scholarly journals Options of severe preeclampsia treatment

2020 ◽  
pp. 278-279
Author(s):  
R.O. Tkachenko
Keyword(s):  
Blood Pressure ◽  
Pulmonary Edema ◽  
Isotonic Saline ◽  
Colloid Osmotic Pressure ◽  
Interstitial Space ◽  
Intravenous Fluid ◽  
Infusion Therapy ◽  
Electrolyte Balance ◽  
Protein Loss ◽  
Fluid Infusion

Background. Preeclampsia (PE) occurs in 2-8 % of all pregnancies. Every day 210 women die from PE, and neonatal losses are even greater (1380 children per day). Fatal complications of severe PE include cerebral hemorrhage, cerebral edema, pulmonary edema, placental abruption, adrenal hemorrhage, dissecting aortic aneurysm, HELLP syndrome, disseminated intravascular coagulation syndrome. Excessive intravenous fluid infusion is one of the causes of pulmonary edema in PE. Objective. To describe the options of severe PE treatment. Materials and methods. Analysis of literature data on this issue. Results and discussion. The pathogenesis of PE is based on total damage to the vascular endothelium, which leads to an increase in its permeability, including for albumin molecules. Plasma protein loss is accompanied by a drop in oncotic blood pressure and fluid leakage into the interstitial space. Thus, in patients with PE there is an associated disturbance of fluid and electrolyte balance: along with intravascular dehydration there is extravascular hyperhydration. Infusion therapy (IT) allows to overcome this imbalance and to increase the colloid-osmotic pressure. According to modern views, a restricted IT regimen improves the effects of PE treatment. There are two ways to correct this disorder: an increase in oncotic blood pressure due to infusion of albumin (indicated in case of blood albumin levels <25 g/L) and the administration of osmotically active drugs, such as Reosorbilact (“Yuria-Pharm”). The latter option prevents the loss of fluid from the vascular bed and promotes its return to the vessels from the intercellular space. The total fluid volume should be limited to physiological needs, taking into account pathological losses (not more than 1 ml/kg/h). The maximum IT volume should not exceed 800 ml per day. The drugs of choice for IT before delivery are balanced isotonic saline solutions and solutions containing 6 % sorbitol. Fresh-frozen plasma is not recommended for the correction of colloid-oncotic pressure. Influence on the redistribution of fluid in the interstitial space without the introduction of significant volumes of infusion solutions is the main principle of low-volume IT. Recommendations for the administration of Reosorbilact comply with this principle. The low osmolarity of Reosorbilact and its ability to improve the osmotic properties of blood justify the use of this drug in women with PE. Conclusions. 1. PE occurs in 2-8 % of all pregnancies. 2. Excessive intravenous fluid infusion is one of the causes of pulmonary edema in PE. 3. Restricted IT mode improves the consequences of PE treatment. 4. Osmotically active drugs (Reosorbilact) are prescribed for this purpose.

scholarly journals Infusion therapy in the internal diseases’ propaedeutics

2020 ◽  
pp. 306-308
Author(s):  
V.I. Chernii
Keyword(s):  
Blood Plasma ◽  
Blood Volume ◽  
Isotonic Saline ◽  
Clinical Manifestations ◽  
Tissue Perfusion ◽  
Coagulation System ◽  
Infusion Therapy ◽  
Electrolyte Balance ◽  
Circulating Blood Volume ◽  
Plasma Substitutes

Background. Infusion therapy (IT) is one of the main methods of drug therapy optimization. The essence of IT is to correct homeostasis disorders in order to detoxify, to restore the disrupted microcirculation and tissue perfusion, to eliminate the disorders of rheological and coagulation blood properties, to eliminate metabolic disorders, to improve drug delivery to the pathological focus, to restore circulating blood volume, to normalize fluid and electrolyte and acid-base balance. Objective. To describe modern IT. Materials and methods. Analysis of the literature sources on this topic. Results and discussion. Requirements for modern plasma substitutes include safety, sufficient and long-lasting volemic effect, rapid renal excretion, lack of accumulation and effect on the coagulation system, maximum similarity to blood plasma, and availability. There are several classes of plasma substitutes, and each of them has its own indications. For example, crystalloids are prescribed for dehydration, and colloids – for hypovolemia. The infusion volume is calculated based on the physiological needs of the organism, taking into account pathological fluid loss (fever, shortness of breath, postoperative wound drainage, vomiting, polyuria). Endogenous intoxication (EI) – a pathological condition that occurs as a result of exposure to toxic substances of exogenous or endogenous nature, which cause dysfunction and the development of extreme conditions – is an important field of IT application. EI can accompany chronic heart failure, peripheral vessels atherosclerosis, autoimmune and allergic diseases. Toxins have a direct (direct destruction of proteins and lipids, blocking of synthetic and oxidative processes in the cell) and indirect (microcirculation system and vascular tone disorders, changes of blood rheological properties) adverse effects. Clinical manifestations of EI include fever, malaise, and the dysfunction of various internal organs. As EI depletes the natural mechanisms of detoxification, worsens the clinical course of the disease, reduces drug sensitivity, suppresses immunity, it is an indication to detoxification via infusion. The tasks of the latter are to improve tissue perfusion, to provide hemodilution with a decrease in the toxins’ concentration, to stimulate diuresis, to eliminate acidosis, and to maintain the functional state of hepatocytes. For this purpose, solutions of polyatomic alcohols (Reosorbilact, Xylate, “Yuria-Pharm”) can be used. Reosorbilact increases the circulating blood volume, improves microcirculation and rheological blood properties, increases tissue perfusion, promotes “wash-out” of toxins, corrects acidosis and fluid and electrolyte balance, normalizes hepatocyte function, improving the own detoxification mechanisms. In case of microcirculation disturbances, it is reasonable to use the combined IT with the inclusion of Reosorbilact, Latren and Tivortin (“Yuria-Pharm”). Latren increases the elasticity of erythrocytes, reduces the aggregation of erythrocytes and platelets, normalizes the electrolyte composition of blood plasma, and Tivortin acts as a substrate for the formation of nitric oxide – the main signaling molecule of the endothelium. In addition to EI, IT usage is often prescribed for diabetic ketoacidosis. In such cases, it is advisable to use Xylate (“Yuria-Pharm”), which has antiketogenic properties, improves hemodynamics, corrects acidosis, and does not increase blood glucose levels. Xylate is recommended to be used only after preliminary rehydration with the help of isotonic saline solutions. Conclusions. 1. IT is an important method of treating a number of diseases. 2. EI accompanies not only diseases that involve intoxication syndrome, but also almost all internal diseases. 3. Reosorbilact and Xylate are the optimal solutions for detoxification. 4. It is reasonable to use combined IT, for example, the combination of Reosorbilact with Latren and Tivortin.

scholarly journals Complications of the infusion therapy and their prevention

2020 ◽  
pp. 45-47
Author(s):  
O.A. Halushko
Keyword(s):  
Side Effects ◽  
Infusion Rate ◽  
Interstitial Space ◽  
Infusion Therapy ◽  
Electrolyte Balance ◽  
Minimal Risk ◽  
Advantages And Disadvantages ◽  
Ringer’S Solution ◽  
Filling Time ◽  
Polyatomic Alcohols

Background. Infusion solutions are divided into several groups: crystalloids, colloids (natural and artificial), polyatomic alcohols, special drugs (infusion antibiotics, analgesics, hemostatics). Each solution type has its own complications. Objective. To identify the main complications of infusions and prevention measures. Materials and methods. Analysis of the available literature on this topic. Results and discussion. After the transfusion of 1 liter of 0.9 % NaCl only 275 ml of this solution remains in plasma, and 725 ml passes into the interstitial space, causing edema. In addition, there is a risk of hyperchloraemic acidosis in case of massive transfusions. 0.9 % NaCl is inadequate in its ionic composition, has no reserve alkalinity, deepens hyperosmolar changes, so it is not used as monotherapy in daily practice. It is used as a solvent only. Ringer’s solution is also easily excreted into the interstitial space with the edema formation. It is hyperosmolar, contains a large number of chlorine ions and is excreted by the kidneys, so it should be used with caution in patients with kidney disease. A number of drugs (aminocaproic acid, amphotericin B, blood products, sodium thiopental) are incompatible with Ringer’s solution and Ringer’s lactate. In turn, 5 % glucose solution is ineffective for detoxification, liver cirrhosis and restoring the circulating blood volume in case of blood loss. Glucose infusions can increase the production of carbon dioxide and lactate, increase ischemic damage to the brain and other organs, and promote tissue edema. At present, the routine use of glucose during surgery and in critically ill patients has been completely abandoned. Preparations of polyatomic alcohols can be divided into the preparations of six-atomic alcohols – mannitol (Mannit) and sorbitol (Sorbilact, Reosorbilact) and five-atomic alcohols (xylitol – Xylate, Gluxyl, Lactoxyl) (all of the listed solutions are made by “Yuria-Pharm”). Side effects of mannitol include tachycardia, thrombophlebitis, chest pain, skin rash, dehydration, dyspepsia, fluid and electrolyte balance, and hallucinations. Hypotension is the most common complication of mannitol usage. Reosorbilact is a modern balanced infusion solution. Its effects include the hypovolemia correction, restoration of electrolyte disturbances, normalization of cardiac activity and nerve conduction, increase of alkaline blood reserve and restoration of energy balance. In case of the significant overdose Reosorbilact can cause alkalosis. Contraindications to its administration include alkalosis, cerebral hemorrhage, pulmonary embolism, and 3 grade hypertension. Xylitol is a five-atom alcohol that is rapidly incorporated into the pentose phosphate metaboliс pathway. Its side effects include the allergic reactions, hypertension, nausea, and lactic acidosis. The main disadvantage of hydroxyethyl starch (HES) drugs is the adverse effect on hemostasis (especially in drugs of the first generation). In addition, HES may impair the renal function, so they should be used in the lowest effective dose for the shortest period of time. In addition to complications associated with infusion solutions, there are complications associated with the injection procedure (hematoma, infiltration, thromboembolism, air embolism, and phlebitis). The thorough monitoring is needed to prevent the complications of all stages of infusion therapy. Such parameters as blood pressure, heart rate, blood gas composition, capillary filling time, mental status, and diuresis should be monitored. It is also necessary to carefully examine the composition of prescribed drugs and instructions for their medical use, to control the infusion rate, and to combine different drugs rationally. Conclusions. 1. There are several classes of infusion solutions, and each of them has its own advantages and disadvantages. 2. Reosorbilact is a balanced drug with the minimal risk of side effects. 3. To prevent complications, it is necessary to monitor the basic physiological parameters, to control the infusion rate, and to rationally combine different tools.

scholarly journals Evaluation of Stroke Volume Variation Obtained by the FloTrac™/Vigileo™ System to Guide Preoperative Fluid Therapy in Patients Undergoing Brain Surgery

2012 ◽  
Vol 40 (3) ◽  
pp. 1175-1181 ◽  
Author(s):  
J Li ◽  
Fh Ji ◽  
Jp Yang
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stroke Volume ◽  
Stroke Volume Variation ◽  
Brain Surgery ◽  
Fluid Loading ◽  
Volume Loading ◽  
Fluid Infusion ◽  
Volume Variation ◽  
Ringer’S Lactate

OBJECTIVE: The accuracy of stroke volume variation (SVV) obtained by the FloTrac™/Vigileo™ system in otherwise healthy patients undergoing brain surgery was assessed. METHODS: Anaesthesia was induced in 48 patients with minimal fluid infusion. Before surgery, fluid volume loading was performed by infusion with Ringer's lactate solution in 200 ml steps over 3 min, repeated successively if the patient responded with an increase in stroke volume of ≥ 10%, until the increase was < 10% (nonresponsive). RESULTS: A total of 157 volume loading steps were performed in the 48 patients. Responsive and nonresponsive steps differed significantly in baseline values of blood pressure, heart rate and SVV. Significant correlations were found between the change in stroke volume after fluid loading and values of blood pressure, heart rate and SVV before fluid loading, with SVV the most sensitive variable. CONCLUSION: Stroke volume variation obtained using the FloTrac™/Vigileo™ system is a sensitive predictor of fluid responsiveness in healthy patients before brain surgery.

Influence of the Type and Rate of Subarachnoid Fluid Infusion on Lethal Neurogenic Pulmonary Edema in Rats

2002 ◽  
Vol 14 (3) ◽  
pp. 194-203 ◽  
Author(s):  
Bernhard Walder ◽  
Marie-Anne Bründler ◽  
Martin Tötsch ◽  
Nadia Elia ◽  
Denis R. Morel
Keyword(s):  
Pulmonary Edema ◽  
Neurogenic Pulmonary Edema ◽  
Fluid Infusion

Abstract 064: 20-HETE Contributes to Vasoconstriction of Renal Microvessels and Sodium Retention in Cyp4a14-/- Mice, a Model of 20-HETE Dependent Hypertension

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Ankit Gilani ◽  
Varunkumar Pandey ◽  
Joseph Zullo ◽  
Priyanka Mishra ◽  
John R Falck ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Weight ◽  
Isotonic Saline ◽  
Urinary Sodium Excretion ◽  
Water Soluble ◽  
Arachidonic Acid Metabolite ◽  
Male Mice ◽  
Kidney Weight ◽  
Doppler Flowmetry ◽  
In The Wild

20-HETE (20-Hydroxyeicosatetraenoic acid), is a cytochrome P450 (CYP) 4A-derived arachidonic acid metabolite. 20-HETE has been linked to both pro-hypertensive (via increased vasoconstriction, vascular remodeling and vascular injury of renal microvessels) and anti-hypertensive (inhibiting ion transport in the distal nephron) functions. In this study we examined the effect of 20-SOLA (2,5,8,11,14,17-hexaoxanonadecan-19-yl-20-hydroxyeicosa-6(Z),15(Z)-dienoate), a water soluble antagonist of the actions of 20-HETE on renal hemodynamics and sodium (Na) excretion in Cyp4a14 knockout (CYP4a14-/-) male mice. The CYP4a14-/- male mice display hypertension accompanied by increased vascular 20-HETE levels. Administration of 20-SOLA (10mg/kg/day in drinking water) normalized blood pressure (BP) in male Cyp4a14-/- mice at day 10 of treatment (124±1 vs. 153±2 mmHg in untreated male Cyp4a14-/- mice; p<0.05). The normalization of blood pressure was accompanied by transient increase in the urinary sodium excretion in the Cyp4a14-/- male mice (8.3±0.7 vs. 5.8±0.5 μmol/g body weight/day; p<0.05). Importantly, 20-SOLA increased glomerular filtration rate (GFR) of Cyp4a14-/- mice (2.38±0.05 vs. 1.88±0.18 μL/min/mg kidney weight, p<0.05) as opposed to no changes observed in the wild type (WT: (2.26±0.18 vs. 2.33±0.20μL/min/mg kidney weight). Evaluation of the renal blood flow (RBF) by laser Doppler flowmetry showed that treatment with 20-SOLA increased the RBF in Cyp4a14-/- mice by 12.3±4%, which remained unaltered in the WT. Additionally, the pressure-induced myogenic tone of isolated preglomerular microvessels was significantly elevated in Cyp4a14-/- mice; 20-SOLA treatment prevented the increase in myogenic responses. The natriuretic response to an isotonic saline loading challenge (10% of body weight, IP) was significantly attenuated in the Cyp4a14-/- mice as compared to the WT (35.5±2.8 vs. 57.4±8.3 percentage of Na load, p<0.05); this was corrected by 20-SOLA (61.7±5.7 percentage of Na load, p<0.05). These results confirm that 20-SOLA normalizes blood pressure of Cyp4a14-/- male mice and demonstrates that this is associated with increases in GFR, RBF and natriuresis.

scholarly journals Corticosteroid regulation of amiloride-sensitive sodium-channel subunit mRNA expression in mouse kidney

2000 ◽  
Vol 165 (1) ◽  
pp. 25-37 ◽  
Author(s):  
P MacDonald ◽  
S MacKenzie ◽  
LE Ramage ◽  
RW Brown ◽  
Keyword(s):  
Blood Pressure ◽  
Sodium Channel ◽  
Mrna Expression ◽  
Collecting Duct ◽  
In Situ Hybridisation ◽  
Electrolyte Balance ◽  
Distal Nephron ◽  
Outer Medulla ◽  
Subunit Mrna ◽  
Sodium Handling

Corticosteroid control of distal nephron sodium handling, particularly through the amiloride-sensitive sodium channel (ENaC), has a key role in blood pressure regulation. The mechanisms regulating ENaC activity remain unclear. Despite the generation of useful mouse models of disorders of electrolyte balance and blood pressure, there has been little study of distal nephron sodium handling in this species. To investigate how corticosteroids regulate ENaC activity we isolated cDNA for the three mouse ENaC subunits (alpha, beta and gamma), enabling their quantitation by competitive PCR and in situ hybridisation. Kidneys were analysed from mice 6 days after adrenalectomy or placement of osmotic mini-pumps delivering aldosterone (50 microg/kg per day), dexamethasone (100 microg/kg per day), spironolactone (20 mg/kg per day) or vehicle alone (controls). In controls, renal ENaCalpha mRNA exceeded beta or gamma by approximately 1.75- to 2.8-fold. All subunit mRNAs were expressed in renal cortex and outer medulla, where the pattern of expression was fully consistent with localisation in collecting duct, whereas the distribution in cortex suggested expression extended beyond the collecting duct into adjacent distal tubule. Subunit mRNA expression decreased from cortex to outer medulla, with a gradual reduction in beta and gamma, and ENaCalpha decreased sharply ( approximately 50%) across the outer medulla. Expression of ENaCbeta and gamma (but not alpha) extended into inner medulla, suggesting the potential for inner medulla collecting duct cation channels in which at least ENaCbetagamma participate. Aldosterone significantly increased ENaC subunit expression; the other treatments had little effect. Aldosterone caused a 1.9- to 3.5-fold increase in ENaCalpha (particularly marked in outer medullary collecting duct), but changes for beta and gamma were minor and limited to the cortex. The results raise the possibility that medullary ENaCalpha upregulation by aldosterone will create more favourable subunit stoichiometry leading to a more substantial increase in ENaC activity. In cortex, such a mechanism is unlikely to have a major role.

Effect of decreased plasma colloid osmotic pressure on development of pulmonary edema in dogs

1981 ◽  
Vol 11 (3) ◽  
pp. 203-208 ◽  
Author(s):  
Nobuyuki Hara ◽  
Akira Nagashima ◽  
Takero Yoshida ◽  
Tsugio Furukawa ◽  
Kiyoshi Inokuchi
Keyword(s):  
Pulmonary Edema ◽  
Osmotic Pressure ◽  
Colloid Osmotic Pressure

Colloid Osmotic Pressure in Newborn Infants: Variations with Birth Weight, Gestational Age, Total Serum Solids, and Mean Arterial Pressure

PEDIATRICS ◽  
1981 ◽  
Vol 68 (6) ◽  
pp. 814-819
Author(s):  
Paul Y. K. Wu ◽  
Gary Rockwell ◽  
Linda Chan ◽  
Shu-Mei Wang ◽  
Vikram Udani
Keyword(s):  
Blood Pressure ◽  
Birth Weight ◽  
Osmotic Pressure ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Newborn Infants ◽  
Colloid Osmotic Pressure ◽  
Large For Gestational Age ◽  
Total Serum ◽  
Arterial Blood

Colloid osmotic pressure (COP) of blood was measured directly at birth with the Wescor membrane colloid osmometer (model 4100) in 91 appropriately grown, 11 large, and nine small for gestational age "well" newborn infants. COP correlated directly with birth weight (r = .726, P &lt; .00001) and gestational age (r = .753, P &lt; .00001). COP values for small for gestational age (SGA) and large for gestational age (LGA) infants were found to fall within the 95% prediction interval with regard to birth weight and gestational age for appropriate for gestational age (AGA) infants. Simultaneous measurements of COP, total serum solids, and central arterial mean blood pressure were made. The results showed that COP correlated directly with total serum solids (r = .89, P &lt; .0001) and mean arterial blood pressure (r = .660, P &lt; .001). Among the factors evaluated, total serum solids was the best predictor of COP.

Effects of continuous positive-pressure ventilation in experimental pulmonary edema

1976 ◽  
Vol 40 (4) ◽  
pp. 568-574 ◽  
Author(s):  
P. C. Hopewell ◽  
J. F. Murray
Keyword(s):  
Pulmonary Edema ◽  
Left Atrial ◽  
Positive Pressure Ventilation ◽  
Colloid Osmotic Pressure ◽  
Intermittent Positive Pressure Ventilation ◽  
Water Volume ◽  
Positive Pressure ◽  
Positive End Expiratory Pressure ◽  
Continuous Positive Pressure ◽  
Double Isotope

We compared the effects of continuous positive-pressure ventilation (CPPV), using 10 cmH2O positive end-expiratory pressure (PEEP), with intermittent positive-pressure ventilation (IPPV), on pulmonary extravascular water volume (PEWV) and lung function in dogs with pulmonary edema caused by elevated left atrial pressure and decreased colloid osmotic pressure. The PEWV was measured by gravimetric and double-isotope indicator dilution methods. Animals with high (22–33 mmHg), moderately elevated (12–20 mmHg), and normal (3–11 mmHg) left atrial pressures (Pla) were studied. The PEWV by both methods was significantly increased in the high and moderate Pla groups, the former greater than the latter (P less than 0.05). There was no difference in the PEWV between animals receiving CPPV and those receiving IPPV in both the high and moderately elevated Pla groups. However, in animals with high Pla, the Pao2 was significantly better maintained and the inflation pressure required to deliver a tidal volume of 12 ml/kg was significantly less with the use of CPPV than with IPPV. We conclude that in pulmonary edema associated with high Pla, PEEP does not reduce PEWV but does improve pulmonary function.

Pathogenesis of pulmonary edema associated with intracisternal endotoxin in dogs

1990 ◽  
Vol 68 (4) ◽  
pp. 1688-1695 ◽  
Author(s):  
A. Nahum ◽  
L. D. Wood ◽  
G. Crawford ◽  
R. Ripper ◽  
L. Segil ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Pulmonary Edema ◽  
Raised Intracranial Pressure ◽  
Oncotic Pressure ◽  
Plasma Albumin ◽  
Pulmonary Wedge Pressure ◽  
Fluid Infusion ◽  
Albumin Ratio ◽  
Wedge Pressure

To examine the role of central nervous system injury in the pathogenesis of pulmonary edema, we injected Escherichia coli endotoxin (5 mg/kg) into the cisterna magna of six dogs (group E) and compared, over 4 h, both the pulmonary edema and cerebrospinal fluid (CSF) abnormalities with those in six control dogs (group C). In group E, intracisternal endotoxin raised intracranial pressure from 21 +/- 6 to 38 +/- 8 cmH2O (P less than 0.001), CSF total protein from 18 +/- 6 to 54 +/- 19 mg/dl (P less than 0.001), and CSF malondialdehyde from 0.12 +/- 0.11 to 0.61 +/- 0.35 nmol/ml (P less than 0.05); all were unchanged in group C. When the pulmonary wedge pressure was maintained at 10 mmHg by fluid infusion, extravascular thermal volume in group E increased from 7.2 +/- 1.2 to 12.0 +/- 2.7 ml/kg (P less than 0.005) at 4 h when the excised lungs weighed 13.6 +/- 1.5 g/kg; in group C, extravascular thermal volume did not increase, and the excised lungs weighed less (10.8 +/- 1.3 g/kg, P less than 0.05) than those in group E. The dry weights of the lungs were not different between groups, and the alveolar lining fluid-to-plasma albumin ratio in both groups remained low, 0.1-0.2. Fluid infusion in group E (9.2 +/- 2.9 liters) caused colloid oncotic pressure to decrease 4.5 +/- 2.8 mmHg; colloid oncotic pressure fell less (0.8 +/- 1.9 mmHg, P less than 0.001) in group C as less fluid (2.2 +/- 1.5 liters, P less than 0.001) was required to maintain pulmonary wedge pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

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