Investigation of biomarkers for impending fluid overload in a feline acute haemorrhage-resuscitation model

Hemodynamic optimization remains the cornerstone of resuscitation in the treatment of sepsis and septic shock. Delay or inadequate management will inevitably lead to hypoperfusion, tissue hypoxia or edema, and fluid overload, leading eventually to multiple organ failure, seriously affecting outcomes. According to a large international survey (FENICE study), physicians frequently use inadequate indices to guide fluid management in intensive care units. Goal-directed and “restrictive” infusion strategies have been recommended by guidelines over “liberal” approaches for several years. Unfortunately, these “fixed regimen” treatment protocols neglect the patient’s individual needs, and what is shown to be beneficial for a given population may not be so for the individual patient. However, applying multimodal, contextualized, and personalized management could potentially overcome this problem. The aim of this review was to give an insight into the pathophysiological rationale and clinical application of this relatively new approach in the hemodynamic management of septic patients.

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Prevalence, risk factors and impact on outcomes of 30-day unexpected rehospitalization in incident peritoneal dialysis patients

BMC Nephrology ◽

10.1186/s12882-020-02201-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jianbo Li ◽

Jing Yu ◽

Naya Huang ◽

Hongjian Ye ◽

Dan Wang ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Peritoneal Dialysis ◽

Fluid Overload ◽

Multivariate Logistic Regression Analysis ◽

Technical Failure ◽

Cox Regression Analysis ◽

Catheter Malfunction ◽

All Cause Mortality ◽

Cvd Mortality

Abstract Background Rehospitalization is a major problem for end stage renal disease (ESRD) populations. However, researches on 30-day unexpected rehospitalzation of incident peritoneal dialysis (PD) patients were limited. This study aimed to investigate the prevalence, risk factors and impact on outcomes of 30-day unexpected rehospitalization in incident PD patients. Methods This was a retrospective cohort study. Patients who accepted PD catheter implantation in our centre from Jan 1, 2006 to Dec 31, 2013 and regular follow-up were included. The demographic characteristics, laboratory parameters, and rehospitalization data were collected and analyzed. The primary outcome was all-cause mortality, and the secondary outcomes included cardiovascular disease (CVD) mortality and technical failure. Results Totally 1632 patients (46.9 ± 15.3 years old, 60.1% male, 25.6% with diabetes) were included. Among them, 149 (9.1%) had a 30-day unexpected rehospitalization after discharge. PD-related peritonitis (n = 48, 32.2%), catheter malfunction (n = 30, 20.1%) and severe fluid overload (n = 19, 12.8%) were the top three causes for the rehospitalization. Multivariate logistic regression analysis showed that length of index hospital stays [Odds ratio (OR) =1.02, 95% confidence interval (CI) 1.00–1.03, P = 0.036) and hyponatremia (OR = 1.85, 95% CI 1.06–3.24, P = 0.031) were independently associated with the rehospitalization. Multivariate Cox regression analysis indicated that 30-day rehospitalization was an independent risk factor for all-cause mortality [Hazard ratio (HR) =1.52, 95% CI 1.07–2.16, P = 0.019) and CVD mortality (HR = 1.73, 95% CI 1.03–2.90, P = 0.038). Conclusions The prevalence of 30-day unexpected rehospitalization for incident PD patients in our centre was 9.1%. The top three causes for the rehospitalization were PD-related peritonitis, catheter malfunction and severe fluid overload. Thirty-day unexpected rehospitalization increased the risk of all-cause mortality and CVD mortality for PD patients.

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Higher total ultrafiltration volume during cardiopulmonary bypass-assisted infant cardiac surgery is associated with acute kidney injury and fluid overload

Pediatric Nephrology ◽

10.1007/s00467-021-04976-2 ◽

2021 ◽

Author(s):

Dominic Zanaboni ◽

Jungwon Min ◽

Roopa Seshadri ◽

J. William Gaynor ◽

Molly Dreher ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Fluid Overload ◽

Kidney Injury

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FP263A COMPARISON BETWEEN BIOIMPEDANCE DATA, LUNG ULTRASONOGRAPHY AND FLUID ACCCUMULATION. THREE CARDS TO DETERMINATE THE STATE OF EUVOLEMIA AND FLUID OVERLOAD IN CRITICAL ILL PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy104.fp263 ◽

2018 ◽

Vol 33 (suppl_1) ◽

pp. i119-i119

Author(s):

Francisco Javier Centellas Pérez ◽

Mercedes Martínez Díaz ◽

Angela Prado Mira ◽

Agustín Ortega Cerrato ◽

Jaime López Tendero ◽

...

Keyword(s):

Fluid Overload ◽

The State ◽

Lung Ultrasonography ◽

Critical Ill Patients ◽

Critical Ill

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Development of a severity scoring system for acute haemorrhage in anaesthetized domestic cats: the CABSS score

Veterinary Anaesthesia and Analgesia ◽

10.1016/j.vaa.2019.11.008 ◽

2020 ◽

Vol 47 (4) ◽

pp. 499-508

Author(s):

Gareth E. Zeiler ◽

Andrea Fuller ◽

Eva Rioja ◽

Peter Kamerman ◽

Roxanne K. Buck ◽

...

Keyword(s):

Scoring System ◽

Domestic Cats ◽

Severity Scoring ◽

Acute Haemorrhage

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Improving transfusion practice in transfusion dependent thalassaemia patients

Thalassemia Reports ◽

10.4081/thal.2017.6821 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

Chathupa Wickremaarachchi ◽

Elizabeth McGill ◽

Annmarie Bosco ◽

Giselee Kidson-Gerber

Keyword(s):

Blood Cells ◽

Maximum Rate ◽

Fluid Overload ◽

Transfusion Practice ◽

Red Cells ◽

Transfusion Rate ◽

Allergic Reactions ◽

Medical Review ◽

Transfusion Reaction ◽

Change In Practice

The aim of this study was to improve current transfusion practice in transfusiondependent thalassaemia patients by determining whether safe transition from triplewashed red cells (TWRC) to leucodepleted red cells (LDRC), increasing transfusion rates, reducing the use of frusemide and creating uniform practice across patients is possible. In patients receiving regular transfusions (50), triple-washed red blood cells were changed to LDRC, transfusion rates were increased to 5 mL/kg/h (in line with the Cooley’s Foundation guidelines) to a maximum of 300 mL/h and frusemide was ceased. Medical review occurred at completion of the transfusion. Of the 20 patients on TWRC, 18 were transitioned to leucodepleted red cells (90%). Recurrent allergic reactions in 2 patients required re-institution of TWRC. 7 of the 8 patients on regular frusemide ceased this practice with no documented transfusion-related fluid overload. One patient refused. Of the eligible 50 patients, 20 patients (40%) were increased to the maximum transfusion rate of 300 mLs/h; 6 (12%) increased rate but refused to go to the maximum; 9 (18%) refused a change in practice and 15 (30%) were already at the maximum rate. There was only one documented transfusion reaction (palpitations) however this patient was able to tolerate a higher transfusion rate on subsequent transfusions. Thalassemia patients on TWRC were safely transitioned to LDRC. Transfusion rates were safely increased, with a calculated reduction in day-stay bed time of 17.45 h per month. This confirms a guideline of 5 mL/kg/h for transfusion-dependant thalassaemia patients with preserved cardiac function is well tolerated and may be translated to other centres worldwide. 本研究的目的是通过确定是否有可能进行从三洗红细胞（TWRC）到去白细胞红细胞（LDRC）的安全过渡，提高输血速率，减少速尿的使用，并在患者中实施统一规则，从而改进输血依赖型地中海贫血患者中现有的输血实践。在接受定期输血的患者（50例）中，将三洗红细胞改为 LDRC，输血速率提高至5 mL/kg/h（符合库利氏贫血基金会的指引），最高可达到300 mL/h，并停止使用速尿。输血完成后进行体检。在使用TWRC的20例患者中，18例转为去白细胞红细胞（90%）。2例患者产生的复发性过敏反应需要重新输以TWRC。8名定期使用速尿的患者中，7名中止了使用该药物，并且没有输血相关液体超负荷的相关记录。一名病人拒绝。在符合条件的50例患者中，20例（40%）增加至300 mL/h的最大输血速率；6例（12%）输血速率提高但拒绝增加至最大；9例（18%）拒绝做出改变，15例（30%）已经达到了最大速率。只产生一例有记录的输血反应（心悸），但是该患者在随后的输血中能够耐受更高的输血速率。使用TWRC的地中海贫血患者安全转用LDRC。输血速率安全地得到提高，计算出减少的白天卧床时间为每月17.45小时。这证实了5 mL/kg/h的指引在心功能得到保护的输血依赖型地中海贫血患者中有良好的耐受性，可以推广至全球其他中心。

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