scholarly journals Understanding Volume Kinetics: The Role of Pharmacokinetic Modeling and Analysis in Fluid Therapy

2020 ◽  
Vol 7 ◽  
Author(s):  
Xiu Ting Yiew ◽  
Shane W. Bateman ◽  
Robert G. Hahn ◽  
Alexa M. E. Bersenas ◽  
William W. Muir
Keyword(s):  
Veterinary Medicine ◽  
Fluid Therapy ◽  
Volume Effect ◽  
The Body ◽  
Pharmacokinetic Analysis ◽  
Evidence Based ◽  
Intravenous Fluids ◽  
Pharmaceutical Drugs ◽  
Modeling And Analysis ◽  
Volume Kinetics

Fluid therapy is a rapidly evolving yet imprecise clinical practice based upon broad assumptions, species-to-species extrapolations, obsolete experimental evidence, and individual preferences. Although widely recognized as a mainstay therapy in human and veterinary medicine, fluid therapy is not always benign and can cause significant harm through fluid overload, which increases patient morbidity and mortality. As with other pharmaceutical substances, fluids exert physiological effects when introduced into the body and therefore should be considered as “drugs.” In human medicine, an innovative adaptation of pharmacokinetic analysis for intravenous fluids known as volume kinetics using serial hemoglobin dilution and urine output has been developed, refined, and investigated extensively for over two decades. Intravenous fluids can now be studied like pharmaceutical drugs, leading to improved understanding of their distribution, elimination, volume effect, efficacy, and half-life (duration of effect) under various physiologic conditions, making evidence-based approaches to fluid therapy possible. This review article introduces the basic concepts of volume kinetics, its current use in human and animal research, as well as its potential and limitations as a research tool for fluid therapy research in veterinary medicine. With limited evidence to support our current fluid administration practices in veterinary medicine, a greater understanding of volume kinetics and body water physiology in veterinary species would ideally provide some evidence-based support for safer and more effective intravenous fluid prescriptions in veterinary patients.

Volume Kinetics of Intravenous Fluid Therapy in the Prehospital Setting

2001 ◽  
Vol 16 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Christer Svensén ◽  
Fredrik Sjöstrand ◽  
Robert G. Hahn
Keyword(s):  
Kinetic Analysis ◽  
Fluid Therapy ◽  
Elimination Rate ◽  
Volume Effect ◽  
The Body ◽  
Control Group ◽  
Trauma Patients ◽  
Acetate Solution ◽  
Crystalloid Fluid ◽  
Ringer’S Acetate Solution

AbstractIntroduction:To study the volume effect of isotonic and hypertonic crystalloid fluid during ambulance transports after mild trauma, a prospective case-control study was initiated, using the ambulance and helicopter transport system in Stockholm.Methods:The hemodilution resulting from intravenous infusion of 1.0 L of Ringer's acetate solution (n = 7) or 250 ml of 7.5% sodium chloride (n = 3) over 30 minutes (min) was measured every 10 min during 1 hour when fluid therapy was instituted at the scene of an accident, or on arrival at the hospital. The dilution was studied by volume kinetic analysis and compared to that of matched, healthy controls who received the same fluid in hospital.Result:The hemodilution at the end of the infusions averaged 7.7% in the trauma patients and 9.1% in the controls, but the dilution was better maintained after trauma. The kinetic analysis showed that the size of the body fluid space expanded by Ringer's solution was 4.6 L and 3.8 L for the trauma and the control patients, respectively, while hypertonic saline expanded a slightly larger space. For both fluids, trauma reduced the elimination rate constant by approximately 30%.Conclusion:Mild trauma prolonged the intravascular persistence of isotonic and hypertonic crystalloid fluid as compared to a control group.

Volume Kinetics of Ringer Solution, Dextran 70, and Hypertonic Saline in Male Volunteers 

1997 ◽  
Vol 87 (2) ◽  
pp. 204-212 ◽  
Author(s):  
Christer Svensen ◽  
Robert G. Hahn
Keyword(s):  
Serum Albumin ◽  
Hypertonic Saline ◽  
Fluid Therapy ◽  
Elimination Rate ◽  
The Body ◽  
Acetate Solution ◽  
Male Volunteers ◽  
Dextran 70 ◽  
Volume Kinetics ◽  
Kinetics Of

Background A knowledge of the distribution of different fluids given by intravenous infusion is basic to the understanding of the effects of fluid therapy. Therefore, a mathematical model was tested to analyze the volume kinetics of three types of fluids. Methods The authors infused 25 ml/kg of Ringer acetate solution, 5 ml/kg of 6% dextran 70 in 0.9% NaCl, and 3 ml/kg of 7.5% NaCl over 30 min in 8 male volunteers aged from 25 to 36 years (mean, 31 years) and measured the changes in total hemoglobin, serum albumin, and total blood water over time. The changes were expressed as fractioned dilution and then plotted against time. The curves were fitted to a one-volume and a two-volume model, which allowed an estimation of the size of the body fluid space expanded by the fluid (V) and the elimination rate constant (k(r) to be made. Results The changes in blood water concentration indicated a mean size of V of 5.9 1 (+/- 0.8, SEM) for Ringer's solution, 2.6 (+/- 0.3) 1 for dextran, and 1.2 (+/- 0.1) 1 for hypertonic saline. The corresponding values of k(r) were 94 (+/- 42), 12 (+/- 6), and 30 (+/- 4) ml/min, respectively. Blood hemoglobin indicated a degree of dilution similar to that indicated by blood water. Serum albumin indicated a more pronounced dilution, which resulted in a larger expandable volume and a greater mean square error for the curvefitting. The larger volume obtained for serum albumin can probably be explained by a loss of intravascular albumin into the tissues along with the infused fluid. Conclusions The distribution of intravenous fluids can be analyzed by a kinetic model adapted for fluid spaces, but slightly different results are obtained, depending on the marker used to indicate dilution of the primary fluid space. Analysis and simulation of plasma volume expansion by this model is a tool that can help the anesthetist to better plan fluid therapy.

Doctor of Nursing Practice: Integrating Theory, Research, and Evidence-Based Practice

2013 ◽  
Vol 6 (1) ◽  
pp. 4-8 ◽  
Author(s):  
Bridget R. Roberts
Keyword(s):  
Nursing Practice ◽  
Evidence Based Practice ◽  
Strong Relationship ◽  
The Body ◽  
Evidence Based ◽  
Advanced Practice ◽  
Nursing Knowledge ◽  
Doctor Of Nursing Practice ◽  
Practice Nurses ◽  
Theory Research

A strong relationship exists between theory, research, and evidence-based practice; and these three entities are necessary to guide practice and contribute to the body of nursing knowledge. Doctor of nursing practice graduates can serve as leaders as they enter into their respective clinical practice areas. Through education of peers, along with translation and evaluation of current theoretical literature and empirical data, these advanced practice nurses can positively influence nursing practice and patient care.

Abstract WP282: Protecting Stroke Patients from Aspiration and Mortality through a Bedside Aspiration Screen

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Edith Matesic
Keyword(s):  
Organizational Learning ◽  
Aspiration Pneumonia ◽  
The Body ◽  
Kappa Statistics ◽  
Evidence Based ◽  
Stroke Patients ◽  
Rater Reliability ◽  
Stroke Treatment ◽  
Risk Of Death ◽  
The Impact

Background: Stroke patients initially experience dysphagia approximately 42-76% of the time, putting them at high risk for developing aspiration pneumonia and increasing the risk of death threefold in the first 30 days following onset of the condition. Interventions to identify risk for aspiration pneumonia are key to reducing mortality in hospitalized patients. However, no generally recognized bedside aspiration screen exists, and few have been rigorously tested. The Edith-Huhn-Matesic Bedside Aspiration Screen (EHMBAS) TM was developed as an evidence-based RN bedside aspiration screening protocol. Purpose: This study analyzed the sensitivity and inter-rater reliability of EHMBAS TM , assessed the efficacy of training methods, evaluated patient feedback, and looked at the impact of organizational learning. Methods: RNs were trained to apply the EHMBAS TM . An evaluation study assessed the sensitivity, specificity and predictability of the screen to detect aspiration in the stroke population study group. Cohen’s Kappa statistics was applied to test inter-rater reliability. Pre- and post-implementation Likert surveys examined patient and staff satisfaction on the education plan and screening process, respectively. Lastly, an analysis of organizational learning examined whether changes enhanced adherence to screening requirements. Results: Results showed that the EHMBAS TM demonstrated strong validity (94% sensitivity) and high inter-rater reliability (Kappa = .92, p<.001). Pre- and post- staff training survey results demonstrated a significant positive change in knowledge gained, feelings of preparedness, and satisfaction with teaching methods. Further, 92.3% of patients surveyed had positive screening experiences. The hospital received Silver recognition from The American Heart Association for following stroke treatment guidelines 85% of the time for at least 12 months, demonstrating the positive impact of the protocol on organizational change. Conclusions: This study contributes to the body of work aimed at establishing a reliable evidence-based, bedside aspiration screen. Patient safety is enhanced, because screen results help determine when patients can safely receive medication and nutrition by mouth.

scholarly journals A RARE CASE OF HEMIPLEGIA

2020 ◽  
pp. 30-30
Author(s):  
Valeti Rajeswari ◽  
Kolluru V D Karthik ◽  
Srinivasula Sriranga Pravallika
Keyword(s):  
Cerebral Infarction ◽  
Honey Bee ◽  
Anaphylactic Shock ◽  
Rare Case ◽  
The Body ◽  
Intravenous Fluids ◽  
Rare Entity ◽  
Bee Sting ◽  
The Face

Honey bee sting induced Cerebral infarction is a rare entity . We report a case of 55year old male presented with anaphylactic shock following honey bee sting along with weakness of left side of the body and the face . He was managed with anti histaminics, adrenaline injections, Intravenous fluids , vasopressors , anti platelets and anticoagulants .

scholarly journals LIVE BIRTHS AND STILLBIRTHS – QUESTIONS OF FORENSIC SCIENCE AND RADIOLOGY: CASES FROM EXPERT PRACTICE

2021 ◽  
Author(s):  
Yulia V. Chumakova ◽  
Sofia E. Dubrova ◽  
Natalia S. Muranova ◽  
Olga M. Popova ◽  
Vladimir A. Klevno
Keyword(s):  
Live Birth ◽  
The Body ◽  
Evidence Based ◽  
Case Presentation ◽  
X Ray ◽  
Congenital Deformities ◽  
Medical Study ◽  
Private House ◽  
Life Tests ◽  
History Of

Introduction: The article deals with the criteria, forensic and radiological "life tests", difficulties in assessing the results of live birth and stillbirth of the fetus. An excursion into the history of the development of X-ray, including pre-sectional, examination of the corpses of newborns is made. Cases from the practice of two corpses of newborns which underwent pre-section computed tomography are presented. Case presentation: Case № 1: examination of the corpse of a baby found in a cardboard box on the unheated terrace of a private house after a secret self-birth. Case № 2: examination of the corpse of an infant with massive injuries and the division of the body into two fragments, found on a sorting tape in the premises of the waste sorting shop. Conclusion: Postmortem CT of newborn corpses was an evidence-based and visual addition to the traditional forensic medical study, which allowed even at the pre-dissection stage to speak about the maturity of fetuses, to identify injuries and anatomical variants of the structure, to refute the presence of congenital deformities; to establish and record evidence-based CT signs of live birth and stillbirth.

scholarly journals Monitoring of the load regime applied on the osseointegrated fixation of a trans-femoral amputee: A tool for evidence-based practice

2008 ◽  
Vol 32 (1) ◽  
pp. 68-78 ◽  
Author(s):  
Laurent Frossard ◽  
Nathan Stevenson ◽  
James Smeathers ◽  
Eva Häggström ◽  
Kerstin Hagberg ◽  
...  
Keyword(s):  
Performance Indicators ◽  
Daily Living ◽  
Evidence Based Practice ◽  
Maximum Load ◽  
The Body ◽  
Evidence Based ◽  
Data Logger ◽  
Actual Usage ◽  
Load Regime ◽  
User Friendly

This study aimed to provide a description of the continuous recording of the true load regime experienced during daily living by the abutment of a trans-femoral amputee fitted with an osseointegrated fixation. The specific objectives: (i) To present an apparatus and a procedure allowing recording of the load regime, and (ii) an example of the raw data and six performance indicators of the usage of the prosthesis obtained with this method. A subject was monitored for a period of 5 hours as he went about his daily activities. The load regime was directly measured and recorded using a commercial transducer and data logger. The overall load profile presented alternative periods of variable length of inactivity (64%) and activity (36%), respectively. The maximum load applied on the mediolateral, anteroposterior and the long axes represented 21%, 21% and 120% of the body weight, respectively. The anteroposterior, mediolateral and long components of the impulse were 395 kN.s, 359 kN.s and 2,323 kN.s, respectively. The amputee generated a total of 2312 gait cycles of the prosthetic leg, giving an approximate overall cadence of 8 stride/min. Preliminary outcomes indicated that the proposed method was an improvement on the current techniques as it provided the true loading and actual usage of the prosthesis during daily living. This study is a stepping stone in the development of future affordable, on-board and user-friendly load recording systems that can be used in evidence-based practice.

Oxytocin versus carbetocin administered to cows after uncomplicated calvings and subsequent fertility

2016 ◽  
Vol 179 (7) ◽  
pp. 175-176
Author(s):  
Natalie Robinson ◽  
Marnie Brennan
Keyword(s):  
Decision Making ◽  
Veterinary Medicine ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Subsequent Fertility ◽  
The University

BestBETs for Vets are generated by the Centre for Evidence-based Veterinary Medicine at the University of Nottingham to help answer specific questions and assist in clinical decision making. Although evidence is often limited, they aim to find, present and draw conclusions from the best available evidence, using a standardised framework. A more detailed description of how BestBETs for Vets are produced was published in VR, April 4, 2015, vol 176, pp 354-356.

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