Diuretics and Invasive Fluid Management Strategies

2018 ◽  
pp. 495-510
Author(s):  
Jack F. Price
Keyword(s):  
Fluid Management ◽  
Management Strategies

Abstract 16766: Intraprocedural Ablation and Fluid Status Management in Heart Failure Patients Undergoing Catheter Ablation for Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sahitya Allam ◽  
Evan Harmon ◽  
Sula Mazimba ◽  
James M Mangrum ◽  
Ilana Kutinsky ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Tertiary Care ◽  
Fluid Management ◽  
Management Strategies ◽  
Clinical Trial Data ◽  
Posterior Wall ◽  
Fluid Status ◽  
Volume Output

Background: Recent randomized clinical trial data has supported catheter ablation (CA) of atrial fibrillation (AF) in patients with heart failure (HF). Ablation and fluid management strategies could impact periprocedural outcomes especially in HF patients. Methods: We conducted a single-center retrospective analysis of 200 consecutive patients with and without HF undergoing CA at a tertiary care academic center from July 2017 through June 2018. HF was defined as any EF < 40%, prior inpatient admission for HF exacerbation, or ambulatory management of HF confirmed by independent chart review. Diuretic regimens were reported as furosemide equivalent. Results: Among 200 patients, 65 (32.5%) had HF and 135 (67.5%) did not. HF patients had longer mean procedure times (299.8 ± 96 min vs 268.4 ± 96 min, p = 0.03) and were more likely to require mitral isthmus (p < 0.001), posterior wall isolation (p = 0.002), and cavotriscupid isthmus (p = 0.004) ablations. There were no differences between the HF vs. non-HF groups’ intraprocedural volume intake, intraprocedural volume output, net fluid status, or intraprocedural diuretic dose (Table 1). HF patients received higher doses of IV (41.5 ± 43.0 mg vs 23.6 ± 11.8 mg, p = 0.007) and PO (43.2 ± 16.7 mg vs 26.7 ± 10.0 mg, p < 0.001) postprocedural diuretic. There were no differences in the rates of major in-hospital complications (Table 1). In a multivariable regression analysis adjusted for procedural covariates, there were higher proportions of posterior wall isolation (p = 0.01) as well as postprocedural PO (p = 0.01) and IV diuretic (p = 0.002) administration in the HF cohort. Conclusion: Intraprocedural volume and diuretic management was similar between HF and non-HF patients undergoing CA of AF, though HF patients tended to receive more aggressive diuresis post procedurally with no difference in complications. Table 1. Intra- and post-procedural management and outcomes in HF vs non-HF patients undergoing CA for AF

scholarly journals Comparison of two fluid-management strategies in acute lung injury

2006 ◽  
Vol 44 (4) ◽  
pp. 909 ◽  
Author(s):  
H.P. Wiedemann ◽  
A.P. Wheeler ◽  
G.R. Bernard
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Fluid Management ◽  
Management Strategies ◽  
Two Fluid

scholarly journals Symposium 5: Joint BAPEN and Nutrition Society Symposium on ‘Feeding size 0: the science of starvation’ Severe malnutrition: therapeutic challenges and treatment of hypovolaemic shock

2009 ◽  
Vol 68 (3) ◽  
pp. 274-280 ◽  
Author(s):  
Kathryn Maitland
Keyword(s):  
District Hospital ◽  
Fluid Management ◽  
Management Strategies ◽  
Case Fatality ◽  
Antimicrobial Treatment ◽  
Severe Malnutrition ◽  
Society Symposium ◽  
Life Threatening ◽  
Systematic Failure ◽  
Nutritional Strategies

The systematic failure to recognise and appropriately treat children with severe malnutrition has been attributed to the elevated case-fatality rates, often as high as 50%, that still prevail in many hospitals in Africa. Children admitted to Kilifi District Hospital, on the coast of Kenya, with severe malnutrition frequently have life-threatening features and complications, many of which are not adequately identified or treated by WHO guidelines. Four main areas have been identified for research: early identification and better supportive care of sepsis; evidence-based fluid management strategies; improved antimicrobial treatment; rational use of nutritional strategies. The present paper focuses on the identification of children with sepsis and on fluid management strategies.

Moderate to Severe Acute Respiratory Distress Syndrome Management Strategies: A Narrative Review

2019 ◽  
Vol 32 (3) ◽  
pp. 347-360 ◽  
Author(s):  
Mitchell S. Buckley ◽  
Amy L. Dzierba ◽  
Justin Muir ◽  
Jeffrey P. Gonzales
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Evidence ◽  
Distress Syndrome ◽  
Fluid Management ◽  
Management Strategies ◽  
Neuromuscular Blocking ◽  
Narrative Review ◽  
Lung Protective Ventilation

Acute respiratory distress syndrome (ARDS) remains a common complication associated with significant negative outcomes in critically ill patients. Lung-protective mechanical ventilation strategies remain the cornerstone in the management of ARDS. Several therapeutic options are currently available including fluid management, neuromuscular blocking agents, prone positioning, extracorporeal membrane oxygenation, corticosteroids, and inhaled pulmonary vasodilating agents (prostacyclins and nitric oxide). Unfortunately, an evidence-based, standard-of-care approach in managing ARDS beyond lung-protective ventilation remains elusive, contributing to significant variability in clinical practice. Although the optimal therapeutic strategy for managing moderate to severe ARDS remains extremely controversial, therapies supported with more robust clinical evidence should be considered first. The purpose of this narrative review is to discuss the published clinical evidence for both pharmacologic and nonpharmacologic management strategies in adult patients with moderate to severe ARDS as well as to discuss practical considerations for implementation.

scholarly journals Peristaltic Pneumatic Compression of the Legs Reduces Fluid Demand and Improves Hemodynamic Stability during Surgery

2011 ◽  
Vol 114 (3) ◽  
pp. 536-544 ◽  
Author(s):  
Nicholas Kiefer ◽  
Judith Theis ◽  
Gabriele Putensen-Himmer ◽  
Andreas Hoeft ◽  
Sven Zenker
Keyword(s):  
Fluid Management ◽  
Management Strategies ◽  
Systolic Pressure ◽  
Control Group ◽  
Fluid Restriction ◽  
Anesthesia Induction ◽  
Induction Phase ◽  
Hemodynamic Stability ◽  
Median Difference ◽  
Minor Surgery

Background Perioperative fluid restriction might be beneficial in specific clinical settings. In this prospective, randomized and blinded study, we assessed whether peristaltic pneumatic compression of the legs can support restrictive fluid management strategies by reducing intraoperative fluid demand and improving hemodynamic stability. Methods Seventy patients scheduled for minor surgery were randomly assigned to receive either intraoperative peristaltic pneumatic compression or placebo compression. Both groups received fluid therapy according to a goal-directed protocol with a crystalloid base rate of 2 ml · kg⁻¹ · h⁻¹ and bolus infusions of 250 ml crystalloids triggered by hypotension, tachycardia, or high Pleth Variability Index. Results Patients treated with peristaltic pneumatic compression received less intravenous fluid: median (interquartile range) 286 (499) versus 921 (900) ml (P &lt; 0.001), resulting in a median difference of 693 ml (95% CI, 495-922 ml) and a median difference of 8.4 ml/kg (95% CI, 5.3-11.5 ml; P &lt; 0.001). After the anesthesia induction phase, median overall infusion rates were 12.2 (14.1) ml · kg⁻¹ · h⁻¹ in the control group and 1.9 (0.4) ml · kg⁻¹ · h⁻¹ in the pneumatic peristaltic compression group (P &lt; 0.001). Among patients treated with pneumatic peristaltic compression, the median cumulative time of hypotension was shorter (0 [12.5] vs. 22.6 [22.8] min; P = 0.002), fewer hypotensive events were recorded (39 vs. 137; P = 0.001), and median lowest individual systolic pressure was higher (92 [8] vs. 85 [16] mmHg; P = 0.002). Conclusions This study demonstrates that peristaltic pneumatic compression of the legs significantly improves hemodynamic stability and reduces fluid demand during minor surgery.

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