Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the t...Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the type of fluid are conflicting and generally come from small single-center randomized controlled trials(RCTs).We therefore conducted a systematic review and meta-analysis to compare the effect of balanced solutions(BS)versus NS on patient-centered clinical outcomes in AP.Methods:From four databases searched up to October 2024,we included only RCTs of adult patients with AP that compared the use of BS(including LR,acetate Ringer’s,etc.)with NS.The primary out-come was the disease advances from AP to moderately severe and severe AP(MSAP/SAP).Trial sequential analyses(TSA)were conducted to control for type-I and type-II errors and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to assess the quality of evidence.Results:Six RCTs were identified and included,involving 260 patients treated with BS and 298 patients with NS.Patients who received the BS had less MSAP/SAP[odds ratio(OR)=0.50,95%confidence in-terval(CI):0.29 to 0.85,P=0.01,I^(2)=0%;5 studies,299 patients],reduced the need of ICU admission(OR=0.60,95%CI:0.39 to 0.93,P=0.02,I^(2)=0%;5 studies,507 patients)and shorter length of hospital stay[mean difference(MD)=-0.88,95%CI:-1.48 to-0.28,P=0.004,I^(2)=0%;6 studies,558 patients;confirmed by TSA with high certainty]compared with those who received NS.The evidence for most of the clinical outcomes was rated as moderate to low due to the risk of bias,imprecision and inconsistency.Conclusions:BS,compared with NS,was associated with improved clinical outcomes in patients with AP.However,given the moderate to low quality of evidence for most of the outcomes assessed,further trials are warranted.展开更多
Background:Whether lactated Ringer's solution is clinically superior to normal saline for routine intravenous administration of fluids is uncertain.Methods:In an open-label,two-period,two-sequence,cross-sectional,...Background:Whether lactated Ringer's solution is clinically superior to normal saline for routine intravenous administration of fluids is uncertain.Methods:In an open-label,two-period,two-sequence,cross-sectional,cluster-randomized,crossover trial,we assigned hospitals in Ontario,Canada,to use either lactated Ringer's solution or normal saline hospital-wide for a period of 12 weeks.展开更多
The efficacy and safety of normal saline （HS） for fluid therapy in critically ill patients remain controversy. In this review, we summarized the evidence of randomized controlled trials （RCTs） which compared NS wi...The efficacy and safety of normal saline （HS） for fluid therapy in critically ill patients remain controversy. In this review, we summarized the evidence of randomized controlled trials （RCTs） which compared NS with other solutions in critically ill patients. The results showed that when compared with 6% hydrox- yethyl starch （HES）, NS may reduce the onset of acute kidney injury （AKI）. However, there is no significant different in mortality and incidence of AKl when compared with 10% HES, albumin and buffered crystalloid solution. Therefore, it is important to prescribe intravenous fluid for patients according to their individual condition.展开更多
AIM:To investigate the effect of pain relief after infu-sion of ropivacaine at port sites at the end of surgery.METHODS:From October 2006 to September 2007,72 patients undergoing laparoscopic cholecystectomy(LC) were ...AIM:To investigate the effect of pain relief after infu-sion of ropivacaine at port sites at the end of surgery.METHODS:From October 2006 to September 2007,72 patients undergoing laparoscopic cholecystectomy(LC) were randomized into two groups of 36 patients.One group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline.A visual analog scale was used to assess postoperative pain when the patient awakened in the operating room,6 and 24 h after surgery,and before discharge.The amount of analgesics use was also recorded.The demographics,laboratory data,hospital stay,and perioperative complications were compared between the two groups.RESULTS:There was no difference between the two groups preoperatively in terms of demographic and lab-oratory data.After surgery,similar operation time,blood loss,and no postoperative morbidity and mortality were observed in the two groups.However,a significantly lower pain score was observed in the patients undergo-ing LC with local anesthesia infusion at 1 h after LC and at discharge.Regarding analgesic use,the amount of meperidine used 1 h after LC and the total used during admission were lower in patients undergoing LC with local anesthesia infusion.This group also had a shorter hospital stay.CONCLUSION:Local anesthesia with ropivacaine at the port site in LC patients signif icantly decreased post-operative pain immediately.This explains the lower meperidine use and earlier discharge for these patients.展开更多
Objective： To investigate the distribution and differentiation of myeloid-derived suppressor cells （MDSCs） in hemorrhagic shock mice, which are resuscitated with normal saline （NS）, hypertonic saline （HTS）, and...Objective： To investigate the distribution and differentiation of myeloid-derived suppressor cells （MDSCs） in hemorrhagic shock mice, which are resuscitated with normal saline （NS）, hypertonic saline （HTS）, and hydroxyethyl starch （HES）. Methods： BALB/c mice were randomly divided into control, NS, HTS, and HES resuscitation groups. Three subgroups （n=8） in each resuscitation group were marked as 2, 24, and 72 h. Flow cytometry was used to detect the MDSCs, monocytic MDSCs （M-MDSCs）, and granulocytic/neutrophilic MDSCs （G-MDSCs） in peripheral blood nucleated cells （PBNCs）, spleen single-cell suspension, and bone marrow nucleated cells （BMNCs）. Results： The MDSCs in BMNCs among three resuscitation groups were lower 2 h after shock, in PBNCs of the HTS group were higher, and in spleen of the NS group were lower （all P〈0.05 vs. control）. The M-MDSC/G-MDSC ratios in PBNCs of the HTS and HES groups were lower （both ,P〈0.05 vs. control）. At 24 h, the MDSCs in PBNCs of the NS and HTS groups were higher, while the spleen MDSCs in the HTS group were higher （all P〈0.05 vs. control）. The M-MDSC/ G-MDSC ratios were all less in PBNCs, spleen, and BMNCs of the NS and HTS groups, and were lower in BMNCs of the HES group （all P〈0.05 vs. control）. At 72 h, the elevated MDSCs in PBNCs were presented in the HTS and HES groups, and in spleen the augment turned up in three resuscitation groups （all P〈0.05 vs. control）. The inclined ratios to M-MDSC were exhibited in spleen of the NS and HTS groups, and in PBNCs of the NS group; the inclination to G-MDSC in BMNCs was shown in the HES group （all P〈0.05 vs. control）. Conclusions： HTS induces the earlier ele- vation of MDSCs in peripheral blood and spleen, and influences its distribution and differentiation, while HES has a less effect on the distribution but a stronger impact on the differentiation of MDSCs, especially in bone marrow.展开更多
Background:Hyperchloremia is associated with increased mortality in critically ill patients.The objective of this study was to investigate the association between increased chloride levels and mortality outcomes in in...Background:Hyperchloremia is associated with increased mortality in critically ill patients.The objective of this study was to investigate the association between increased chloride levels and mortality outcomes in intracerebral hemorrhage(ICH)patients admitted to the intensive care unit(ICU).Methods:We performed a retrospective study of all patients diagnosed with ICH and included in the Medical Information Mart for Intensive Care(MIMIC-III)from 2001 to 2012.Inclusion criteria were the first diagnosis of ICH,ICU length of stay(LOS)over 72 h,and not receiving hypertonic saline treatment.Serum chloride perturbation within 72 h of admission was evaluated as a predictor of outcomes.The increase in chloride from baseline was dichotomized based on an increase in chloride in 72 h(≤5 mmol/L or>5 mmol/L).The primary outcome was 90-day mortality.Results:A total of 376 patients(54.5%male,median age 70 years,interquartile range:58–79 years)were included.The overall 90-day mortality was 32.2%(n=121),in-hospital mortality was 25.8%(n=97),and Day 2 acute kidney injury(AKI)occurred in 29.0%(n=109)of patients.The prevalence of hyperchloremia on admission,during the first 72 h,and an increase in chloride(>5 mmol/L)were 8.8%,39.4%,and 42.8%,respectively.After adjusting for confounders,the hazard ratio of increase in chloride(>5 mmol/L)was 1.66(95%confidence interval:1.05–2.64,P=0.031).An increase in chloride(>5 mmol/L)was associated with a higher odds ratio for 90-day mortality in both the AKI and non-AKI groups.Conclusions:An increase in chloride from baseline is common in adult patients with ICH admitted to ICU.The increase is significantly associated with elevated mortality.These results support the significance of diligently monitoring chloride levels in these patients.展开更多
文摘Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the type of fluid are conflicting and generally come from small single-center randomized controlled trials(RCTs).We therefore conducted a systematic review and meta-analysis to compare the effect of balanced solutions(BS)versus NS on patient-centered clinical outcomes in AP.Methods:From four databases searched up to October 2024,we included only RCTs of adult patients with AP that compared the use of BS(including LR,acetate Ringer’s,etc.)with NS.The primary out-come was the disease advances from AP to moderately severe and severe AP(MSAP/SAP).Trial sequential analyses(TSA)were conducted to control for type-I and type-II errors and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to assess the quality of evidence.Results:Six RCTs were identified and included,involving 260 patients treated with BS and 298 patients with NS.Patients who received the BS had less MSAP/SAP[odds ratio(OR)=0.50,95%confidence in-terval(CI):0.29 to 0.85,P=0.01,I^(2)=0%;5 studies,299 patients],reduced the need of ICU admission(OR=0.60,95%CI:0.39 to 0.93,P=0.02,I^(2)=0%;5 studies,507 patients)and shorter length of hospital stay[mean difference(MD)=-0.88,95%CI:-1.48 to-0.28,P=0.004,I^(2)=0%;6 studies,558 patients;confirmed by TSA with high certainty]compared with those who received NS.The evidence for most of the clinical outcomes was rated as moderate to low due to the risk of bias,imprecision and inconsistency.Conclusions:BS,compared with NS,was associated with improved clinical outcomes in patients with AP.However,given the moderate to low quality of evidence for most of the outcomes assessed,further trials are warranted.
文摘Background:Whether lactated Ringer's solution is clinically superior to normal saline for routine intravenous administration of fluids is uncertain.Methods:In an open-label,two-period,two-sequence,cross-sectional,cluster-randomized,crossover trial,we assigned hospitals in Ontario,Canada,to use either lactated Ringer's solution or normal saline hospital-wide for a period of 12 weeks.
文摘The efficacy and safety of normal saline （HS） for fluid therapy in critically ill patients remain controversy. In this review, we summarized the evidence of randomized controlled trials （RCTs） which compared NS with other solutions in critically ill patients. The results showed that when compared with 6% hydrox- yethyl starch （HES）, NS may reduce the onset of acute kidney injury （AKI）. However, there is no significant different in mortality and incidence of AKl when compared with 10% HES, albumin and buffered crystalloid solution. Therefore, it is important to prescribe intravenous fluid for patients according to their individual condition.
文摘AIM:To investigate the effect of pain relief after infu-sion of ropivacaine at port sites at the end of surgery.METHODS:From October 2006 to September 2007,72 patients undergoing laparoscopic cholecystectomy(LC) were randomized into two groups of 36 patients.One group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline.A visual analog scale was used to assess postoperative pain when the patient awakened in the operating room,6 and 24 h after surgery,and before discharge.The amount of analgesics use was also recorded.The demographics,laboratory data,hospital stay,and perioperative complications were compared between the two groups.RESULTS:There was no difference between the two groups preoperatively in terms of demographic and lab-oratory data.After surgery,similar operation time,blood loss,and no postoperative morbidity and mortality were observed in the two groups.However,a significantly lower pain score was observed in the patients undergo-ing LC with local anesthesia infusion at 1 h after LC and at discharge.Regarding analgesic use,the amount of meperidine used 1 h after LC and the total used during admission were lower in patients undergoing LC with local anesthesia infusion.This group also had a shorter hospital stay.CONCLUSION:Local anesthesia with ropivacaine at the port site in LC patients signif icantly decreased post-operative pain immediately.This explains the lower meperidine use and earlier discharge for these patients.
基金Project supported by the National Natural Science Foundation of China(No.81272075)
文摘Objective： To investigate the distribution and differentiation of myeloid-derived suppressor cells （MDSCs） in hemorrhagic shock mice, which are resuscitated with normal saline （NS）, hypertonic saline （HTS）, and hydroxyethyl starch （HES）. Methods： BALB/c mice were randomly divided into control, NS, HTS, and HES resuscitation groups. Three subgroups （n=8） in each resuscitation group were marked as 2, 24, and 72 h. Flow cytometry was used to detect the MDSCs, monocytic MDSCs （M-MDSCs）, and granulocytic/neutrophilic MDSCs （G-MDSCs） in peripheral blood nucleated cells （PBNCs）, spleen single-cell suspension, and bone marrow nucleated cells （BMNCs）. Results： The MDSCs in BMNCs among three resuscitation groups were lower 2 h after shock, in PBNCs of the HTS group were higher, and in spleen of the NS group were lower （all P〈0.05 vs. control）. The M-MDSC/G-MDSC ratios in PBNCs of the HTS and HES groups were lower （both ,P〈0.05 vs. control）. At 24 h, the MDSCs in PBNCs of the NS and HTS groups were higher, while the spleen MDSCs in the HTS group were higher （all P〈0.05 vs. control）. The M-MDSC/ G-MDSC ratios were all less in PBNCs, spleen, and BMNCs of the NS and HTS groups, and were lower in BMNCs of the HES group （all P〈0.05 vs. control）. At 72 h, the elevated MDSCs in PBNCs were presented in the HTS and HES groups, and in spleen the augment turned up in three resuscitation groups （all P〈0.05 vs. control）. The inclined ratios to M-MDSC were exhibited in spleen of the NS and HTS groups, and in PBNCs of the NS group; the inclination to G-MDSC in BMNCs was shown in the HES group （all P〈0.05 vs. control）. Conclusions： HTS induces the earlier ele- vation of MDSCs in peripheral blood and spleen, and influences its distribution and differentiation, while HES has a less effect on the distribution but a stronger impact on the differentiation of MDSCs, especially in bone marrow.
基金supported by the Foundation of Beijing Tongren Hospital,Capital Medical University(No.2021-YJJ-ZZL-026).
文摘Background:Hyperchloremia is associated with increased mortality in critically ill patients.The objective of this study was to investigate the association between increased chloride levels and mortality outcomes in intracerebral hemorrhage(ICH)patients admitted to the intensive care unit(ICU).Methods:We performed a retrospective study of all patients diagnosed with ICH and included in the Medical Information Mart for Intensive Care(MIMIC-III)from 2001 to 2012.Inclusion criteria were the first diagnosis of ICH,ICU length of stay(LOS)over 72 h,and not receiving hypertonic saline treatment.Serum chloride perturbation within 72 h of admission was evaluated as a predictor of outcomes.The increase in chloride from baseline was dichotomized based on an increase in chloride in 72 h(≤5 mmol/L or>5 mmol/L).The primary outcome was 90-day mortality.Results:A total of 376 patients(54.5%male,median age 70 years,interquartile range:58–79 years)were included.The overall 90-day mortality was 32.2%(n=121),in-hospital mortality was 25.8%(n=97),and Day 2 acute kidney injury(AKI)occurred in 29.0%(n=109)of patients.The prevalence of hyperchloremia on admission,during the first 72 h,and an increase in chloride(>5 mmol/L)were 8.8%,39.4%,and 42.8%,respectively.After adjusting for confounders,the hazard ratio of increase in chloride(>5 mmol/L)was 1.66(95%confidence interval:1.05–2.64,P=0.031).An increase in chloride(>5 mmol/L)was associated with a higher odds ratio for 90-day mortality in both the AKI and non-AKI groups.Conclusions:An increase in chloride from baseline is common in adult patients with ICH admitted to ICU.The increase is significantly associated with elevated mortality.These results support the significance of diligently monitoring chloride levels in these patients.
