The correlation between Corrected Flow Time (FTc) Based on Esophageal Doppler Monitoring and Pleth Variability Index (PVI) in the Fluid Therapy in Patients undergoing Total Abdominal Hysterectomy

Background: The occurrence of bleeding during major surgeries is common and requires timely and accurate management in the prevention and treatment of hypovolemia and hemodynamic instability during and after surgery. This study evaluated the correlation and agreement between the two protocols determining the status of the hypovolemia during hysterectomy. Methods: This study was a randomized single-blinded clinical trial. The study population included 30 patients undergoing Total Abdominal Hysterectomy in Shariati Hospital in Tehran between 2015 and 2016. The patients were randomly assigned to two groups using a randomized table of numbers, so that in the FTc group, fluid therapy was performed based on the FTc index and in the PVI group based on the PVI index. The changes in FTc and PVI values were recorded every 5 minutes and the changes in the two indicators from the beginning to the end of the treatment were evaluated. At the beginning and end of the surgery, an arterial blood gas analysis (ABG) was also performed. The amount of bleeding during operation and urinary output were recorded in two groups. Results: There was no significant difference across the two groups in total fluid intake during surgery, mean volume of blood loss, mean urine output, and duration of surgery. The arterial blood gas status was also similar in both groups at the beginning and the end of the operation. We found a strong adverse correlation between FTC and PVI indices at the different time points evaluated within the surgery. In total, there was a strong correlation between the mean FTC and the mean PVI during the first hour (r=-0.765, P < 0.001) and the second hour (r=-0.941, -P < 0.001) of operation. Considering the cut-off point of 350msec for the FTC and 13% for the PVI in predicting hypovolemia, the agreement between the two protocols in fluid therapy during the first hour after surgery was 79.8% and 76.6%. Conclusion: There is a strong and significant correlation between the two FTC (with a cut off of 350) and PVI (with a cut point of 13%) to predict need for fluid therapy.

Fluid Intake Status and its Relationship with Cognitive Impairment among Elderlies of Naein City, Iran

Introduction: Water, as one of the most essential nutrients, is involved in almost all biochemical processes of the human body. Although different degrees of dehydration have various symptoms such as physical and mental decline, severe dehydration is associated with decreased survival capacity in the physiological environment of the body that can put individuals, especially the elderly, at the risk of death. The present study aimed to determine the status of fluid intake and its association with cognitive impairments in the elderly people of Naein City in 2018. Methods: This cross-sectional study was conducted among 225 randomly selected elderlies in Naein City. Data collection tools included demographic questionnaire, Mini–Mental State Examination, and 24-hour food recall questionnaire. The obtained data were analyzed using ANOVA, t-test and chi-square via SPSS software. Results: The mean of total fluid intake was 2637.05 ± 772.35 ml / day. Among 225 participants, 36.4%, 37.3%, and 26.2% had normal, mild, and moderate cognitive impairment, respectively. Cognitive impairment had a significant relationship with gender, occupational status, level of education, marital status, and place of residence (p < 0.05). No significant relationship was observed between the mean of water consumption and cognitive impairment (p = 0.6). Conclusion: The amount of fluid intake in elderly people living in Naein City was at a satisfactory level. Since no significant relationship was observed between the amount of fluid intake and cognitive impairments and more than half of the participants had cognitive impairments, we hypothesize that other factors are involved in prevalent of cognitive impairment.

Evaluation of Fluid Intake in College Students During the Initial Response to the COVID-19 Pandemic

Objectives To evaluate fluid intake of college students during the initial response to the COVID-19 pandemic. Methods College students (n = 1015 (75.5% Female); 59 freshmen, 139 sophomores, 264 juniors, 245 seniors, 289 graduate) participated in an online questionnaire from colleges/universities within the United States during the Spring 2020 academic semester. Participants were asked about their fluid intake over the previous 30 days using the BEVQ-15. The questionnaire consisted of demographic and living status questions as well as 16 questions detailing type (e.g., water, milk, etc.), frequency (“how often”), and volume of fluids for each consumption (“how much each time”). Kruskal-Wallis analyses (test statistic reported as chi-square, χ2) were used to compare the total fluid intake, frequency of plain water intake, and volume with each consumption between those with and without a change in living situation and by academic standing. Data reported as (median [interquartile range]). Results A change in living status was reported by 426/1015 (42%) participants. Median fluid intake was 1848 mL ([1295, 2532] mL) for all participants. Total fluid intake [χ2(1) = 18.07, P &lt; 0.001] was different between those with (1709 [1199, 2366] mL) and without (1940 [1378, 2644] mL) a change in living situation. However, the volume of plain water intake was not different between those with (710 [473, 1420] mL) and without (1065 [591, 1420] mL) a change in living situation [χ2(1) = 2.81, P = 0.09]. Frequency [χ2(1) = 3.10, P = 0.08] and the volume with each consumption [χ2(1) = 1.16, P = 0.28] of plain water were also not different based on a change in living situation. Academic standing impacted the volume of total fluid intake [χ2(4) = 14.33, P = 0.006], with juniors (1751 [1161, 2455] mL) reporting less than graduate students (1940 [1041, 2780] mL, P = 0.01). Conclusions These data suggest a change in living situation affected total fluid intake, however, there were no differences in the frequency and volume of plain water intake. Further, academic standing impacted the fluid intake behaviors. Future investigations are warranted to evaluate factors guiding fluid intake frequency and volumes in the college student population. Funding Sources N/A

Hidden Fluids in Plain Sight: Identifying Intravenous Medication Classes as Contributors to Intensive Care Unit Fluid Intake

Introduction: Fluid stewardship targets optimal fluid management to improve patient outcomes. Intravenous (IV) medications, flushes, and blood products, collectively referred to as hidden fluids, contribute to fluid intake in the intensive care unit (ICU). The impact of specific IV medications on fluid intake is unknown. Objective: Characterize IV medication classes based on contribution to ICU fluid intake by frequency of administration and total volume infused to identify targets for fluid stewardship. Methods: This multi-center, retrospective nested cohort study included patients admitted to a medical or surgical ICU between January 2017 and December 2018. The primary outcome was to identify the volume contribution of specific IV medication classes administered over the first 3 ICU days. Secondary outcomes were the administration frequency of these medications and their proportion of total daily volume intake over the first 3 ICU days. Results: The study included 210 patients. The largest mean administration volumes over the course of the first 3 ICU days were attributed to antibacterials (968 ± 846 mL), vitamins/minerals/electrolytes (416 ± 935 mL), pain/agitation/delirium agents (310 ± 512 mL), and vasoactive agents (282 ± 744 mL). The highest frequencies over the course of the first 3 ICU days were attributed to antibacterials (n = 180; 86%), pain/agitation/delirium agents (n = 143; 68%), vitamins/minerals/electrolytes (n = 123; 59%), and vasoactive agents (n = 96; 46%). IV medications contributed 2601 ± 2573 mL of fluid volume per patient over the first 3 ICU days, accounting for 42% ± 29% of overall volume. Conclusion: IV medications contribute over 40% of total fluid intake within the first 3 days of ICU admission, with antibacterials as top contributors by administration volume and frequency. Future research implementing fluid stewardship to ICU fluid sources, such as concentrating IV medications, switching IV medications to oral formulations, de-escalation of antibacterials, and reduction of maintenance fluids, should be performed to minimize hidden fluids from IV medications.

Assessment and Impact of Intravenous Medication Fluid Administration in Critically Ill Patients With Acute Respiratory Failure

Background: Positive fluid balance early in critical illness is associated with poor outcomes. Reducing intravenous medication volume may mitigate volume overload. Objective: Assessment of fluid and medication administration and clinical outcomes in acute respiratory failure. Methods: Single-center, prospective observational study of hemodynamically stable adult patients in a medical intensive care unit (MICU) with acute respiratory failure. Results: Median cumulative total intake volume was 12 890 (interquartile range [IQR] = 8654-22 221) mL (n = 27), and median cumulative intravenous medication volume was 3563 (IQR = 2371-9412) mL over the first 7 days. Medication volume accounted for 27.6% of aggregate fluid volume. Median daily intravenous medication volume administered was 591 (IQR = 339-1082) mL. Cumulative fluid volume was associated with reduced ventilator-free days ( r2 = −0.393; P = 0.043), and cumulative fluid volumes during the first 3 and 7 days were associated with increased MICU length of stay (LOS ± standard error 0.73 ± 0.35 d/L, P = 0.047, and 0.38 ± 0.16 d/L, P = 0.021, respectively). Cumulative medication volume administered significantly reduced the likelihood of mechanical ventilator liberation (hazard ratio [HR] = 0.917; 95% CI: 0.854, 0.984; P = 0.016) and MICU discharge (HR = 0.911; 95% CI: 0.843, 0.985; P = 0.019). Small-volume infusion may decrease cumulative intravenous medication volume by 38%. Conclusion and Relevance: Intravenous medication diluent contributes substantially to total fluid intake in patients with acute respiratory failure and is associated with poor outcomes. Reduction of intravenous medication fluid volume to improve clinical outcomes should be further investigated.

GLP1 Receptor Agonists Reduce Fluid Intake in Primary Polydipsia

Background Primary polydipsia, characterized by excessive fluid intake, carries the risk of water intoxication and hyponatremia, but treatment options are scarce. Glucagon-like peptide-1 (GLP-1) reduces appetite and food intake. In experimental models, they also play a role in thirst and drinking behavior in. The aim of this trial was to investigate whether GLP-1 receptor agonists reduce fluid intake in patients with primary polydipsia. Methods: In this randomized, double-blind, placebo-controlled, 3-week crossover-trial, 34 patients with primary polydipsia received weekly dulaglutide (Trulicity®) 1.5mg and placebo (0.9% sodium chloride). During the last treatment week, patients attended an 8-hour evaluation visit with free water access. The primary endpoint was total fluid intake during the evaluation visits. The treatment effect was estimated using a linear mixed-effects model. In a subset of 15 patients and matched controls, thirst perception and neuronal activity in response to beverage pictures were assessed by functional MRI. Results Median [IQR] total fluid intake was 2250ml [1600-2600] on dulaglutide versus 2400ml [1850-3400] on placebo. Patients on dulaglutide reduced fluid intake by 490ml [95%-CI -780, -199], p=0.002, corresponding to a relative reduction of 17%. 24-hour urinary output was reduced by -943ml [95%-CI -1473, -413]. Thirst perception in response to beverage pictures was higher in patients with primary polydipsia versus controls and lower on dulaglutide versus placebo, but functional neuronal activity was similar between groups and treatments. Conclusion: GLP-1 receptor agonists reduce fluid intake and thirst perception in patients with primary polydipsia and could therefore be a novel treatment option for these patients.

Estimates of fluid intake, urine output and hydration-levels in women from Somaliland: a cross-sectional study

The study objective was to measure fluid intake and associations with background characteristics and hydration biomarkers in healthy, free-living, non-pregnant women aged 15–69 years from Hargeisa city. We also wanted to estimate the proportion of euhydrated participants and corresponding biomarker cut-off values. Data from 136 women, collected through diaries and questionnaires, 24h urine samples and anthropometric measurements, were obtained with a cross-sectional, purposeful sampling from fifty-two school and health clusters, representing approximately 2250 women. The mean (95 % CI) 24 h total fluid intake (TFI) for all women was 2⋅04 (1⋅88, 2⋅20) litres. In multivariate regression with weight, age, parity and a chronic health problem, only weight remained a predictor (P 0.034, B 0.0156 (l/kg)). Pure water, Somali tea and juice from powder and syrup represented 49⋅3, 24⋅6 and 11⋅7 % of TFI throughout the year, respectively. Mean (95 % CI) 24 h urine volume (Uvol) was 1⋅28 (1⋅17, 1⋅39) litres. TFI correlated strongly with 24 h urine units (r 0.67) and Uvol (r 0.59). Approximately 40 % of the women showed inadequate hydration, using a threshold of urine specific gravity (Usg) of 1⋅013 and urine colour (Ucol) of 4. Five percent had Usg > 1⋅020 and concomitant Ucol > 6, indicating dehydration. TFI lower cut-offs for euhydrated, non-breast-feeding women were 1⋅77 litres and for breast-feeding, 2⋅13 litres. Euhydration cut-off for Uvol was 0⋅95 litre, equalling 9⋅2 urine units. With the knowledge of adverse health effects of habitual hypohydration, Somaliland women should be encouraged to a higher fluid intake.

Smartphone-based application vs paper-based record: female adolescents acceptance on fluid record tool

Introduction: Water is essential for normal functioning of the human body. Total fluid intake assessment using fluid record method is considered to be a burden for respondents, and the development of technology is expected to contribute favourably to this issue. My Fluid Diary is a smartphone-based application developed by the researcher as a fluid intake recording tool. This study aimed to evaluate the acceptance of manual, paper-based fluid intake recording compared to using My Fluid Diary as a trial among Indonesian vocational female students. Methods: A qualitative study was conducted to explore students’ acceptance of fluid intake recording using the smartphone-based application. An exploratory case study approach involving 38 female students as key informants was used via focus group discussion and in-depth interview as a method of triangulation. Results: Based on the data, female adolescents admitted that the application was more acceptable for fluid intake than recording manually using a book, in consideration of three aspects - the benefits, the easiness, and the application display or features. Based on its benefits, My Fluid Diary was mentioned as easy to learn and use. However, in order to improve the application, there is still a need for research development. Conclusion: My Fluid Diary was an application with respectable acceptance for fluid record compared to the manual, paper-based method among female adolescents.

Echocardiography-Guided Hemodynamic Management of Severe Sepsis and Septic Shock in Adults: A Randomized Controlled Trial

Background: Echocardiography (ECHO) is used to guide septic shock resuscitation, but without evidence for efficacy. Therefore, we compared the outcome of early goal-directed therapy (EGDT) and ECHO-guided management of hemodynamics in severe sepsis and septic shock. Materials and Methods: This is a single center, randomized controlled trial conducted on 100 adult patients with severe sepsis or septic shock. Patients were assessed and treated with either EGDT protocol (EGDT group) or ECHO-guided resuscitation protocol (ECHO group). Results: Only 87 patients (45 in group I and 42 in group II) were analyzed. There was a significant increase of mean norepinephrine and dobutamine doses and a significant decrease in total fluids in the first 24 hours, time to normalization, time to weaning of vasopressors, total MV days, MV free days and ICU and hospital stays in ECHO group. At 30 days, the mortality rate in EGDT group was 35.6% which was significantly higher compared to 14.3% in ECHO group. At 90 days, the overall mortality was significantly higher in EGDT group compared to Echo group (40.0% vs 16.7% respectively). Hazardous ratio of mortality was 1.630 (95% confidence interval (CI): 1.123 - 2.366) and 1.653 (95% CI: 1.137 - 2.404) at 30 and 90 days respectively in EGDT group compared to ECHO group. Conclusions: In severe sepsis and septic shock, ECHO-guided management of hemodynamics resulted in a decrease in mortality, lower total fluid intake, higher vasopressor and inotrope support, earlier weaning of vasopressors and less MV days, ICU and hospital stay.