Sanjeev Sivakumar, Christos Lazaridis
Management of volume status, arterial blood pressure, and cardiac output are core elements in approaching the patients with aneurysmal subarachnoid hemorrhage (SAH). For the prevention and treatment of delayed cerebral ischemia (DCI), euvolemia is advocated and caution is made towards the avoidance of hypervolemia. Induced hypertension and cardiac output augmentation are the mainstays of medical management during active DCI, whereas the older triple-H paradigm has fallen out of favor due to lack of demonstrable physiological or clinical benefits and serious concern for adverse effects such as pulmonary edema and multiorgan system dysfunction...
2020: Critical Care Research and Practice
Michael George Zaki Ghali, Marc J Kim
RATIONALE: Hyponatremia occurs frequently in the hospital setting and may be attributable to a host of etiologies. Drugs are frequently implicated. Trimethoprim-sulfamethoxazole (TMP/SMX) represents a well-recognized pharmacologic precipitant of drug-induced hyponatremia, with several reports extant in the retrievable literature. Nephrologists thus debate the mechanisms giving rise to TMP/SMX-induced hyponatremia and the precise mechanism by which treatment with TMP/SMX generates reductions of serum sodium concentration remain controversial...
August 14, 2020: Medicine (Baltimore)
Andrea Kleindienst, Simeon Georgiev, Sven Martin Schlaffer, Michael Buchfelder
Context: The relevance of hyponatremia has been acknowledged by guidelines from the United States (2013) and Europe (2014). However, treatment recommendations differ due to limited evidence. Objective: In hyponatremia following pituitary surgery-caused by the syndrome of inappropriate antidiuretic hormone (SIADH) secretion-we compared fluid restriction with the pharmacological increase of water excretion by blocking the vasopressin 2 receptors with tolvaptan at a low and a moderate dose...
July 1, 2020: Journal of the Endocrine Society
Jason Chui, Rosemary Craen, Christine Dy-Valdez, Rizq Alamri, Mel Boulton, Sachin Pandey, Ian Herrick
BACKGROUND: Maintenance of euvolemia and cerebral perfusion are recommended for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). We conducted a pilot randomized controlled study to assess the feasibility and efficacy of goal-directed therapy (GDT) to correct fluid and hemodynamic derangements during endovascular coiling in patients with aSAH. METHODS: This study was conducted between November 2015 and February 2019 at a single tertiary center in Canada...
June 2, 2020: Journal of Neurosurgical Anesthesiology
Keith Killu, Victor Coba, Dionne Blyden, Semeret Munie, Darlene Dereczyk, Pridvi Kandagatla, Amy Tang
Objective: The objective of the study was to use an ultrasound-based numerical scoring system for assessment of intravascular fluid estimate (SAFE) and test its validity. Methods: A prospective, observational study was carried out in the surgical intensive care unit (ICU) of an urban tertiary care teaching hospital. Patient's intravascular volume status was assessed using the standard methods of heart rate, blood pressure, central venous pressure, cardiac output, lactate and saturation of venous oxygen, and others...
2020: Critical Care Research and Practice
Alessandro Puntoni, Domenico Giannese, Enrico Varricchio, Claudia D'Alessandro, Maria Francesca Egidi, Adamasco Cupisti
Estimating the euvolemia and dry weight of hemodialysis patients still represents a challenge for the nephrologist, since both dehydration and hyperhydration are associated with intradialytic events and cardiovascular complications in the short and long term. Despite the need for a precise and objective definition of the dry weight for the individual patient on dialysis, this is usually determined on a clinical basis. To obtain greater sensitivity the dosage of natriuretic peptides, Bioelectrical Impedance Analysis (BIA) and, more recently, Lung Ultra-Sound (LUS) can all be used...
February 12, 2020: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Angela Yee-Moon Wang, Jie Dong, Xiao Xu, Simon Davies
BACKGROUND: Appropriate volume control is one of the key goals in a peritoneal dialysis (PD) prescription. As such it is an important component of the International Society of Peritoneal Dialysis (ISPD) guideline for "High-quality PD prescription" necessitating a review of the literature on volume management. The workgroup recognized the importance of including within its scope measures of volume status and blood pressure in prescribing high-quality PD therapy. METHODS: A Medline and PubMed search for publications addressing volume status and its management in PD since the publication of the 2015 ISPD Adult Cardiovascular and Metabolic Guidelines, from October 2014 through to July 2019, was conducted...
May 2020: Peritoneal Dialysis International
B E Wellge, C J Trepte, C Zöllner, J R Izbicki, M Bockhorn
An appropriate perioperative infusion management is pivotal for the perioperative outcome of the patient. Optimization of the perioperative fluid treatment often results in enhanced postoperative outcome, reduced perioperative complications and shortened hospitalization. Hypovolemia as well as hypervolemia can lead to an increased rate of perioperative complications. The main goal is to maintain perioperative euvolemia by goal-directed therapy (GDT), a combination of fluid management and inotropic medication, to optimize perfusion conditions in the perioperative period; however, perioperative fluid management should also include the preoperative and postoperative periods...
February 2020: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Veena S Rao, Jeffrey M Turner, Matthew Griffin, Devin Mahoney, Jennifer Asher, Sangchoon Jeon, Peter S Yoo, Nabil Boutagy, Attila Feher, Albert Sinusas, F Perry Wilson, Fredric Finkelstein, Jeffrey M Testani
BACKGROUND: Loop diuretics have well-described toxicities, and loss of response to these agents is common. Alternative strategies are needed for the maintenance of euvolemia in heart failure (HF). Nonrenal removal of sodium directly across the peritoneal membrane (direct sodium removal [DSR]) with a sodium-free osmotic solution should result in extraction of large quantities of sodium with limited off-target solute removal. METHODS: This article describes the preclinical development and first-in-human proof of concept for DSR...
March 31, 2020: Circulation
Pichayen Duangthongphon, Bunika Souwong, Waranon Munkong, Amnat Kitkhuandee
Objective: In 2015, a protocol to prevent rebleeding was implemented to improve the outcome of patients with ruptured intracranial aneurysm. We performed a single-center retrospective analysis to compare the outcomes of pre/post using protocol. Methodology: Over a 3-year period, 208 patients with ruptured cerebral aneurysm were treated at our institution. The protocol for preventing rebleeding was initiated in 2015. We compared the two cohorts between the group of patients before initiating the protocol ( n = 104) and after initiating the protocol ( n = 104)...
July 2019: Asian Journal of Neurosurgery
Daniel Patschan, Susann Patschan, Ivo Buschmann, Oliver Ritter
BACKGROUND: Loop diuretics (LD) are widely used in emergency and intensive care medicine. SUMMARY: The substances increase the clearance of electrolytes and water; thus, they allow us to control hypervolemia and to prevent patients from pulmonary edema. LD are also frequently applied to patients with an acute decrease in glomerular filtration rate, namely, acute kidney injury (AKI). Nevertheless, volume depletion may be associated with reduced renal perfusion and possibly slower restitution or even aggravation of kidney dysfunction...
2019: Kidney & Blood Pressure Research
Sean C Dowdy, Eleftheria Kalogera, Michael Scott
In the past, best practices for perioperative management have been based as much on dogma as science. The creation of optimized perioperative pathways, known as enhanced recovery after surgery, has been shown to simultaneously improve patient outcomes and reduce cost. In this article, we critically review interventions (and omission of interventions) that should be considered by every surgical team to optimize preanesthesia care. This includes patient education, properly managing existing medical comorbidities, optimizing nutrition, and the use of medications before incision that have been shown to reduce surgical stress, opioid requirements, and postoperative complications...
August 2019: Obstetrics and Gynecology
Lina A Colucci, Kristin M Corapi, Matthew Li, Xavier Vela Parada, Andrew S Allegretti, Herbert Y Lin, Dennis A Ausiello, Matthew S Rosen, Michael J Cima
Magnetic resonance imaging (MRI) is a powerful diagnostic tool, but its use is restricted to the scanner suite. Here, we demonstrate that a bedside nuclear magnetic resonance (NMR) sensor can assess fluid status changes in individuals at a fraction of the time and cost compared to MRI. Our study recruited patients with end-stage renal disease (ESRD) who were regularly receiving hemodialysis treatments with intradialytic fluid removal as a model of volume overload and healthy controls as a model of euvolemia...
July 24, 2019: Science Translational Medicine
Per W Moller, David Berger
No abstract text is available yet for this article.
July 1, 2019: Journal of Applied Physiology
Rafael Dalmau
No abstract text is available yet for this article.
July 1, 2019: Journal of Applied Physiology
Russell Bartt, Stephanie Jarvis, Lauren Cittadino, Benjamin Atchie, Kathryn McCarthy, Rebecca van Vliet, Alicia Bennett, Jeffrey Wagner, Alessandro Orlando, David Bar-Or
Introduction: The limited research on the management of aneurysmal subarachnoid hemorrhages (aSAHs) has not assessed the efficacy of neurology-led care. Our objective was to describe aSAH patients' outcomes after transitioning from a neurosurgery-led intensive care unit (ICU) to a neurology-led multidisciplinary care neurocritical care unit (NCCU). The study hypothesis was that the neurology-led multidisciplinary care would improve patient outcomes. Methods: This was a retrospective cohort study...
May 2019: Journal of Vascular and Interventional Neurology
Eleftheria Kalogera, Sean C Dowdy
Enhanced recovery pathways were first developed in colorectal surgery and have since been adapted to other surgical subspecialties including gynecologic surgery. Mounting evidence has shown that the adoption of a standardized perioperative pathway based on evidence-based literature reduces length of hospital stay, reduces cost, reduces opioid requirements with stable to improved pain scores, and accelerates return to normal function as measured by validated patient reported outcomes measurements. The many elements of enhanced recovery may be distilled into 3 concepts: (1) optimizing nutrition before and after surgery, recognizing that nutritional status directly impacts healing; (2) opioid-sparing analgesia, considering the current American prescription opioid crisis and the importance of pain control to regaining functional recovery; and (3) maintenance of euvolemia before, during, and after surgery...
December 2019: Clinical Obstetrics and Gynecology
Usama Iqbal, Jeremy B Green, Srikant Patel, Yiru Tong, Marcus Zebrower, Alan D Kaye, Richard D Urman, Matthew R Eng, Elyse M Cornett, Henry Liu
Enhanced recovery pathways are a novel approach focused on enhancing the care of surgical patients. "Prehabilitation" is the term applied to any intervention administered before surgery to reduce surgery-related morbidity, decrease the length of hospital stay, expedite the return of organ function, and facilitate the patient's return to normal life. A PubMed search was performed with the following key words: enhanced recovery, preoperative preparation, cessation of smoking and euvolemia. The results from this Pubmed search revealed that female patients may have higher levels of anxiety than male patients...
April 2019: Journal of Anaesthesiology, Clinical Pharmacology
E T Arun Thomas, M K Mohandas, Jacob George
INTRODUCTION: Correct dry weight estimation is very crucial for hemodialysis (HD) patients to maintain euvolemia. Most dialysis centers practice clinical judgment for dry weight estimation, which is subjective and can differ significantly from the actual weight. We designed this study to redefine the clinically estimated dry weight of patients on HD using integrated lung-inferior vena cava (IVC) ultrasonography (USG) and compare the symptoms arising due to volume overload and/or volume depletion before and after modifying the dry weight...
October 2019: Hemodialysis International
Peter Kotanko
Evidence from both observational and randomized controlled studies indicates that the use of bioimpedance in the care of chronic hemodialysis patients is associated with improved outcomes, in particular better volume and blood pressure control. Bioimpedance as a means to assess fluid status in dialysis patients has been approved by numerous regulatory agencies and is being used in dozens of countries around the globe. The most notable exception to the worldwide acceptance of this technique is the US where no BIA device has been approved by the US Food and Drug Administration for use in dialysis patients...
May 2019: Seminars in Dialysis
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