a heterogeneous multiscale method(HMM)to describe the flow fields accurately.The multiscale approach combines a hyperbolic system of balance laws on the continuum scale with molecular-dynamics(MD)simulations on the microscale level.Notably,the multiscale approach is necessary to compute the interface dynamics because there is—at present—no closed continuum-scale model.The basic HMM relies on a moving-mesh finite-volume method and has been introduced recently for the compressible one-component flow with phase transitions by Magiera and Rohde in(J Comput Phys 469:111551,2022).To overcome the numerical complexity of the MD microscale model,a deep neural network is employed as an efficient surrogate model.The entire approach is finally applied to simulate droplet dynamics for argon-methane mixtures in several space dimensions.To our knowledge,such compressible two-phase dynamics accounting for microscale phase-change transfer rates have not yet been computed.展开更多
While angiotensin-converting enzyme(ACE)is traditionally known for its ability to regulate blood pressure and fluid balance through the renin‒angiotensin system,ACE also plays a pivotal role in immune activation[1].Ma...While angiotensin-converting enzyme(ACE)is traditionally known for its ability to regulate blood pressure and fluid balance through the renin‒angiotensin system,ACE also plays a pivotal role in immune activation[1].Macrophages in which ACE is overexpressed display enhanced inflammatory responses,as evidenced by increased antitumor and antibacterial activity[2].This increase in inflammation coincides with increased lipid metabolism and ATP production[3,4].The mechanisms by which ACE enhances cellular metabolism and inflammation remain unknown.In this issue of Cellular and Molecular Immunology,Saito et al.[5]provide compelling evidence that peroxisome proliferator-activated receptorα(PPARα)is central to the observed enhanced immune capabilities of macrophages overexpressing ACE.展开更多
文摘AIM: To investigate the effects of 7.5% hypertonic saline on positive fluid balance and negative fluid balance, after radical surgery for gastrointestinal carcinoma. METHODS: Fifty-two patients with gastrointestinal carcinoma undergoing radical surgery were studied. The patients were assigned to receive either Ringer lactate solution following 4 mL/kg of 7.5% hypertonic saline (the experimental group, n = 26) or Ringer lactate solution (the control group, n = 26) during the early postoperative period in SICU. Fluid infusion volumes, urine outputs, fluid balance, body weight change, PaO2/FiO2 ratio, anal exhaust time as well as the incidence of complication and mortality were compared between the two groups. RESULTS: Urine outputs on the operative day and the first postoperative day in experimental group were significantly more than in control group (P<0.000001, P=0.000114). Fluid infusion volumes on the operative day and the first postoperative day were significantly less in experimental group than in control group (P= 0.000042, P= 0.000415). The volumes of the positive fluid balance on the operative day and during the first 48 h after surgery, in experimental group, were significantly less than in control group (P<0.000001). Body weight gain post-surgery was significantly lower in experimental group than in control group (P<0.000001). The body weight fall in experimental group occurred earlier than in control group (P<0.000001). PaO2/FiO2 ratio after surgery was higher in experimental group than in control group (P= 0.000111). The postoperative anal exhaust time in experimental group was earlier than in control group (P= 0.000006). The overall incidence of complications and the incidence of pulmonary infection were lower in experimental group than in control group (P= 0.0175, P= 0.0374). CONCLUSION: 7.5% hypertonic saline has an intense diuretic effect and causes mobilization of the retained fluid, which could reduce fluid infusion volumes and positive fluid balance after radical surgery for gastrointestinal carcinoma, as well as, accelerate the early appearance of negative fluid balance after the surgery, improve the oxygen diffusing capacity of the patients' alveoli, and lower the overall incidence of complications and pulmonary infection after the surgery.
基金Shanghai Shenkang Hospital Development Center of China(SHDC12017116)Program for Outstanding Medical Academic,Shanghai Municipal Committee of Science and Technology(184119500900)+1 种基金Shanghai Municipal Commission of Health and Family Planning(2016ZB0206,ZHYY-ZXYJHZX-1-201702)and Shanghai Jiao Tong University School of Medicine(DLY201803)to Er-zhen ChenShanghai Municipal Commission of Health and Family Planning(201640089)to Zhi-tao Yang.
文摘BACKGROUND:Fluid management is crucial to acute respiratory distress syndrome(ARDS)secondary to sepsis.However,choices of fluid resuscitation strategies and fluid input volumes remain a thorny problem.Our study aimed to elucidate the relationship between fluid balance and prognosis of ARDS patients secondary to sepsis.METHODS:Our study included 322 sepsis patients from Ruijin Hospital between 2014 and 2018,and 84 patients were diagnosed as ARDS within 72 hours after onset of sepsis according to Berlin ARDS Defi nition.RESULTS:Among the 322 sepsis patients,84(26.1%)were complicated with ARDS within 72 hours.ARDS patients had a lower oxygenation index(PaO2/FiO2166.4±71.0 vs.255.0±91.2,P<0.05),longer duration of mechanical ventilation(11[6-24]days vs.0[0-0]days,P<0.05)than those without ARDS.Sepsis patients with ARDS showed daily positive net fl uid balance during seven days compared with those without ARDS who showed daily negative net fluid balance since the second day with signifi cant statistical differences.Among the 84 sepsis patients with ARDS,58(69.0%)died.Mean daily fl uid input volumes were much lower in survivors than in non-survivors(43.2±16.7 mL/kg vs.51.0±25.2 mL/kg,P<0.05)while output volumes were much higher in survivors(45.2±19.8 mL/kg vs.40.2±22.7 mL/kg,P<0.05).Using binary logistic regression analysis,we found that the mean daily fl uid balance was independently associated with mortality of sepsis patients complicating with ARDS(P<0.05).CONCLUSIONS:Early negative fluid balance is independently associated with a better prognosis of sepsis patients complicated with ARDS.
基金Guangdong Province Medical Scientific Research Foundation(No.A2019445)。
文摘Background Early adequate fluid infusion could prevent organ hypoperfusion after surgery. However,excessive fluid expansion after pediatric cardiac surgery adversely influences multiple organ systems. This retrospective,observational study aimedto determine the relationship between the first 24 hours postoperative positive fluid balance and mortality and morbidity in neonates undergoing cardiac surgery. Methods In total,256 neonates who had undergone cardiovascular surgery were enrolled. The baseline characteristics,fluid input,output,and clinical outcomes were obtained. Fluid balance was calculated as(total fluid in total fluid out). Cox proportionalhazards regressions were used to analyze the relationship between early positive fluid balance and postoperative mortality. Results No difference was observed between the positive fluid balance group and negative fluid balance group in terms of age,weight,height,RACHS-1 score,cardiopulmonary bypass time,and aortic crossclamp time. Positive fluid balance group patients were more likely to have a higher rate of male(P=0.01),more peritoneal drainage after surgery(P=0.015),higher maximum vasoactive-inotropicscore(P<0.001)than those with negative fluid balance. There was no difference in the duration of mechanical ventilation and hospital length of stay after surgery between two groups(P=0.296 and 0.38,respectively).Predictors of in-hospital mortality from multivariate analyses were cardiopulmonary bypass time(HR 1.01,95%CI 1.002-1.021,P=0.013),chest drainage(HR 1.01,95%CI 1.000-1.011,P=0.045),and positive fluid balance(HR 7.85,95%CI 1.395-44.159,P=0.019). Conclusions Early postoperative positive fluid balance is associated with higher mortality in neonates following cardiopulmonary bypass cardiac surgery. However,postoperative positive fluid balance is not associated with increased duration of mechanical ventilation and hospital length of stay.
文摘Objective:This study aimed to investigate the longitudinal trajectories of cumulative fluid balance(CFB)in intensive care unit(ICU)patients and analyze the relationship between different trajectory groups and the occurrence of pressure injuries(PIs).Methods:In this retrospective longitudinal study,we obtained health-related data from the Medical Information Mart for Intensive Care IV database,including sociodemographic,disease-related variables,and ICU treatment variables.The daily CFB adjusted for body weight was calculated,and the occurrence of PIs during the ICU stay was recorded.A group-based trajectory model was used to explore the different CFB trajectories.Binary logistic regression was used to analyze the relationship between the CFB trajectory group and PIs.Results:Among the 4,294 included participants,we identified four distinct trajectories of CFB in ICU patients:the rapid accumulation group(12.5%),the slow accumulation group(28.5%),the neutral balance group(41.7%),and the negative decrease group(17.3%).After adjusting for some sociodemographic,disease-related variables,and ICU treatment variables,the rapid accumulation group had an OR of 1.63(95%CI:1.30,2.04)for all stages of PIs and an OR of 1.36(95%CI:1.08,1.72)for stage II or higher PIs compared to the neutral balance group.Conclusions:Four unique trajectories of CFB were identified among patients in the ICU,including rapid accumulation,slow accumulation,neutral balance,and negative decrease.Rapid accumulation independently increased the risk of PIs during ICU stay.
文摘The effect of intravenous bolus rates on patient outcomes is a complex and crucial aspect of critical care.Fluid challenges are commonly used in critically ill patients to manage their hemodynamic status,but there is limited information available on the specifics of when,how much,and at what rate fluids should be administered during these challenges.The aim of this review is to thoroughly examine the relationship between intravenous bolus rates,fluid-electrolyte balance,and mortality and to analyze key research findings and methodologies to understand these complex dynamics better.Fluid challenges are commonly employed in managing hemodynamic status in this population,yet there is limited information on the optimal timing,volume,and rate of fluid administration.Utilizing a narrative review approach,the analysis identified nine relevant studies that investigate these variables.The findings underscore the importance of a precise and individualized approach in clinical settings,highlighting the need to tailor intravenous bolus rates to each patient's specific needs to maximize outcomes.This review provides valuable insights that can inform and optimize clinical practices in critical care,emphasizing the necessity of meticulous and exact strategies in fluid administration.
基金a grant from the Bureauof Science & Technology of Guangxi province(No.0342014).
文摘BACKGROUND: Although liver transplantation (LT) has made rapid progress, early pulmonary complications still occur. More attention should be paid to fluid therapy that may be an important factor leading to these complications. It is necessary to investigate the correlation between intraoperative and postoperative fluid therapy and early pulmonary complications after LT, then attempt to provide a reasonable fluid therapy in the perioperative period. METHODS: Sixty-two patients who had undergone Ff were enrolled and analyzed retrospectively. Based on early phase prognosis after LT, the 62 patients were divided into a non-pulmonary complication group and a pulmonary complication group. Twenty perioperative variables were analyzed in both groups to screen out several factors causing early pulmonary complications, then the parameters reflecting postoperative recovery were analyzed. RESULTS: The pulmonary complication group had 29 patients (46.77%), 3 (4.84%) of whom died during the perioperative period. Using monofactorial analysis for each variable, the two groups differed in the following variables: preoperative lung function, volume of intraoperative transfusion, volume of intraoperative bleeding, and volume of intraoperative net fluid retention and fluid balance (<=-500 ml) in >= 2 of the first 3 days after operation. Analysis of the relationship between multivariate factors and pulmonary complications after LT by logistic multivariate regression analysis showed that preoperative lung function, volume of intraoperative bleeding, and fluid balance (<=-500 ml) in >=-2 of the first 3 days after operation were influential factors. CONCLUSIONS: It is important to maintain fluid balance during the perioperative period of LT. If the hemodynamics are stable, appropriate negative fluid balance in the first 3 days after operation apparently decreases the incidence of early pulmonary complications after LT. These measures are associated with better postoperative recovery.
文摘Central venous pressure(CVP)serves as a direct approximation of right atrial pressure and is influenced by factors like total blood volume,venous compliance,cardiac output,and orthostasis.Normal CVP falls within 8-12 mmHg but varies with volume status and venous compliance.Monitoring and managing disturbances in CVP are vital in patients with circulatory shock or fluid disturbances.Elevated CVP can lead to fluid accumulation in the interstitial space,impairing venous return and reducing cardiac preload.While pulmonary artery catheterization and central venous catheter obtained measurements are considered to be more accurate,they carry risk of complications and their usage has not shown clinical improvement.Ultrasound-based assessment of the internal jugular vein(IJV)offers real-time,non-invasive measurement of static and dynamic parameters for estimating CVP.IJV parameters,including diameter and ratio,has demonstrated good correlation with CVP.Despite significant advancements in non-invasive CVP measurement,a reliable tool is yet to be found.Present methods can offer reasonable guidance in assessing CVP,provided their limitations are acknowledged.
基金Hebei Health Science and Education Project,No.20200852.
文摘BACKGROUND The mortality rate from septic shock in patients with hematological malignancies(HMs)remains significantly higher than that in patients without HMs.A longer resuscitation time would definitely be harmful because of the irreversibly immunocompromised status of the patients.Shortening the resuscitation time through continuous renal replacement therapy(CRRT)with oXiris^(■)would be an attractive strategy in managing such patients.AIM To explore the effects of CRRT and oXiris^(■)in shortening the resuscitation time and modifying the host response by reducing inflammation mediator levels.METHODS Forty-five patients with HM were diagnosed with septic shock and underwent CRRT between 2018 and 2022.Patients were divided into two groups based on the hemofilter used for CRRT(oXiris^(■)group,n=26;M150 group,n=19).We compared the number of days of negative and total fluid balance after 7 d of CRRT between the groups.The heart rate,norepinephrine dose,Sequential Organ Failure Assessment(SOFA)score,and blood lactic acid levels at different time points in the two groups were also compared.Blood levels of inflammatory mediators in the 26 patients in the oXiris^(■)group were measured to further infer the possible mechanism.RESULTS The average total fluid balance after 7 d of CRRT in the oXiris^(■)group was significantly lower than that of patients in the M150 hemofilter group.The SOFA scores of patients after CRRT with oXiris^(■)therapy were significantly lower than those before treatment on day 1(d1),d3 and d7 after CRRT;these parameters were also significantly lower than those of the control group on d7.The lac level after oXiris^(■)therapy was significantly lower than that before treatment on d3 and d7 after CRRT.There were no significant differences in the above parameters between the two groups at the other time points.In the oXiris^(■)group,procalcitonin levels decreased on d7,whereas interleukin-6 and tumor necrosis factor levels decreased significantly on d3 and d7 after treatment.CONCLUSION CRRT with oXiris^(■)hemofilter may improve hemodynamics by reducing inflammatory mediators and playing a role in shortening the resuscitation period and decreasing total fluid balance in the resuscitation phases.
文摘The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic acid-base bal- ance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume （〉2 L） saline infusion in healthy adults induces hyperohloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload （80 ml/kg） in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger （NHE） and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemody- namics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising 02 delivery to the renal perenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, in- creases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastroin- testinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.
基金Funding Open Access funding enabled and organized by Projekt DEAL.When preparing this manuscript,the authors have kept the COPE guidelines on how to deal with potential acts of misconduct.The research leading to these results received funding from Deutsche Forschungsgemeinschaft(DFG,German Research Foundation)through the project SFB-TRR 75 with the project number 84292822the DFG under Germanys Excellence Strategy-EXC2075with the project number390740016.
文摘Understanding the dynamics of phase boundaries in fluids requires quantitative knowledge about the microscale processes at the interface.We consider the sharp-interface motion of the compressible two-component flow and propose a heterogeneous multiscale method(HMM)to describe the flow fields accurately.The multiscale approach combines a hyperbolic system of balance laws on the continuum scale with molecular-dynamics(MD)simulations on the microscale level.Notably,the multiscale approach is necessary to compute the interface dynamics because there is—at present—no closed continuum-scale model.The basic HMM relies on a moving-mesh finite-volume method and has been introduced recently for the compressible one-component flow with phase transitions by Magiera and Rohde in(J Comput Phys 469:111551,2022).To overcome the numerical complexity of the MD microscale model,a deep neural network is employed as an efficient surrogate model.The entire approach is finally applied to simulate droplet dynamics for argon-methane mixtures in several space dimensions.To our knowledge,such compressible two-phase dynamics accounting for microscale phase-change transfer rates have not yet been computed.
文摘While angiotensin-converting enzyme(ACE)is traditionally known for its ability to regulate blood pressure and fluid balance through the renin‒angiotensin system,ACE also plays a pivotal role in immune activation[1].Macrophages in which ACE is overexpressed display enhanced inflammatory responses,as evidenced by increased antitumor and antibacterial activity[2].This increase in inflammation coincides with increased lipid metabolism and ATP production[3,4].The mechanisms by which ACE enhances cellular metabolism and inflammation remain unknown.In this issue of Cellular and Molecular Immunology,Saito et al.[5]provide compelling evidence that peroxisome proliferator-activated receptorα(PPARα)is central to the observed enhanced immune capabilities of macrophages overexpressing ACE.
