20. #ifad2019 fluid therapy in massive bleeding (llau)
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A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects. Many questions remain to be answered indeed: Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost? Does HES still have a place in the OR? Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin? Is it really impossible to avoid fluid overload by using only crystalloids? Is there still a definitive place for human albumin? How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others? How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy? What with the fluids beyond resuscitation? And what do the authors of the big fluid trials do in real life themselves? The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill. Date: October 26th 2019, 8:00 - 18:00
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Everything you need to know about fluid therapy – Manu Malbrain (#IFAD2018)
Everything you need to know about fluid therapy – Manu Malbrain (#IFAD2018)International Fluid Academy
In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose, and timing of intravenous fluid administration.
There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications, and for parenteral nutrition.
In this lecture, the different fluid management strategies are discussed including early adequate goal-directed fluid management, late conservative fluid management, and late goal-directed fluid removal.
In addition, the concept of the "four D’s" of fluid therapy is introduced, namely drug, dosing, duration, and de-escalation.
During the treatment of patients with septic shock, four phases of fluid therapy should be considered in order to provide answers to four basic questions. These four phases are the resuscitation phase, the optimization phase, the stabilization phase, and the evacuation phase.
The four questions are “When to start intravenous fluids?”, “When to stop intravenous fluids?”, “When to start de-resuscitation or active fluid removal?” and finally “When to stop de-resuscitation?”.
In analogy to the way we handle antibiotics in critically ill patients, it is time for fluid stewardship.Which cardiac output monitoring?
1) The document discusses choosing cardiac output monitoring devices for peri-operative and ICU settings. It considers devices' reliability with changing vascular resistance and ability to provide useful clinical information.
2) For peri-operative monitoring of high-risk surgical patients, less invasive devices using uncalibrated pulse contour analysis like Vigileo and Clearsight may be suitable when vascular resistance does not change significantly.
3) For ICU patients receiving vasopressors where resistance changes greatly, more reliable thermodilution methods like PiCCO, EV1000 and pulmonary artery catheter are recommended to measure cardiac output and assess ventricular function.
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- Controversy around transfusion triggers in the ICU, with studies showing increased risks with liberal transfusion strategies.
- Risks of blood transfusion including infections, TRALI, and immunomodulation effects.
- Specific transfusion guidelines and considerations for septic patients, bleeding patients, and massive transfusion situations.
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In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose, and timing of intravenous fluid administration.
There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications, and for parenteral nutrition.
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In addition, the concept of the "four D’s" of fluid therapy is introduced, namely drug, dosing, duration, and de-escalation.
During the treatment of patients with septic shock, four phases of fluid therapy should be considered in order to provide answers to four basic questions. These four phases are the resuscitation phase, the optimization phase, the stabilization phase, and the evacuation phase.
The four questions are “When to start intravenous fluids?”, “When to stop intravenous fluids?”, “When to start de-resuscitation or active fluid removal?” and finally “When to stop de-resuscitation?”.
In analogy to the way we handle antibiotics in critically ill patients, it is time for fluid stewardship.Which cardiac output monitoring?
1) The document discusses choosing cardiac output monitoring devices for peri-operative and ICU settings. It considers devices' reliability with changing vascular resistance and ability to provide useful clinical information.
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The document discusses blood transfusion in the ICU, including:
- The history of blood transfusion and evolution of transfusion medicine.
- Controversy around transfusion triggers in the ICU, with studies showing increased risks with liberal transfusion strategies.
- Risks of blood transfusion including infections, TRALI, and immunomodulation effects.
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3) Other ventilator strategies discussed include prone positioning, neuromuscular blockade, recruitment maneuvers, and extracorporeal membrane oxygenation for severe cases, though evidence on benefits is mixed.
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Sao Paulo, Brazil, experiences flooding every year. This exposes locals to Leptospira bacteria. The severe form of disease this causes – leptospirosis - sees patients end up on mechanical ventilators. These machines were traditionally complicated, with a huge number of settings and buttons.
Marcelo Amato trained in this setting. He, alongside his colleagues, developed methods to halt bleeding in leptospirosis by manipulating ventilator settings. He calls it “protective ventilation”. It was not long before the same principles were being applied to patients suffering acute respiratory distress syndrome.
Through research, Marcelo and his team concluded that driving pressures, above all other ventilator settings, were most important for patient survival.
Driving pressure is the oscillation of alveolar pressure or variation of pressures inside the lungs. It is what your lungs are sensing. Although there is an obsession with tidal volume, which is displayed on ventilators, Marcello explains, driving pressures are easily calculated and more important.
Marcelo discusses the increasing mortality with mechanical ventilation. The medical community, especially physiologists, are traditionally wrapped up in the concept of volutrauma. However, it is the gradient of pressures oscillating inside the lung (the driving pressure) that is causing lung injuries.
So, the question became - would the lessons learnt the study on mechanical ventilation for leptospirosis be transferable to reducing risk in acute respiratory distress syndrome?
Marcelo presents over twelve years of research. In doing so he highlights the changing dogma of the protective role of small tidal volumes. Research shows that the size of the tidal volume does not matter in terms of mortality. What matters is the pressure that is generated. The force with which the lung is deformed is much more important than the size of the deformation.
The message: Do not look at absolute pressures, rather look at the swings in pressure. The only way a patient can survive is through a decrease in driving pressure, and not through a decrease in tidal volume.
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This document discusses anesthesia considerations for renal transplantation. It begins by outlining the history of anesthesia used in kidney transplantation, noting the early use of spinal anesthesia and limited monitoring. It then discusses:
- Kidney transplantation being the most common transplant procedure worldwide.
- Indications and contraindications for transplantation.
- Outcomes being greatly improved compared to remaining on dialysis.
- Types of donors including living and cadaveric.
- Anesthesia goals for living donors focusing on safety.
- Evaluation, induction, maintenance and monitoring for recipients.
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Peritoneal Dialysis
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1) The patient presented with severe ARDS due to bilateral pneumonia and septic cardiomyopathy. She required intubation and mechanical ventilation with hypoxemia.
2) She was treated with prone ventilation for 20 hours which improved her oxygenation with PaO2/FiO2 ratio increasing from 96 to 207.
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Airway Pressure Release Ventilation
APRV (Airway Pressure Release Ventilation) is a ventilation mode that applies continuous positive airway pressure (CPAP) for a prolonged high-pressure phase (T high) to recruit and maintain lung volume. It then has a brief low-pressure release phase (T low) where most ventilation and CO2 removal occurs. Compared to conventional ventilation, APRV may cause less ventilator-induced lung injury due to maintaining higher end-expiratory lung volumes without repetitive opening/closing of alveoli. It also allows for spontaneous breathing which improves patient comfort and outcomes. While APRV does not reduce mortality, it can improve other outcomes such as shorter ventilation times and ICU stays.
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Heated, humidified high-flow nasal cannula (HHHFNC) is commonly used as a noninvasive mode of respiratory support in the NICU to avoid prolonged ventilator support and ventilator-induced lung injury. HHHFNC delivers humidified heated and blended oxygen/air at flow rates greater than 1L/min via nasal cannula. The mechanisms of how HHHFNC works include flushing out the nasal airway, providing some positive end-expiratory pressure, and conditioning the gas. Benefits of HHHFNC include improved comfort for babies, less abdominal distension than CPAP, and easier access for procedures. HHHFNC is considered insufficient support if a baby has
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2) Management of ARDS focuses on treating underlying causes, preventing complications, and using ventilator strategies like low tidal volume ventilation to prevent ventilator-induced lung injury.
3) Other ventilator strategies discussed include prone positioning, neuromuscular blockade, recruitment maneuvers, and extracorporeal membrane oxygenation for severe cases, though evidence on benefits is mixed.
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This document discusses goal directed fluid therapy and fluid management in the perioperative period. It begins by introducing the importance of intravenous fluid therapy and issues related to both excess and restrictive fluid administration. It then discusses various fluid monitoring techniques including static parameters measured by pulmonary artery catheters, minimally invasive monitors like LiDCO and pulse contour analysis devices, dynamic parameters like stroke volume variation, and echocardiography. The document also addresses fluid responsiveness, factors influencing venous return and the Frank-Starling relationship, and the high incidence of non-responders to fluid challenges.
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This document discusses ischemic heart disease and its anesthetic management. It begins with defining ischemic heart disease and its causes. It then discusses the perioperative concerns and management for patients undergoing non-cardiac surgery who have ischemic heart disease. This includes preoperative evaluation and testing, intraoperative goals of maintaining a favorable myocardial supply and demand relationship, and anesthetic techniques including general or regional anesthesia to minimize cardiac risk.
Mechanical Ventilation in Critical Care: Why driving pressure matters
Marcelo Amota makes the case for why driving pressures matter during mechanical ventilation in critical care.
Sao Paulo, Brazil, experiences flooding every year. This exposes locals to Leptospira bacteria. The severe form of disease this causes – leptospirosis - sees patients end up on mechanical ventilators. These machines were traditionally complicated, with a huge number of settings and buttons.
Marcelo Amato trained in this setting. He, alongside his colleagues, developed methods to halt bleeding in leptospirosis by manipulating ventilator settings. He calls it “protective ventilation”. It was not long before the same principles were being applied to patients suffering acute respiratory distress syndrome.
Through research, Marcelo and his team concluded that driving pressures, above all other ventilator settings, were most important for patient survival.
Driving pressure is the oscillation of alveolar pressure or variation of pressures inside the lungs. It is what your lungs are sensing. Although there is an obsession with tidal volume, which is displayed on ventilators, Marcello explains, driving pressures are easily calculated and more important.
Marcelo discusses the increasing mortality with mechanical ventilation. The medical community, especially physiologists, are traditionally wrapped up in the concept of volutrauma. However, it is the gradient of pressures oscillating inside the lung (the driving pressure) that is causing lung injuries.
So, the question became - would the lessons learnt the study on mechanical ventilation for leptospirosis be transferable to reducing risk in acute respiratory distress syndrome?
Marcelo presents over twelve years of research. In doing so he highlights the changing dogma of the protective role of small tidal volumes. Research shows that the size of the tidal volume does not matter in terms of mortality. What matters is the pressure that is generated. The force with which the lung is deformed is much more important than the size of the deformation.
The message: Do not look at absolute pressures, rather look at the swings in pressure. The only way a patient can survive is through a decrease in driving pressure, and not through a decrease in tidal volume.
Anaesthesia for renal transplantation
This document discusses anesthesia considerations for renal transplantation. It begins by outlining the history of anesthesia used in kidney transplantation, noting the early use of spinal anesthesia and limited monitoring. It then discusses:
- Kidney transplantation being the most common transplant procedure worldwide.
- Indications and contraindications for transplantation.
- Outcomes being greatly improved compared to remaining on dialysis.
- Types of donors including living and cadaveric.
- Anesthesia goals for living donors focusing on safety.
- Evaluation, induction, maintenance and monitoring for recipients.
- Positioning, fluid management and hemodynamic goals.
Cvl bundle presentation
1) Central venous catheters are a major cause of bloodstream infections, with approximately 90% occurring through CVCs. Between 500-4000 patients die annually from CVC-related BSIs.
2) The Institute for Healthcare Improvement developed bundles of best practices to prevent CVC-related BSIs which include hand hygiene, maximal sterile barriers, chlorhexidine skin antisepsis, and optimal site selection. When these bundles are applied consistently, they result in greater reductions in infection rates.
3) Hospitals have implemented policies and provided supplies to help staff consistently follow the CVC bundle. This includes designated CVC insertion carts stocked with supplies, requirement that physicians use full sterile barriers, and
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Post resuscitation care
Therapeutic hypothermia, or induced hypothermia, involves deliberately cooling cardiac arrest patients to between 32-34°C for 12-24 hours after return of spontaneous circulation (ROSC) to reduce reperfusion injury to organs like the brain, heart, liver and kidneys from hypoperfusion and ischemia during the cardiac arrest. It aims to improve outcomes by reducing the effects of post-cardiac arrest syndrome, which involves a complex pathophysiological cascade following ischemia. Current research shows benefits of inducing therapeutic hypothermia before or during the cardiac arrest event. Key aspects of care involve induction of hypothermia within 6 hours, preferably 2 hours, of ROSC, maintenance of target temperature for 12-24 hours,
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Similar to 20. #ifad2019 fluid therapy in massive bleeding (llau)
The four phases of intravenous fluid therapy: Manu Malbrain
This document discusses fluid management in intensive care patients. It notes that fluids are drugs that require appropriate dosing, timing, and de-escalation. Inappropriate fluid therapy can lead to hyperchloremic metabolic acidosis, acute kidney injury, and increased mortality. The key factors in empiric fluid therapy are considering patient risk factors for fluid overload and targeting fluids specifically for resuscitation, maintenance, or replacement needs rather than focusing solely on hemodynamic parameters. Fluid removal should begin when shock is resolved to avoid complications from fluid overload.
Peritoneal Dialysis
Peritoneal dialysis is a way to remove waste products from your blood when your kidneys can no longer do the job adequately.
A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste products from your blood. After a prescribed period of time, the fluid with filtered waste products flows out of your abdomen and is discarded.
Peritoneal dialysis differs from hemodialysis, a more commonly used blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments at home, at work or while traveling.
Peritoneal Dialysis
Peritoneal dialysis is a way to remove waste products from your blood when your kidneys can no longer do the job adequately.
A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste products from your blood. After a prescribed period of time, the fluid with filtered waste products flows out of your abdomen and is discarded.
Peritoneal dialysis differs from hemodialysis, a more commonly used blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments at home, at work or while traveling.
Fluid management in patients with trauma: Restrictive versus Liberal Approach
The document summarizes the key points from a review article on fluid management approaches for trauma patients. It discusses the pathophysiology of hemorrhagic shock and how overly aggressive fluid resuscitation can cause further harm by diluting coagulation factors and increasing bleeding. Several studies are highlighted that found a restrictive fluid approach with permissive hypotension led to better outcomes than early liberal fluid resuscitation for uncontrolled hemorrhage. The concept of damage control resuscitation is also introduced, emphasizing the need to avoid the "lethal triad" of acidosis, hypothermia, and coagulopathy in severely injured trauma patients.
Peri-operative fluid therapy – Trends
1) Evidence suggests restrictive fluid infusion and avoidance of fluid overload during and after surgery can significantly reduce complications and length of postoperative hospital stay.
2) Goal-directed fluid therapy using cardiac output monitoring can help guide fluid titration and has been shown in some studies to reduce complications compared to standard fluid management without monitoring.
3) For lower risk surgery in fast-track programs, restrictive fluid protocols limiting intravenous fluids after surgery and encouraging early oral intake may be sufficient.
Chronic empyema
1) The document discusses the diagnosis and management of chronic empyema, beginning with the definition, causes, stages, and clinical presentation.
2) Diagnostic evaluations including imaging like chest X-ray, CT, and ultrasound are described, as well as biochemical analysis of pleural fluid.
3) Treatment options are provided for each stage of empyema, including thoracocentesis, chest tube drainage, fibrinolytics, VATS, decortication, and window thoracostomy. Antibiotic recommendations are also covered.
sepsis new guidelines 2017
This document provides guidelines for the management of severe sepsis and septic shock. It recommends early identification and treatment, including rapid fluid resuscitation within 3 hours, obtaining cultures before antibiotics, initiating broad-spectrum antibiotics within 1 hour, and controlling the infection source. It also provides guidance on vasopressor use, corticosteroids, blood products, glucose control, and against sodium bicarbonate therapy except in certain cases. The guidelines emphasize prompt diagnosis and treatment as key to improving outcomes in sepsis patients.
ESA 2018 FLUIDS ARE DRUGS.pptx
This document discusses introducing fluid stewardship programs to improve intravenous (IV) fluid safety and prescribing. It recommends treating fluids as drugs by considering their indications, adverse effects, dose, duration, and de-escalating when possible. The 4 D's of fluid therapy are outlined as dose, duration, de-escalation and considering fluids as drugs with contraindications. Clinical audits found inappropriate fluid prescriptions and a lack of monitoring electrolytes. Introducing fluid stewardship through education, guidance, and audits can help address these issues and improve outcomes.
Non-invasive Transdermal Delivery of Medical Carbon Dioxide with D`OXYVA® Boo...
Transdermal delivery of medical carbon dioxide via D'OXYVA has been shown to boost microcirculation and balance the autonomic nervous system. A study delivering CO2 to participants' thumbs found significant increases in skin perfusion pressure in their toes for up to 4 hours after, indicating improved remote microvascular function and wound healing potential. Further research suggests D'OXYVA delivery balances sympathetic and parasympathetic nerve activity by initially decreasing sympathetic activity during delivery and potentially extending parasympathetic activity afterwards. These effects were seen without adverse events and show promise for conditions involving microvascular dysfunction.
High Flow Nasal Cannula - Grand Rounds 2018
This document discusses the benefits and optimal use of high flow nasal cannula (HFNC) in the emergency department. It finds that HFNC is comfortable for patients, improves oxygenation, and decreases respiratory rate. It can be used effectively in both the ED and ICU to treat hypoxemic respiratory failure without hypercapnia. HFNC may reduce intubation and mortality compared to conventional oxygen therapy. It also maintains oxygenation during intubation and is preferable to other devices for preoxygenation. However, HFNC should be used cautiously for cardiogenic pulmonary edema and COPD given limited evidence.
40 seyrafian peritoneal dialysis
The document discusses peritoneal dialysis (PD), including its modalities and how to organize a PD program. It provides information on indications for PD versus hemodialysis, factors to consider in modality selection, contraindications for each, and techniques to reduce peritonitis rates. Successful PD depends on educating patients, an interdisciplinary care team, and motivated nursing staff.
Dry weight management mansoura 2017
This document discusses hypertension in dialysis patients and dry weight management. It begins by outlining the cardiovascular risk of dialysis patients and defining hypertension and dry weight in this population. It then discusses various methods for assessing hydration status, such as clinical criteria, lab tests, medical devices, and blood pressure monitoring. Maintaining the proper dry weight is key to controlling hypertension and reducing mortality risk from fluid overload in dialysis patients. Intradialytic hypertension is also addressed.
1st Gulf Hypertension Conference
Officially endorsed by the European Hypertension Society, the 1st Gulf Hypertension Conference is the NEW addition in the Arab Health Congress 2015. The aim of the conference is to provide the most updated clinical and scientific data in the field of hypertension (HTN).
Over two-action packed days most aspects of hypertension management will be discussed. A group of highly specialised physicians will gather to present and discuss the latest recommendations, guidelines and debates in the field. The conference will elaborate on the extent of the disease and its impact in the region.
It will provide physicians, as well as regional health agencies, with recent advancements in the field as well as improving hypertension management, ultimately reflecting in the delivery of better patient care and outcomes.
Key topics
Epidemiology of HTN
Updates on antihypertensive medications
Renal denervation and baroreceptor stimulation therapies in treating hypertension
Chronic kidney disease and diabetic nephropathy updates
Hypertension in pregnancy and transplant populations
Assesment and treatment of acutely ill adult
The document outlines an ABCDE approach for assessing and treating acutely ill adult patients, with A representing airway assessment, B for breathing, C for circulation, D for disability, and E for exposure. It provides guidance on evaluating each component through history, examination, and monitoring, while simultaneously aiming to reach a diagnosis to allow for definitive treatment. The approach emphasizes beginning oxygen therapy, intravenous access, fluid resuscitation, and monitoring as needed based on the patient's condition.
IMPRESS development of diagnostic algorithms
This document discusses approaches to addressing breathlessness from an integrated perspective across specialties and settings. It notes that breathlessness affects a large portion of the population but is underdiagnosed and inconsistently addressed. The working group recommends taking a systematic history, using various tests to assess underlying conditions, addressing mental health and obesity factors, and providing evidence-based treatments like rehabilitation and smoking cessation. Commissioners are urged to foster integration across specialties and providers to improve outcomes for those with breathlessness.
Letter 2 Dr. Paul W. Corey
The letter discusses rational approaches to perioperative fluid management and the benefits of using an esophageal Doppler to guide fluid administration. It notes that randomized controlled trials have shown improved outcomes such as decreased length of stay and complications when using esophageal Doppler-guided fluid optimization compared to standard fluid handling. The author argues that understanding hemodynamics in real-time with continuous data from an esophageal Doppler is important for proper fluid management and care of patients.
Basic science of fluid therapy - Robert Hahn - SSAI2017
A talk by Robert Hahn at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
Weaning from mechanical ventilation and extubation by dr tareq
Weaning from mechanical ventilation and extubation requires careful assessment of patient readiness and involves gradually reducing ventilator support. While no single protocol can predict successful weaning in all cases, clinical judgment and experience are important. Early weaning when possible can reduce risks like nosocomial infection and improve patient outcomes. Factors such as respiratory status, hemodynamics, oxygen needs and sedation levels must be optimized before attempting weaning through slowly reducing settings on the ventilator. Noninvasive respiratory support like nasal CPAP is preferred after extubation over headbox oxygen. Caffeine, corticosteroids and chest physiotherapy may also improve chances of successful extubation.
Is there evidence for any fluid therapy in the critically ill? Anders Perner ...
A talk by Anders Perner at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
All conference content listed here: https://scanfoam.org/ssai2017/
Similar to 20. #ifad2019 fluid therapy in massive bleeding (llau) (20)
The four phases of intravenous fluid therapy: Manu Malbrain
The four phases of intravenous fluid therapy: Manu Malbrain
Fluid management in patients with trauma: Restrictive versus Liberal Approach
Fluid management in patients with trauma: Restrictive versus Liberal Approach
Non-invasive Transdermal Delivery of Medical Carbon Dioxide with D`OXYVA® Boo...
Non-invasive Transdermal Delivery of Medical Carbon Dioxide with D`OXYVA® Boo...
Basic science of fluid therapy - Robert Hahn - SSAI2017
Basic science of fluid therapy - Robert Hahn - SSAI2017
Weaning from mechanical ventilation and extubation by dr tareq
Weaning from mechanical ventilation and extubation by dr tareq
Is there evidence for any fluid therapy in the critically ill? Anders Perner ...
Is there evidence for any fluid therapy in the critically ill? Anders Perner ...
More from International Fluid Academy
19. #ifad2019 triggering celular oxygenation (carmona)
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
18. #ifad2019 heart lung interactions (aldecoa)
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
16. #ifad219 report of fluid day spain (colomina)
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
14. #ifad2019 is there a place left for album (caironi)
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
12. #ifad2019 everything you nbeed to know about maintenance and resuscitatio...
12. #ifad2019 everything you nbeed to know about maintenance and resuscitatio...International Fluid Academy
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
9. #ifad2019 review of recent fluid trials (funcke)
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
8. #ifad2019 review of recent monitoring trials (edwards)
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
7. #ifad2019 how to assess volemic status (langer)
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
6. #ifad2019 how to measure fluid resppnsiveness (alonso inigo)
This document discusses fluid responsiveness monitoring during surgery. It begins by outlining parameters used to evaluate fluid responsiveness, such as pulse pressure variation (PPV) and stroke volume variation (SVV). It notes that PPV directly measures pressure changes while SVV estimates volume changes. The document then examines other hemodynamic parameters like arterial elastance and dynamic elastance. It argues that a multiparameter model integrating pressures, perfusion, afterload, flow and dynamic vascular tone can better guide fluid management than any single parameter. The overall message is that fluid assessment during surgery requires considering multiple interconnected physiologic factors.
5. #ifad2019 the role of the glycocalyx (chappell)
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
21. #ifad2019 how to guide deresuscitation (malbrain)
(1) This document discusses fluid overload in intensive care patients. It defines terms like fluid balance, fluid overload, and approaches to fluid management.
(2) Fluid overload is associated with worse outcomes and can be assessed using clinical signs, biomarkers, hemodynamic parameters, organ function tests, and imaging studies. Persistent positive cumulative fluid balance and signs of generalized increased permeability syndrome indicate the need for de-resuscitation.
(3) De-resuscitation, or late goal-directed fluid removal, can be guided by monitoring changes in parameters like extravascular lung water index, pulmonary vascular permeability index, and intra-abdominal pressure in response to diuretics or renal replacement therapy. The goal
4. #ifad2019 what happened in meantime literature on fluid physiology (cair...
4. #ifad2019 what happened in meantime literature on fluid physiology (cair...International Fluid Academy
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
1. time to look back, what happened in the past 40 years in critical care #uz...
1. time to look back, what happened in the past 40 years in critical care #uz...International Fluid Academy
This symposium provides an overview of the (r)evolution in intensive care medicine. The programme is based on lectures of 20 minutes where each speaker presents in two 10 minute talks (in der Beschränkung zeigt sich erst der Meister) the good things that happened in the last 40 years in critical care vs our mistakes or what is missing with respect to that topic. At the end of the session the speakers participate in an interactive round table discussion with online voting to get the audience involved. Will be discussed: Theoretical concepts, basic physiology and pathophysiology, monitoring, and future directions. 2. (r)evolution in nutrition in critically ill #uzb40 icu (de waele e)
This symposium provides an overview of the (r)evolution in intensive care medicine. The programme is based on lectures of 20 minutes where each speaker presents in two 10 minute talks (in der Beschränkung zeigt sich erst der Meister) the good things that happened in the last 40 years in critical care vs our mistakes or what is missing with respect to that topic. At the end of the session the speakers participate in an interactive round table discussion with online voting to get the audience involved. Will be discussed: Theoretical concepts, basic physiology and pathophysiology, monitoring, and future directions.
3. (r)evolution in hemodynamic monitoring in critically ill #uzb40 icu (monnet)
3. (r)evolution in hemodynamic monitoring in critically ill #uzb40 icu (monnet)International Fluid Academy
This symposium provides an overview of the (r)evolution in intensive care medicine. The programme is based on lectures of 20 minutes where each speaker presents in two 10 minute talks (in der Beschränkung zeigt sich erst der Meister) the good things that happened in the last 40 years in critical care vs our mistakes or what is missing with respect to that topic. At the end of the session the speakers participate in an interactive round table discussion with online voting to get the audience involved. Will be discussed: Theoretical concepts, basic physiology and pathophysiology, monitoring, and future directions.4. (r)evolution in respiratory failure in critically ill #uzb40 icu (reuter)
4. (r)evolution in respiratory failure in critically ill #uzb40 icu (reuter)International Fluid Academy
This symposium provides an overview of the (r)evolution in intensive care medicine. The programme is based on lectures of 20 minutes where each speaker presents in two 10 minute talks (in der Beschränkung zeigt sich erst der Meister) the good things that happened in the last 40 years in critical care vs our mistakes or what is missing with respect to that topic. At the end of the session the speakers participate in an interactive round table discussion with online voting to get the audience involved. Will be discussed: Theoretical concepts, basic physiology and pathophysiology, monitoring, and future directions.5. (r)evolution in kidney failure in critically ill #uzb40 icu (molnar)
This symposium provides an overview of the (r)evolution in intensive care medicine. The programme is based on lectures of 20 minutes where each speaker presents in two 10 minute talks (in der Beschränkung zeigt sich erst der Meister) the good things that happened in the last 40 years in critical care vs our mistakes or what is missing with respect to that topic. At the end of the session the speakers participate in an interactive round table discussion with online voting to get the audience involved. Will be discussed: Theoretical concepts, basic physiology and pathophysiology, monitoring, and future directions.
6. (r)evolution in neurologic monitoring and tbi #uzb40 icu (taccone)
This symposium provides an overview of the (r)evolution in intensive care medicine. The programme is based on lectures of 20 minutes where each speaker presents in two 10 minute talks (in der Beschränkung zeigt sich erst der Meister) the good things that happened in the last 40 years in critical care vs our mistakes or what is missing with respect to that topic. At the end of the session the speakers participate in an interactive round table discussion with online voting to get the audience involved. Will be discussed: Theoretical concepts, basic physiology and pathophysiology, monitoring, and future directions.
7. (r)evolution in liver failure in critically ill #uzb40 icu (wilmer)
This symposium provides an overview of the (r)evolution in intensive care medicine. The programme is based on lectures of 20 minutes where each speaker presents in two 10 minute talks (in der Beschränkung zeigt sich erst der Meister) the good things that happened in the last 40 years in critical care vs our mistakes or what is missing with respect to that topic. At the end of the session the speakers participate in an interactive round table discussion with online voting to get the audience involved. Will be discussed: Theoretical concepts, basic physiology and pathophysiology, monitoring, and future directions.
8. (r)evolution in gastrointestinal failure in critically ill #uzb40 icu (de ...
8. (r)evolution in gastrointestinal failure in critically ill #uzb40 icu (de ...International Fluid Academy
This symposium provides an overview of the (r)evolution in intensive care medicine. The programme is based on lectures of 20 minutes where each speaker presents in two 10 minute talks (in der Beschränkung zeigt sich erst der Meister) the good things that happened in the last 40 years in critical care vs our mistakes or what is missing with respect to that topic. At the end of the session the speakers participate in an interactive round table discussion with online voting to get the audience involved. Will be discussed: Theoretical concepts, basic physiology and pathophysiology, monitoring, and future directions.More from International Fluid Academy (20)
19. #ifad2019 triggering celular oxygenation (carmona)
19. #ifad2019 triggering celular oxygenation (carmona)
14. #ifad2019 is there a place left for album (caironi)
14. #ifad2019 is there a place left for album (caironi)
12. #ifad2019 everything you nbeed to know about maintenance and resuscitatio...
12. #ifad2019 everything you nbeed to know about maintenance and resuscitatio...
9. #ifad2019 review of recent fluid trials (funcke)
9. #ifad2019 review of recent fluid trials (funcke)
8. #ifad2019 review of recent monitoring trials (edwards)
8. #ifad2019 review of recent monitoring trials (edwards)
7. #ifad2019 how to assess volemic status (langer)
7. #ifad2019 how to assess volemic status (langer)
6. #ifad2019 how to measure fluid resppnsiveness (alonso inigo)
6. #ifad2019 how to measure fluid resppnsiveness (alonso inigo)
5. #ifad2019 the role of the glycocalyx (chappell)
5. #ifad2019 the role of the glycocalyx (chappell)
21. #ifad2019 how to guide deresuscitation (malbrain)
21. #ifad2019 how to guide deresuscitation (malbrain)
4. #ifad2019 what happened in meantime literature on fluid physiology (cair...
4. #ifad2019 what happened in meantime literature on fluid physiology (cair...
1. time to look back, what happened in the past 40 years in critical care #uz...
1. time to look back, what happened in the past 40 years in critical care #uz...
2. (r)evolution in nutrition in critically ill #uzb40 icu (de waele e)
2. (r)evolution in nutrition in critically ill #uzb40 icu (de waele e)
3. (r)evolution in hemodynamic monitoring in critically ill #uzb40 icu (monnet)
3. (r)evolution in hemodynamic monitoring in critically ill #uzb40 icu (monnet)
4. (r)evolution in respiratory failure in critically ill #uzb40 icu (reuter)
4. (r)evolution in respiratory failure in critically ill #uzb40 icu (reuter)
5. (r)evolution in kidney failure in critically ill #uzb40 icu (molnar)
5. (r)evolution in kidney failure in critically ill #uzb40 icu (molnar)
6. (r)evolution in neurologic monitoring and tbi #uzb40 icu (taccone)
6. (r)evolution in neurologic monitoring and tbi #uzb40 icu (taccone)
7. (r)evolution in liver failure in critically ill #uzb40 icu (wilmer)
7. (r)evolution in liver failure in critically ill #uzb40 icu (wilmer)
8. (r)evolution in gastrointestinal failure in critically ill #uzb40 icu (de ...
8. (r)evolution in gastrointestinal failure in critically ill #uzb40 icu (de ...
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3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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- 1. Juan V. Llau, MD, PhD Dept. Anaesthesiology and Critical Care – University Hospital “Doctor Peset” Associated Professor of Anaesthesiology – University of València València - Spain juanvllau@gmail.com Fluid-therapy in massive bleeding
- 2. Conflict of interest Honoraria/travel support for consulting/educational programs/lecturing Octapharma CSL-Behring Boehringer Fresenius Cardinal Sanofi Pfizer Rovi LFB
- 3. Agenda • Previous concepts • Physiopathology • Which fluid? • How much – how long? • Key messages
- 4. Agenda • Previous concepts • Physiopathology • Which fluid? • How much – how long? • Key messages
- 5. Previous concept MASSIVE BLEEDING OUTCOME DAMAGE-CONTROL RESUSCITATION Fluids Stop bleeding RBC + Haemostatics Drugs
- 6. DCR: role of fluids MASSIVE BLEEDING FLUIDS OUTCOME Which one? How much? How long? SYSTEMIC ENDOTHELIOPATHY TRAUMA INDUCED COAGULOPATHY
- 7. Agenda • Previous concepts • Physiopathology • Which fluid? • How much – how long? • Key messages
- 8. Physiopathology Spahn DR et al. 2019
- 9. Physiopathology Spahn DR et al. 2019
- 10. Physiopathology Spahn DR et al. 2019
- 11. Physiopathology Maegele M et al. 2017
- 12. Endothelium and glycocalyx Mildfort EM et al. 2019 Chappel 2008 et al. 2008
- 17. Agenda • Previous concepts • Physiopathology • Which fluid? • How much – how long? • Key messages
- 18. Which fluid? Spahn DR et al. 2019
- 19. Which fluid? Kozek-Langenecker SA et al. 2017
- 20. Which fluid? Llau JV et al. 2016 Isotonic crystalloids better than colloids Avoid hypotonic crystalloids (RL) if severe TBI If use colloids, follow recommended dosage
- 21. Which fluid?
- 22. Which fluid? Wise R et al. 2017
- 23. Which fluid? James MFM et al. 2011 (FIRST trial)
- 24. Which fluid? Annane D et al. 2011 (CRISTAL trial)
- 25. Which fluid? Choice: Isotonic (balanced) crystalloids Possible: initial combination with colloids
- 26. Agenda • Previous concepts • Physiopathology • Which fluid? • How much – how long? • Key messages
- 27. Avoid hypervolemia Modified from P. Van der Linden, presented at ISICEM 2015 “Dry” “Wet” Fluid optimisation
- 28. Avoid hypervolemia Spahn DR et al. 2019
- 30. Prevention of endotheliopathy “Damage-control resuscitation concept” Less clear fluids More haemostatics Schochl H et al. 2014
- 31. Prevention of endotheliopathy Benz D et al. 2017 “Damage-control resuscitation concept” Permissive hypotension Restriction of isotonic fluids Early transfusion
- 33. Prevention of tissue hypoxia Kozek-Langenecker SA et al. 2017
- 34. Prevention of tissue hypoxia Llau JV et al. 2016 Fluids initially based on haemodynamic response Hypotensive resuscitation Use dynamic parameters face to static ones in second-step fluid therapy
- 35. Prevention of tissue hypoxia Wise R et al. 2017
- 36. How much – how long? Choice: Restrictive (“no wet”) Possible: Vasopressors in addition to fluids Choice: GDO: dynamic HMD parameters Possible: Initial response to fluid administration Choice: Early transfusion
- 37. Agenda • Previous concepts • Physiopathology • Which fluid? • How much – how long? • Key messages
- 38. Key messages Fluids in the management of massive bleeding Which fluid? Choice: Isotonic crystalloids Possible: initial combination with colloids How much fluid? How long? Choice: Restrictive (“no wet”) Possible: Vasopressors in addition to fluids Choice: GDO: dynamic HMD parameters Possible: Initial response to fluid administration Choice: Early transfusion
- 39. Juan V. Llau, MD, PhD Dept. Anaesthesiology and Critical Care – University Hospital “Doctor Peset” Associated Professor of Anaesthesiology – University of València València - Spain juanvllau@gmail.com Fluid-therapy in massive bleeding