7. #ifad2019 how to assess volemic status (langer)
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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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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
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
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
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.
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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.
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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
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
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This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations. Recommended
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
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
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
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.
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.
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
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
1. introduction and role of abdominal pressure in ecmo #beach2019 (malbrain)
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This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations. 1. time to look back, what happened in the past 40 years in critical care #uz...
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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. Goal Directed Fluid Therapy: Fact, Fiction, Findings and the Future
Goal Directed Fluid Therapy: Fact, Fiction, Findings and the FutureNC Association of Nurse Anesthetists
This document discusses goal directed fluid therapy (GDFT) and the evidence surrounding conventional fluid administration practices. It reviews the assumptions of perioperative fluid therapy and examines factors related to intravascular volume and tissue perfusion. The evidence suggests there is great variability in how providers administer fluids. GDFT uses cardiac output measurements to guide IV fluids with the goal of optimizing tissue oxygen delivery and preventing complications. A case study demonstrates using dynamic variables like stroke volume variation to determine fluid responsiveness and optimize a patient's fluid status.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.Balanced solution is a boon for fluid resuscitation
Balanced crystalloids are emerging as the fluid of choice for resuscitation over normal saline. Normal saline can cause hyperchloremic acidosis due to its high chloride content. Balanced crystalloids more closely mimic the electrolyte composition of plasma. Studies show balanced crystalloids may reduce complications like renal injury and need for renal replacement therapy compared to normal saline in critically ill patients. The optimal fluid choice depends on factors like the patient's clinical condition, electrolyte levels, and volume needed.
Pathophysiological mechanisms and consequences of gut edema (Annika Reintam W...
Gut edema in acute illness is not yet sufficiently studied and existing knowledge is largely based on experimental animal studies or small studies in healthy volunteers. However, increasing evidence confirms that gut edema impairs intestinal motility and healing of bowel anastomoses, being therefore an important contributor to outcome.
Current presentation focuses mainly on the role of fluids in development of intestinal edema.
Monitoring macro and microcirculation (Joel Starkopf WSACS session ESA 2018 #...
Monitoring macro and microcirculation (Joel Starkopf WSACS session ESA 2018 #...International Fluid Academy
Splanchnic blood flow
- Takes up to one third of cardiac output in normal physiology
- Is increased postprandially, and in septic shock
Splanchnic microcirculation
- Indirect assessment via clinical signs and biomarkers
- Role for sublingual videomicroscopy in the future?
Optimisation of splanchnic blood flow
- Fluid management
- Intra-abdominal pressure and abdominal perfusion pressure are important
- Vasopressors and inotropes, depending on status
- Hypovolemia and hypotension vs venous congestion
- Little coherence between macro- and microcirculation
Update on Fluid Resuscitation
1) The patient has signs of shock including hypotension, tachycardia, and elevated lactate and base deficit.
2) Fluid resuscitation with 2L LR improved hemodynamics but lactate and base deficit remain elevated, indicating ongoing shock.
3) Aggressive resuscitation with blood products following a 1:1:1 ratio of PRBCs, FFP, and platelets is indicated to replace blood loss and prevent coagulopathy, given the suspicion for hemorrhage.
Hemodialysis orders part 1
This three-part document discusses hemodialysis prescription and targets. It begins with an introduction and overview of hemodialysis history and statistics on end-stage renal disease from the USRDS 2020 report. Part I covers breaking the news to patients about needing dialysis and variables in deciding on dialysis. Parts II and III will discuss choosing filters and dialysate composition, hemodynamics, ultrafiltration, and research aspects of optimizing hemodialysis prescription. The goal is targeting a dialysis treatment that is friendly to patients.
Frederic Michard - Perioperative Fluid Management - IFAD 2012
Dr. Frederic Michard discusses perioperative fluid management and optimization. He advocates using pulse pressure variation (PPV) or stroke volume variation (SVV) to guide fluid administration when possible. When those values cannot be used, stroke volume response to fluid challenges should be monitored. Compliance to fluid optimization protocols is important. Graphical displays and checklists may improve compliance, while closed-loop systems could achieve near 100% compliance, but their safety requires further clinical studies.
Daily Dialysis , is it Better?
This document summarizes key findings from studies comparing outcomes of daily dialysis versus conventional hemodialysis. It discusses how dialysis dose is measured, what constitutes an "adequate" dose, and whether more dialysis leads to better or worse outcomes. Studies found no difference in mortality between standard and high-dose dialysis or between low-flux and high-flux dialyzers. Higher frequency dialysis was associated with improved small and middle molecule clearance but no RCTs had been done until the one described, which found daily dialysis reduced left ventricular mass and improved physical health scores compared to conventional dialysis.
Introduction of ECLS to Egypt
1. The document describes the introduction and establishment of extracorporeal life support (ECLS) at the Critical Care Department of Cairo University Hospitals in Egypt.
2. An ECLS team was formed, physicians were trained abroad, and equipment was acquired to begin treating patients using ECLS.
3. The first few ECLS cases involved treating acute respiratory distress syndrome and had successful outcomes, demonstrating the viability of the new program in Egypt.
Sepsis and early goal directed therapy
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Greenberg et al-2015-anesthesia_&_analgesia
This editorial discusses the ongoing controversy around the safety of hydroxyethyl starch (HES) for perioperative fluid therapy. While HES has been used clinically for over 40 years, recent large trials in sepsis patients found an association with renal failure and need for renal replacement therapy. However, the risk appears greater in more critically ill patients. Two new studies presented in the journal found mixed results - one in lower risk patients found no renal effects, while another in higher risk liver transplant patients found a dose-dependent increased risk of acute kidney injury with HES. The editorial concludes that more research is still needed to determine safety in different patient populations and clinical contexts of HES use.
When to initiate RRT in patients with AKI - Does timing matter?
When to initiate RRT in patients with AKI remains an area of debate due to lack of consensus on the optimal timing. The document reviews evidence on using various biochemical parameters and clinical indicators to guide RRT initiation. Studies have shown conflicting results for triggers like serum creatinine, urea, and oliguria. Earlier initiation of RRT may improve outcomes by preventing fluid overload, though high-quality randomized trials are still needed to definitively establish best practices. The cause of AKI and individual patient factors are also important considerations in determining optimal timing.
When to Initiate RRT in Patients with AKI - Does Timing Matter?
Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT. This problem is confounded by a paucity of high quality evidence in the current literature. This review examines the role of usual biochemical parameters as well as conventional clinical indications for commencing RRT. It also discusses the potential role of biomarkers as predictors for the need of RRT in AKI. Initiating dialysis in AKI should be based on dynamic clinical criteria and not only on specific biochemical values.
Perioperative fluid management
This document discusses nutrition and fluid therapy in the peri-operative period. It covers several topics:
- The normal distribution of water in the body and barriers between fluid compartments.
- Developments in fluid management practices from liberal to restrictive/goal-directed strategies.
- Evidence that crystalloids are preferred to colloids and balanced solutions to saline for fluid therapy.
- Techniques for assessing fluid status and predicting fluid responsiveness like fluid challenges.
- The importance of considering both macrocirculation and microcirculation in fluid management.
- Guidelines for perioperative nutritional support based on albumin levels and optimal enteral feeding.
ICN Victoria: Robertson on "The Case For Albumin"
ICN Victoria presents Dr Megan Robertson arguing the case FOR albumin, in part one of "The Great Albumin Debate - a Battle of Colloidal Proportions".
Haemodialysis related ascites prof. mohamed sobh
This document discusses nephrogenic ascites, a condition where patients with end-stage renal disease develop refractory ascites. It defines nephrogenic ascites and notes the condition is diagnosed by excluding other causes of ascites through tests and imaging. The document outlines the clinical presentation, poor prognosis, and various treatment options for nephrogenic ascites that have been attempted, including fluid restriction, peritoneal dialysis, peritoneovenous shunt placement, and renal transplantation, with transplantation found to be the most effective treatment.
Myburgh on Fluids ICN NSW 2015
This document summarizes the history and evidence around fluid management and the use of colloids like albumin and hydroxyethyl starch (HES). It discusses several large randomized controlled trials that compared albumin and HES to crystalloids in critically ill patients. The SAFE study found increased mortality with albumin compared to saline in ICU patients. Subsequent trials found increased mortality and renal failure with HES compared to crystalloids in sepsis patients. This led regulatory agencies around the world to restrict or withdraw approval for HES use in high-risk patients like those with sepsis or renal impairment. The evidence suggests colloids like HES may increase mortality and renal failure compared to crystalloid fluids in critically ill patients.
surviving Sepsis 2016
This document provides an update to the 2012 Surviving Sepsis Campaign guidelines for the management of sepsis and septic shock. A consensus committee of 55 international experts from 25 organizations reviewed evidence and developed recommendations. They addressed 93 statements, including 32 strong recommendations, 39 weak recommendations, and 18 best practice statements. No recommendation was provided for four questions. The guidelines are intended to improve outcomes for patients with sepsis or septic shock in a hospital setting, though clinical judgment is still required given variability in individual patients.
ARF.pptx
Acute renal failure occurs when the kidneys fail to remove waste and regulate electrolytes. It is characterized by a rapid loss of renal function due to kidney damage. There are three phases of acute renal failure: initiation, oliguria, and diuresis. Risk factors include pre-existing kidney disease, liver disease, diabetes, hypertension, heart failure, and obesity. Causes can be pre-renal such as dehydration, intra-renal such as infection or toxicity, or post-renal like obstruction. Symptoms include oliguria, lethargy, dry skin and metabolic acidosis. Treatment focuses on fluid management, electrolyte control, and treating the underlying cause. Nursing care centers around monitoring output
Hydration scientific library volume 3
Two randomized clinical trials have found that increased water intake can help reduce headache symptoms. The trials conducted by researchers at Maastricht University found that drinking an additional 1.5 liters of water per day resulted in statistically significant improvements in migraine-specific quality of life and subjective reports of headache improvement. However, increased water intake did not significantly reduce the number of days with moderate headaches. Most marathon runners are dehydrated at the end of races but some drink too much and can develop hyponatremia. A study of London marathon runners found many had poor understanding of appropriate fluid intake amounts and types.
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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. Goal Directed Fluid Therapy: Fact, Fiction, Findings and the Future
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This document discusses goal directed fluid therapy (GDFT) and the evidence surrounding conventional fluid administration practices. It reviews the assumptions of perioperative fluid therapy and examines factors related to intravascular volume and tissue perfusion. The evidence suggests there is great variability in how providers administer fluids. GDFT uses cardiac output measurements to guide IV fluids with the goal of optimizing tissue oxygen delivery and preventing complications. A case study demonstrates using dynamic variables like stroke volume variation to determine fluid responsiveness and optimize a patient's fluid status.8. (r)evolution in gastrointestinal failure in critically ill #uzb40 icu (de ...
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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.Balanced solution is a boon for fluid resuscitation
Balanced crystalloids are emerging as the fluid of choice for resuscitation over normal saline. Normal saline can cause hyperchloremic acidosis due to its high chloride content. Balanced crystalloids more closely mimic the electrolyte composition of plasma. Studies show balanced crystalloids may reduce complications like renal injury and need for renal replacement therapy compared to normal saline in critically ill patients. The optimal fluid choice depends on factors like the patient's clinical condition, electrolyte levels, and volume needed.
Pathophysiological mechanisms and consequences of gut edema (Annika Reintam W...
Gut edema in acute illness is not yet sufficiently studied and existing knowledge is largely based on experimental animal studies or small studies in healthy volunteers. However, increasing evidence confirms that gut edema impairs intestinal motility and healing of bowel anastomoses, being therefore an important contributor to outcome.
Current presentation focuses mainly on the role of fluids in development of intestinal edema.
Monitoring macro and microcirculation (Joel Starkopf WSACS session ESA 2018 #...
Monitoring macro and microcirculation (Joel Starkopf WSACS session ESA 2018 #...International Fluid Academy
Splanchnic blood flow
- Takes up to one third of cardiac output in normal physiology
- Is increased postprandially, and in septic shock
Splanchnic microcirculation
- Indirect assessment via clinical signs and biomarkers
- Role for sublingual videomicroscopy in the future?
Optimisation of splanchnic blood flow
- Fluid management
- Intra-abdominal pressure and abdominal perfusion pressure are important
- Vasopressors and inotropes, depending on status
- Hypovolemia and hypotension vs venous congestion
- Little coherence between macro- and microcirculation
Update on Fluid Resuscitation
1) The patient has signs of shock including hypotension, tachycardia, and elevated lactate and base deficit.
2) Fluid resuscitation with 2L LR improved hemodynamics but lactate and base deficit remain elevated, indicating ongoing shock.
3) Aggressive resuscitation with blood products following a 1:1:1 ratio of PRBCs, FFP, and platelets is indicated to replace blood loss and prevent coagulopathy, given the suspicion for hemorrhage.
Hemodialysis orders part 1
This three-part document discusses hemodialysis prescription and targets. It begins with an introduction and overview of hemodialysis history and statistics on end-stage renal disease from the USRDS 2020 report. Part I covers breaking the news to patients about needing dialysis and variables in deciding on dialysis. Parts II and III will discuss choosing filters and dialysate composition, hemodynamics, ultrafiltration, and research aspects of optimizing hemodialysis prescription. The goal is targeting a dialysis treatment that is friendly to patients.
Frederic Michard - Perioperative Fluid Management - IFAD 2012
Dr. Frederic Michard discusses perioperative fluid management and optimization. He advocates using pulse pressure variation (PPV) or stroke volume variation (SVV) to guide fluid administration when possible. When those values cannot be used, stroke volume response to fluid challenges should be monitored. Compliance to fluid optimization protocols is important. Graphical displays and checklists may improve compliance, while closed-loop systems could achieve near 100% compliance, but their safety requires further clinical studies.
Daily Dialysis , is it Better?
This document summarizes key findings from studies comparing outcomes of daily dialysis versus conventional hemodialysis. It discusses how dialysis dose is measured, what constitutes an "adequate" dose, and whether more dialysis leads to better or worse outcomes. Studies found no difference in mortality between standard and high-dose dialysis or between low-flux and high-flux dialyzers. Higher frequency dialysis was associated with improved small and middle molecule clearance but no RCTs had been done until the one described, which found daily dialysis reduced left ventricular mass and improved physical health scores compared to conventional dialysis.
Introduction of ECLS to Egypt
1. The document describes the introduction and establishment of extracorporeal life support (ECLS) at the Critical Care Department of Cairo University Hospitals in Egypt.
2. An ECLS team was formed, physicians were trained abroad, and equipment was acquired to begin treating patients using ECLS.
3. The first few ECLS cases involved treating acute respiratory distress syndrome and had successful outcomes, demonstrating the viability of the new program in Egypt.
Sepsis and early goal directed therapy
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Greenberg et al-2015-anesthesia_&_analgesia
This editorial discusses the ongoing controversy around the safety of hydroxyethyl starch (HES) for perioperative fluid therapy. While HES has been used clinically for over 40 years, recent large trials in sepsis patients found an association with renal failure and need for renal replacement therapy. However, the risk appears greater in more critically ill patients. Two new studies presented in the journal found mixed results - one in lower risk patients found no renal effects, while another in higher risk liver transplant patients found a dose-dependent increased risk of acute kidney injury with HES. The editorial concludes that more research is still needed to determine safety in different patient populations and clinical contexts of HES use.
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Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT. This problem is confounded by a paucity of high quality evidence in the current literature. This review examines the role of usual biochemical parameters as well as conventional clinical indications for commencing RRT. It also discusses the potential role of biomarkers as predictors for the need of RRT in AKI. Initiating dialysis in AKI should be based on dynamic clinical criteria and not only on specific biochemical values.
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This document summarizes the history and evidence around fluid management and the use of colloids like albumin and hydroxyethyl starch (HES). It discusses several large randomized controlled trials that compared albumin and HES to crystalloids in critically ill patients. The SAFE study found increased mortality with albumin compared to saline in ICU patients. Subsequent trials found increased mortality and renal failure with HES compared to crystalloids in sepsis patients. This led regulatory agencies around the world to restrict or withdraw approval for HES use in high-risk patients like those with sepsis or renal impairment. The evidence suggests colloids like HES may increase mortality and renal failure compared to crystalloid fluids in critically ill patients.
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This document provides an update to the 2012 Surviving Sepsis Campaign guidelines for the management of sepsis and septic shock. A consensus committee of 55 international experts from 25 organizations reviewed evidence and developed recommendations. They addressed 93 statements, including 32 strong recommendations, 39 weak recommendations, and 18 best practice statements. No recommendation was provided for four questions. The guidelines are intended to improve outcomes for patients with sepsis or septic shock in a hospital setting, though clinical judgment is still required given variability in individual patients.
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When to initiate RRT in patients with AKI - Does timing matter?
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Basic Concepts of Fluid and Electrolyte Theraphy.pdf
I bought this file from (FB name: Dee Dee). The files are extremely helpful, visit his Facebook account or Facebook page.
https://web.facebook.com/groups/670462807397676/
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20. #ifad2019 fluid therapy in massive bleeding (llau)
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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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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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...
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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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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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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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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)
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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.
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This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.
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This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.
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This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.
13. the role of foam in ecmo education #beach2019 (antonini)
This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.
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This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.
11. weaning from ecmo #beach2019 (bouchez)
This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.
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This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.
9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckh...
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This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.More from International Fluid Academy (20)
20. #ifad2019 fluid therapy in massive bleeding (llau)
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12. #ifad2019 everything you nbeed to know about maintenance and resuscitatio...
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16. the role for echocardiography during ecmo #beach2019 (lochy)
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15. hemodynamic monitoring during ecmo #beach2019 (bouchez)
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Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Role of Mukta Pishti in the Management of Hyperthyroidism
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Journal Article Review on Rasamanikya
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
The Electrocardiogram - Physiologic Principles
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...
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Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
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The Nervous and Chemical Regulation of Respiration
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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7. #ifad2019 how to assess volemic status (langer)
- 1. How to assess volemic status? Overload vs. Underload. Department of Pathophysiology and Transplantation, University of Milan; Pediatric Intensive Care Unit "De Marchi", Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy Valencia, 26th October 2019 Thomas Langer, MD Thomas.Langer@unimi.it @Thom_Langer
- 2. Agenda Basics — Fluid compartments Fluid assessment — Examination & Physiology Fluid administration — Indications & Prevalence Conclusions — Wrap it up!
- 3. Agenda Basics — Fluid compartments Fluid assessment — Examination & Physiology Fluid administration — Indications & Prevalence Conclusions — Wrap it up!
- 4. On the importance of body water Aurelia Aurita Lowndes AG Nature 1942;150:234–5.Thomas.Langer@unimi.it TBW = 95.5%
- 5. Body Fluid Compartments Tortora G et al. Principles of Anatomy and Physiology.Thomas.Langer@unimi.it
- 6. Fluid compartments and their composition LangerT Anesth IntTher 2017Thomas.Langer@unimi.it
- 7. Intracellular Extracellular 280 mOsm/kg 280 mOsm/kg H2O H2O K+ = 140 mEq/L Na+ = 140 mEq/L 25 litres 17 litres Volume Water, osmolarity and osmolar equilibrium
- 8. Agenda Basics — Fluid compartments Fluid assessment — Examination & Physiology Fluid administration — Indications & Prevalence Conclusions — Wrap it up!
- 10. BLOOD FLOW Return functionCardiac function • Heart rate • Preload • Afterload • Contractility of ventricles • Vascular volume • Venous compliance • Venous resistance • Downstream CVP THE BASICS
- 11. Pra Q Pra Q Cardiac function Return functionCardiacOutput VenousReturn
- 12. QCardiac Output Venous Return Crys. 500 ml Pra
- 13. Agenda Basics — Fluid compartments Fluid assessment — Examination & Physiology Fluid administration — Indications & Prevalence Conclusions — Wrap it up!
- 14. Indications for parenteral fluid FLUID RESUSCITATION: AIM: Correct an acute intravascular or extracellular fluid volume deficit FLUID REPLACEMENT: AIM: Replace past or ongoing losses of extracellular fluid, which cannot be compensated by oral fluid intake alone FLUID MAINTENANCE: AIM: Provide water and electrolytes in haemodynamically stable patients that are not able/allowed to drink water Thomas.Langer@unimi.it
- 15. Cumulative mean daily fluid rate: 114 ml/h ~2.5 L 14654 pts 103098 ICU days Van Regenmortel N Intensive Care Med 2018 32.5% 25% 6.5% 3% 33%
- 17. Sodium and water balance in health Rose BD Textbook 5th edition
- 18. Time [hours] Time [hours] Fluidbalance[ml] 4190 ml 3120 ml Van Regenmortel N Intensive Care Med 2019 [Na+] = 154 (n=34) [Na+] = 54 (n=33)
- 19. H2O Na+ 14 mEq/kg/day150 ml/kg/day Critically ill children < 3 years, ventialted ≥ 48 hours LangerT under review Suggested Na intake 1-2 mEq/kg/day
- 20. Total Sodium intake [mEq] Cumulativefluidbalance[ml] Total sodium intake and WB in critical children LangerT under review
- 21. Agenda Basics — Fluid compartments Fluid assessment — Examination & Physiology Fluid administration — Indications & Prevalence Conclusions — Wrap it up!
- 22. • We are made of water and salt • Fluid assessment is fundamental • Resuscitation vs. Maintenance/creep [6.5% vs. 57%] • Water and salt overload Conclusions
- 23. Fluid assessment
Editor's Notes
- We evaluate the patients
- We evaluate the patients
- We evaluate the patients
- Sottolineare che in un caso un aumento del preload migliora la funzione cardiaca, mentre sull’altro versante un aumento della CVP riduce il ritorno venoso.
- We evaluate the patients
- We evaluate the patients