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[PMID]:28452823
[Au] Autor:Hahn RG
[Ad] Endereço:From the Research Unit, Department of Patient Safety and Quality, Södertälje Hospital, Södertälje, Sweden.
[Ti] Título:Arterial Pressure and the Rate of Elimination of Crystalloid Fluid.
[So] Source:Anesth Analg;124(6):1824-1833, 2017 06.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Excretion of crystalloid fluid is slow during general anesthesia. The distribution and elimination of buffered Ringer's solution were analyzed to determine whether the rate of elimination correlates with a hemodynamic factor, consciousness, patient posture, or the type of general anesthesia. Data were derived from 4 separately published studies in which 30 volunteers and 48 anesthetized patients had received 0.833 (1 series 0.667) mL/kg/min of lactated or acetated Ringer's solution over 30 minutes. Frequent measurements of the blood hemoglobin and mean urinary excretion were used as input in a kinetic analysis according to a 2-volume model and covariates, using microconstants and mixed-effects modeling software.The results show that rate of elimination of crystalloid fluid decreased with the mean arterial pressure (MAP) and patient age, but was unaffected by consciousness and inhalational or intravenous anesthesia. The elimination rate constant was 6.5 (95% confidence interval, 5.2-7.9) × 10 × (MAP/mean MAP) × (Age/mean Age). The mean MAP for the 2108 data points was 81.3 mm Hg and the mean age was 40 years. The central fluid space that was expanded by infused fluid (Vc, plasma volume) increased with body weight but decreased with general anesthesia and with reductions of MAP.Simulations revealed a more than 10-fold difference in the excreted fluid volume after a theoretical 30-minute infusion, depending on whether the MAP was 50 or 100 mm Hg.In conclusion, the rate of elimination of crystalloid fluid decreased in proportion to MAP but was independent of general anesthesia and moderate-sized surgery.
[Mh] Termos MeSH primário: Anestesia Geral
Pressão Arterial
Hidratação/métodos
Soluções Isotônicas/farmacocinética
Soluções para Reidratação/farmacocinética
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Idoso
Simulação por Computador
Feminino
Seres Humanos
Infusões Intravenosas
Soluções Isotônicas/administração & dosagem
Masculino
Taxa de Depuração Metabólica
Meia-Idade
Modelos Biológicos
Soluções para Reidratação/administração & dosagem
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Isotonic Solutions); 0 (Rehydration Solutions); 0 (Ringer's acetate); 0 (crystalloid solutions); 8022-63-7 (Ringer's lactate)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002075


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[PMID]:28930854
[Au] Autor:Wang A; Li X; Dookhun MN; Zhang T; Xie P; Cao Y
[Ad] Endereço:aDepartment of Cardiology, Gansu Provincial Hospital bSchool of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou cDepartment of Intensive Care, Minhang Hospital, Fudan University, Shanghai dDepartment of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
[Ti] Título:A female patient with hypokalaemia-induced J wave syndrome: An unusual case report.
[So] Source:Medicine (Baltimore);96(38):e8098, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Prominent J waves can be seen in life-threatening cardiac arrhythmias such as Brugada syndrome, early repolarization syndrome, and ventricular fibrillation. We herein present an unusual case report of hypokalemia-induced J wave syndrome and ST (a part of ECG) segment elevation. PATIENTS CONCERNS: A 52-year-old woman with chief complaints of chest pain for 2 hours and diarrhea showed a marked hypokalemia (2.8 mmol/L) and slightly elevated creatine kinase-MB (CK-MB) (57.5 U/L). The electrocardiographic (ECG) recording was normal upon admission and computed tomography (CT) aorta angiography excluded an aorta dissection. ECG done 17 hours after admission showed ST segment elevation and elevated J wave in leads II, III and aVF, and fusion of T and U wave in all leads. DIAGNOSIS: We first thought that the diagnosis of this patient was acute myocardial syndrome. INTERVENTION: Potassium chloride and oflocaxin treatment was given to the patient. OUTCOMES: Laboratory test showed the level of serum potassium ion increased to 3.4 mmol/L and CK-MB did not have any significant change. The infusion of potassium chloride-induced disappearance of the elevated J wave, although QT (a part of ECG) intervals were still longer than that upon admission. LESSONS: This case tells us that hypokalaemia might induce J wave and elevated ST segments which should be distinguished from acute myocardial syndrome.
[Mh] Termos MeSH primário: Arritmias Cardíacas/diagnóstico
Arritmias Cardíacas/etiologia
Hipopotassemia/complicações
[Mh] Termos MeSH secundário: Antibacterianos/uso terapêutico
Arritmias Cardíacas/tratamento farmacológico
Dor no Peito/etiologia
Diagnóstico Diferencial
Eletrocardiografia
Feminino
Seres Humanos
Hipopotassemia/tratamento farmacológico
Levofloxacino/uso terapêutico
Meia-Idade
Infarto do Miocárdio/diagnóstico
Cloreto de Potássio/uso terapêutico
Soluções para Reidratação/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Rehydration Solutions); 660YQ98I10 (Potassium Chloride); 6GNT3Y5LMF (Levofloxacin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171015
[Lr] Data última revisão:
171015
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170921
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008098


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[PMID]:28806049
[Au] Autor:Harris L
[Ad] Endereço:Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060.
[Ti] Título:Electrolytes: Oral Electrolyte Solutions.
[So] Source:FP Essent;459:35-38, 2017 Aug.
[Is] ISSN:2159-3000
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Oral electrolyte solutions are used widely for rehydration in diarrheal illness and to maintain hydration during vigorous exercise. In diarrheal illness, an oral rehydration solution (ORS) typically is preferred over intravenous fluids except for patients with severe dehydration. The preferred ORS is one similar to the glucose-containing reduced osmolarity World Health Organization ORS. There also are polymer-based solutions that use rice or wheat as the source of carbohydrates but these are not widely recommended. Use of other liquids, such as sport drinks, juice, soft drinks, and chicken broth is not recommended, though these can be considered for patients with no or mild dehydration. For maintaining hydration during exercise, particularly vigorous high-intensity exercise, recommendations are to consume fluids (ie, 5 to 7 mL/kg) and a sodium-containing snack at least 4 hours before. During exercise, individuals require 200 to 800 mL/hour of liquid that should contain 20 to 30 mEq/L of sodium. Carbohydrate intake is recommended during high-intensity exercise. Intake of excessive sodium-free fluids should be avoided to prevent exercise-induced hyponatremia. Additional fluids (ie, 1.5 L/kg of weight lost) can be consumed after exercise to restore hydration. Vitamin and mineral supplements are not recommended routinely for athletes unless known deficiencies exist.
[Mh] Termos MeSH primário: Desidratação/terapia
Exercício
Hidratação/métodos
Soluções para Reidratação/uso terapêutico
Desequilíbrio Hidroeletrolítico/terapia
[Mh] Termos MeSH secundário: Bicarbonatos/uso terapêutico
Desidratação/etiologia
Diarreia/complicações
Glucose/uso terapêutico
Seres Humanos
Cloreto de Potássio/uso terapêutico
Cloreto de Sódio/uso terapêutico
Desequilíbrio Hidroeletrolítico/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Bicarbonates); 0 (Rehydration Solutions); 0 (World Health Organization oral rehydration solution); 451W47IQ8X (Sodium Chloride); 660YQ98I10 (Potassium Chloride); IY9XDZ35W2 (Glucose)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE


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[PMID]:28806045
[Au] Autor:Weiss BD
[Ad] Endereço:University of Arizona College of Medicine, 1450 North Cherry, Tucson, AZ 85719, bdweiss@email.arizona.edu.
[Ti] Título:Electrolytes: Foreword.
[So] Source:FP Essent;459:2, 2017 Aug.
[Is] ISSN:2159-3000
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Soluções para Reidratação/uso terapêutico
Desequilíbrio Hidroeletrolítico/metabolismo
[Mh] Termos MeSH secundário: Hidratação
Seres Humanos
Desequilíbrio Hidroeletrolítico/fisiopatologia
Desequilíbrio Hidroeletrolítico/terapia
[Pt] Tipo de publicação:INTRODUCTORY JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Rehydration Solutions)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE


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[PMID]:28774488
[Au] Autor:Ghodraty MR; Rokhtabnak F; Dehghan HR; Pournajafian A; Baghaee Vaji M; Koleini ZS; Porhomayon J; Nader ND
[Ad] Endereço:Iran University of Medical Sciences, Tehran, Iran.
[Ti] Título:Crystalloid versus colloid fluids for reduction of postoperative ileus after abdominal operation under combined general and epidural anesthesia.
[So] Source:Surgery;162(5):1055-1062, 2017 Nov.
[Is] ISSN:1532-7361
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The main objective of this study was to compare the effect of perioperative administration of crystalloid versus colloid solutions and its impact on reversal of ileus after resection with primary anastomosis of intestine. We hypothesized that inclusion of colloids will improve the return of intestinal motility. METHODS: In a double-blinded clinical trial, 91 the American Society of Anesthesiologists I to III patients undergoing abdominal operation for resection with anastomosis of small or large intestine were randomized to receive either lactated Ringer solution crystalloid group or 6% hydroxyethyl starch colloid group to replace intraoperative fluid loss (blood loss + third space). The time to resume normal intestinal motility was the primary end point and the prevalence of composite postoperative complications was the secondary end point. RESULTS: Average duration of ileus was 86.7 ± 23.6 hours in crystalloid group and it lasted 73.4 ± 20.8 hours in colloid group (P = .006). While there was no difference in the frequency of postoperative nausea and vomiting between the 2 groups (P = .3), the actual vomiting occurred less frequently in colloid group (P = .02). Serum concentrations of potassium ion decreased significantly in both groups, whereas the degree of potassium changes was more remarkable in colloid group compared with crystalloid group (P = .03). Postoperative ileus did not correlate with sex, age, and the duration of operation. Duration of hospital stay was similar between the 2 groups. CONCLUSION: We concluded that administration of colloids as a part of perioperative fluid management improves intestinal motility and shortens the duration of ileus after gastrointestinal operations. This may improve the tolerance for enteral feeding and reduce ileus-related symptoms.
[Mh] Termos MeSH primário: Anastomose Cirúrgica/efeitos adversos
Motilidade Gastrointestinal/efeitos dos fármacos
Trato Gastrointestinal/cirurgia
Íleus/prevenção & controle
Soluções Isotônicas/administração & dosagem
Soluções para Reidratação/administração & dosagem
[Mh] Termos MeSH secundário: Abdome/cirurgia
Adulto
Idoso
Anestesia Epidural
Anestesia Geral
Coloides/administração & dosagem
Coloides/farmacologia
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Método Duplo-Cego
Feminino
Hidratação/métodos
Trato Gastrointestinal/efeitos dos fármacos
Seres Humanos
Derivados de Hidroxietil Amido/administração & dosagem
Derivados de Hidroxietil Amido/farmacologia
Íleus/etiologia
Intestinos/efeitos dos fármacos
Intestinos/cirurgia
Soluções Isotônicas/farmacologia
Laparotomia/efeitos adversos
Masculino
Meia-Idade
Substitutos do Plasma/administração & dosagem
Substitutos do Plasma/farmacologia
Soluções para Reidratação/farmacologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Colloids); 0 (Hydroxyethyl Starch Derivatives); 0 (Isotonic Solutions); 0 (Plasma Substitutes); 0 (Rehydration Solutions); 0 (crystalloid solutions); 8022-63-7 (Ringer's lactate)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170805
[St] Status:MEDLINE


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[PMID]:28514324
[Au] Autor:Messina A; Longhini F; Coppo C; Pagni A; Lungu R; Ronco C; Cattaneo MA; Dore S; Sotgiu G; Navalesi P
[Ad] Endereço:From the *Anesthesia and Intensive Care Medicine, Maggiore della Carità University Hospital, Novara, Italy; †Anesthesia and Intensive Care Medicine, Sant'Andrea Hospital (ASL VC), Vercelli, Italy; ‡Department of Translational Medicine, Università del Piemonte Orientale "Amedeo Avogadro," Alessandria-Novara-Vercelli, Italy; §Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy; and ‖Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
[Ti] Título:Use of the Fluid Challenge in Critically Ill Adult Patients: A Systematic Review.
[So] Source:Anesth Analg;125(5):1532-1543, 2017 Nov.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The fluid challenge (FC) aims at identifying patients in whom fluid administration improves hemodynamics. Although the FC has been extensively studied, the implementation and definition of improvement are not standardized. This systematic review of studies published between January 1, 1994 and December 31, 2014 characterizes these key components of the FC for critically ill adult patients, as described in the medical literature in the last 20 years. A literature search was performed using MEDLINE, Embase, and Cochrane. For each study, data were collected on study design, study size, study setting, patient population, and how the FC was administered. Eligibility criteria for FC were (1) the infusion of a definite quantity of fluid, (2) of a specific type, (3) in a fixed time period (expressed as either span or infusion rate), (4) with a defined hemodynamic variable as the target, and (5) for a predetermined threshold. One hundred fifty-seven full-text manuscripts were extracted from 870 potentially relevant studies. The inclusion criteria were met by 71 studies including 3617 patients. Sixty-six studies were from a single center and 45 were prospective observational in format. The most common amount infused was 500 cc, used by 55 (77.5%) studies. The most commonly infused fluids were colloids (62.0%). In 43 (60.5%) studies, the FC was administered between 20 and 30 minutes. A positive response to fluid administration was defined as an increase ≥15% of cardiac index or cardiac output in 44 (62.6%) studies. Static or dynamic physiologic indices were utilized in a minority of studies (16.9%) and safety limits for interrupting the FC are adopted in 4 (5.6%) studies only. This systematic review indicates that the FC most commonly consists in infusing 500 mL of crystalloids or colloids in 20-30 minutes, and considered an increase in cardiac index ≥15% as a positive response. However, definite standards for FC administration and evaluation remain undefined.
[Mh] Termos MeSH primário: Hidratação
Hemodinâmica
Soluções Isotônicas/administração & dosagem
Substitutos do Plasma/administração & dosagem
Soluções para Reidratação/administração & dosagem
Choque/terapia
[Mh] Termos MeSH secundário: Adulto
Pressão Sanguínea
Débito Cardíaco
Coloides
Estado Terminal
Feminino
Seres Humanos
Infusões Intravenosas
Soluções Isotônicas/efeitos adversos
Masculino
Meia-Idade
Seleção de Pacientes
Substitutos do Plasma/efeitos adversos
Valor Preditivo dos Testes
Soluções para Reidratação/efeitos adversos
Choque/diagnóstico
Choque/fisiopatologia
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Colloids); 0 (Isotonic Solutions); 0 (Plasma Substitutes); 0 (Rehydration Solutions); 0 (crystalloid solutions)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170518
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002103


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[PMID]:28498856
[Au] Autor:Hammond NE; Taylor C; Finfer S; Machado FR; An Y; Billot L; Bloos F; Bozza F; Cavalcanti AB; Correa M; Du B; Hjortrup PB; Li Y; McIntryre L; Saxena M; Schortgen F; Watts NR; Myburgh J; Fluid-TRIPS and Fluidos Investigators; George Institute for Global Health, The ANZICS Clinical Trials Group, BRICNet, and the REVA research Network
[Ad] Endereço:Critical Care and Trauma Division, The George Institute for Global Health, Sydney, Australia.
[Ti] Título:Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: An international cross-sectional study.
[So] Source:PLoS One;12(5):e0176292, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In 2007, the Saline versus Albumin Fluid Evaluation-Translation of Research Into Practice Study (SAFE-TRIPS) reported that 0.9% sodium chloride (saline) and hydroxyethyl starch (HES) were the most commonly used resuscitation fluids in intensive care unit (ICU) patients. Evidence has emerged since 2007 that these fluids are associated with adverse patient-centred outcomes. Based on the published evidence since 2007, we sought to determine the current type of fluid resuscitation used in clinical practice and the predictors of fluid choice and determine whether these have changed between 2007 and 2014. METHODS: In 2014, an international, cross-sectional study was conducted (Fluid-TRIPS) to document current patterns of intravenous resuscitation fluid use and determine factors associated with fluid choice. We examined univariate and multivariate associations between patients and prescriber characteristics, geographical region and fluid type. Additionally, we report secular trends of resuscitation fluid use in a cohort of ICUs that participated in both the 2007 and 2014 studies. Regression analysis were conducted to determine changes in the administration of crystalloid or colloid between 2007 and 2014. FINDINGS: In 2014, a total of 426 ICUs in 27 countries participated. Over the 24 hour study day, 1456/6707 (21.7%) patients received resuscitation fluid during 2716 resuscitation episodes. Crystalloids were administered to 1227/1456 (84.3%) patients during 2208/2716 (81.3%) episodes and colloids to 394/1456 (27.1%) patients during 581/2716 (21.4%) episodes. In multivariate analyses, practice significantly varied between geographical regions. Additionally, patients with a traumatic brain injury were less likely to receive colloid when compared to patients with no trauma (adjusted OR 0.24; 95% CI 0.1 to 0.62; p = 0.003). Patients in the ICU for one or more days where more likely to receive colloid compared to patients in the ICU on their admission date (adjusted OR 1.75; 95% CI 1.27 to 2.41; p = <0.001). For secular trends in fluid resuscitation, 84 ICUs in 17 countries contributed data. In 2007, 527/1663 (31.7%) patients received fluid resuscitation during 1167 episodes compared to 491/1763 (27.9%) patients during 960 episodes in 2014. The use of crystalloids increased from 498/1167 (42.7%) in 2007 to 694/960 (72.3%) in 2014 (odds ratio (OR) 3.75, 95% confidence interval (CI) 2.95 to 4.77; p = <0.001), primarily due to a significant increase in the use of buffered salt solutions. The use of colloids decreased from 724/1167 (62.0%) in 2007 to 297/960 (30.9%) in 2014 (OR 0.29, 95% CI 0.19 to 0.43; p = <0.001), primarily due to a decrease in the use of HES, but an overall increase in the use of albumin. CONCLUSIONS: Clinical practices of intravenous fluid resuscitation have changed between 2007 and 2014. Geographical location remains a strong predictor of the type of fluid administered for fluid resuscitation. Overall, there is a preferential use of crystalloids, specifically buffered salt solutions, over colloids. There is now an imperative to conduct a trial determining the safety and efficacy of these fluids on patient-centred outcomes. TRIAL REGISTRATION: Clinicaltrials.gov: Fluid-Translation of research into practice study (Fluid-TRIPS) NCT02002013.
[Mh] Termos MeSH primário: Hidratação/estatística & dados numéricos
Unidades de Terapia Intensiva/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Coloides/administração & dosagem
Estudos Transversais
Seres Humanos
Soluções Isotônicas/administração & dosagem
Análise Multivariada
Soluções para Reidratação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Colloids); 0 (Isotonic Solutions); 0 (Rehydration Solutions); 0 (crystalloid solutions)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170513
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0176292


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[PMID]:28319546
[Au] Autor:Shiraishi T; Kurosaki D; Nakamura M; Yazaki T; Kobinata S; Seki Y; Kasama K; Taniguchi H
[Ad] Endereço:From the *Minimally Invasive Surgery Center, Department of Anaesthesiology, Yotsuya Medical Cube, Tokyo, Japan; and †Perioperative Support Center, Saiseikai Yokohama-shi Tobu Hospital, Yokohama, Japan.
[Ti] Título:Gastric Fluid Volume Change After Oral Rehydration Solution Intake in Morbidly Obese and Normal Controls: A Magnetic Resonance Imaging-Based Analysis.
[So] Source:Anesth Analg;124(4):1174-1178, 2017 Apr.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although preoperative fluid intake 2 hours before anesthesia is generally considered safe, there are concerns about delayed gastric emptying in obese subjects. In this study, the gastric fluid volume (GFV) change in morbidly obese subjects was investigated after ingesting an oral rehydration solution (ORS) and then compared with that in nonobese subjects. METHODS: GFV change over time after the ingestion of 500 mL of ORS containing 2.5% carbohydrate (OS-1) was measured in 10 morbidly obese subjects (body mass index [BMI], >35) scheduled for bariatric surgery and 10 nonobese (BMI, 19-24) using magnetic resonance imaging. After 9 hours of fasting, magnetic resonance imaging scans were performed at preingestion, 0 min (just after ingestion), and every 30 minutes up to 120 minutes. GFV values were compared between morbidly obese and control groups and also between preingestion and postingestion time points. RESULTS: The morbidly obese group had a significantly higher body weight and BMI than the control group (mean body weight and BMI in morbidly obese, 129.6 kg and 46.3 kg/m, respectively; control, 59.5 kg and 21.6 kg/m, respectively). GFV was significantly higher in the morbidly obese subjects compared with the control group at preingestion (73 ± 30.8 mL vs 31 ± 19.9 mL, P = .001) and at 0 minutes after ingestion (561 ± 30.8 mL vs 486 ± 42.8 mL; P < .001). GFV declined rapidly in both groups and reached fasting baseline levels by 120 minutes (morbidly obese, 50 ± 29.5 mL; control, 30 ± 11.6 mL). A significant correlation was observed between preingestion residual GFV and body weight (r = .66; P = .001). CONCLUSIONS: Morbidly obese subjects have a higher residual gastric volume after 9 hours of fasting compared with subjects with a normal BMI. However, no differences were observed in gastric emptying after ORS ingestion in the 2 populations, and GFVs reached baseline within 2 hours after ORS ingestion. Further studies are required to confirm whether the preoperative fasting and fluid management that are recommended for nonobese patients could also be applied to morbidly obese patients.
[Mh] Termos MeSH primário: Hidratação/métodos
Conteúdo Gastrointestinal/diagnóstico por imagem
Imagem por Ressonância Magnética/métodos
Obesidade Mórbida/diagnóstico por imagem
Soluções para Reidratação/administração & dosagem
[Mh] Termos MeSH secundário: Administração Oral
Adulto
Bicarbonatos/administração & dosagem
Jejum/fisiologia
Feminino
Esvaziamento Gástrico/efeitos dos fármacos
Esvaziamento Gástrico/fisiologia
Conteúdo Gastrointestinal/efeitos dos fármacos
Glucose/administração & dosagem
Seres Humanos
Masculino
Meia-Idade
Obesidade Mórbida/terapia
Cloreto de Potássio/administração & dosagem
Cloreto de Sódio/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Bicarbonates); 0 (Rehydration Solutions); 0 (World Health Organization oral rehydration solution); 451W47IQ8X (Sodium Chloride); 660YQ98I10 (Potassium Chloride); IY9XDZ35W2 (Glucose)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170321
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000001886


  9 / 1372 MEDLINE  
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[PMID]:28277352
[Au] Autor:Maher MA; Sayyed TM; Elkhouly N
[Ad] Endereço:Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt.
[Ti] Título:Sildenafil Citrate Therapy for Oligohydramnios: A Randomized Controlled Trial.
[So] Source:Obstet Gynecol;129(4):615-620, 2017 Apr.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare sildenafil plus hydration with hydration alone in improving the amniotic fluid index and neonatal outcomes in pregnancies complicated by idiopathic oligohydramnios ( amniotic fluid index less than 5 cm without underlying maternal or fetal causes and with normal fetal growth). METHODS: This was an open-label randomized trial for women carrying singleton pregnancies at 30 weeks of gestation or more with idiopathic oligohydramnios detected during routine ultrasonogram. Women received either oral sildenafil citrate (25 mg every 8 hours) plus intravenous infusion of 2 L isotonic solution or fluids only until delivery. The primary study outcome was the amniotic fluid volume at 6 weeks of follow-up or the final volume before delivery, whichever occurred first. Secondary outcomes were duration of pregnancy prolongation, mode of delivery, and select neonatal outcomes. The study was powered to detect a 45% difference between groups, so, at an α level of 0.05 and 80% power, a sample size of 167 women was required. RESULTS: From February 24, 2015, through April 2016, 196 women were screened and 184 were randomized. Follow-up was completed in 166 (90%): 82 in the sildenafil group and 84 in the hydration group. Baseline characteristics were similar between groups. The amniotic fluid volume was higher in the sildenafil group at the final assessment (11.5 compared with 5.4 cm, P=.02). The sildenafil group delivered later (38.3 compared with 36.0 weeks of gestation, P=.001), had a lower rate of cesarean delivery (28% compared with 73%), and their neonates were less likely to be admitted to the neonatal intensive care unit (11% compared with 41%, P=.001). CONCLUSION: Sildenafil citrate increases amniotic fluid volume in pregnancies complicated by oligohydramnios. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT02372487.
[Mh] Termos MeSH primário: Oligo-Hidrâmnio
Soluções para Reidratação/administração & dosagem
Citrato de Sildenafila/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Líquido Amniótico
Monitoramento de Medicamentos/métodos
Feminino
Hidratação/métodos
Seres Humanos
Recém-Nascido
Oligo-Hidrâmnio/diagnóstico
Oligo-Hidrâmnio/fisiopatologia
Oligo-Hidrâmnio/terapia
Gravidez
Resultado da Gravidez
Ultrassonografia/métodos
Agentes Urológicos/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Rehydration Solutions); 0 (Urological Agents); BW9B0ZE037 (Sildenafil Citrate)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170621
[Lr] Data última revisão:
170621
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170310
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000001928


  10 / 1372 MEDLINE  
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[PMID]:27982484
[Au] Autor:Forbat L; Kunicki N; Chapman M; Lovell C
[Ad] Endereço:Centre of Palliative Care Research, Calvary Health Care and Australian Catholic University, Canberra, ACT, Australia.
[Ti] Título:How and why are subcutaneous fluids administered in an advanced illness population: a systematic review.
[So] Source:J Clin Nurs;26(9-10):1204-1216, 2017 May.
[Is] ISSN:1365-2702
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS AND OBJECTIVES: To identify the mechanisms of subcutaneous fluid administration in advanced illness. BACKGROUND: Hydration at end of life is a fundamental issue in quality care internationally. Decision-making regarding the provision of artificial hydration in advanced illness is complicated by a paucity of evidence-based guidance. Despite considerable attention given to the topic including two recent Cochrane reviews, there has been no focus in systematically identifying papers that report the mechanisms for delivering hydration subcutaneously. Consequently, there is a need to produce guidance on the site, mode, volume and rate of infusion, based on empirical evidence. DESIGN: Systematic review of papers reporting empirical research data. METHODS: Key databases (CENTRAL, Medline, EMBASE, Web of Science, CINAHL) were searched in September 2015, with no date limitations. Inclusion criteria focused on hypodermoclysis in adults within an advanced illness population. Selected studies were reviewed for quality and a risk-of-bias assessment was conducted for the included studies. RESULTS: Fourteen papers were included in the analysis; most (n = 8) were conducted in hospices with others (n = 6) in long-stay units with a population affected by chronic conditions associated with ageing. Studies were of moderate or high quality. The site and mode of infusion were not well described in these papers, and rates of infusion varied widely allowing for little clear consensus to guide clinical practice in the administration of subcutaneous fluids. CONCLUSIONS: Studies under-report the mechanisms by which artificial hydration is provided, creating a paucity of evidence-based guidance by which to practice. There is a need for evidence generated from nonmalignant populations to ensure applicability to the large number of people with other advanced illness. RELEVANCE TO CLINICAL PRACTICE: In the absence of sufficiently powered robust evidence, the mode of delivery of artificial hydration at end of life remains in the gloaming between evidence and unfounded habit.
[Mh] Termos MeSH primário: Desidratação/terapia
Hidratação/métodos
Infusões Subcutâneas
Cuidados Paliativos/métodos
Soluções para Reidratação/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Tomada de Decisões
Medicina Baseada em Evidências
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Rehydration Solutions)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170529
[Lr] Data última revisão:
170529
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:161217
[St] Status:MEDLINE
[do] DOI:10.1111/jocn.13683



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