Bio-electrical impedance analysis for perioperative fluid evaluation in open major abdominal surgery.

Water retention and intercompartmental redistribution occur frequently in association with adverse postoperative outcomes, yet the available strategies for non-invasive assessment are limited. One such approach for evaluating body water composition in various circumstances is bio-electrical impedance analysis (BIA). This study aims to appraise the usefulness of the Body Composition Monitor (BCM, Fresenius Medical Care, Germany) in assessing body fluid composition and intercompartmental shifts before and after open major abdominal surgery. This prospective, clinician blinded observational study enrolled all the patients scheduled consecutively for elective major open abdominal surgery during a 1-year period starting from January 1st, 2016. BIA parameters-total body water (TBW), extracellular water (ECW), intracellular water (ICW), absolute fluid overload (AFO), and relative fluid overload (RFO) were measured before and after surgery. The results were compared with fluid balance and outcome parameters such as organ dysfunction, ICU-and hospital length of stay (-LOS). The study population included 71 patients aged 60.2 ± 12 of whom 60.6% men and with a BMI of 26.3 ± 5.1 kg/m2. Postoperative acute kidney injury, respiratory dysfunction, and infections occurred in 14.0%, 19.7% and 28.1% of cases, respectively. The median LOS in ICU was 20 h and the hospital-LOS was 10 days. Positive intraoperative fluid balance (2.4 ± 1.0 L) resulted in a significant increase of TBW (1.4 ± 2.4 L) and of ECW (1.4 ± 1.2 L). Intraoperative fluid balance significantly correlated with TBW change (r = 0.23, p = 0.04) and with AFO change (r = 0.31, p < 0.01). A significant correlation was found between pre- and postoperative AFO and RFO on one hand, and ICU-LOS on the other. BIA may be a useful tool for the perioperative assessment of volume status.

Monitoring Perfusion Index in Patients Presenting to the Emergency Department Due to Drug Use.

(1) Background: The perfusion index (PI) represents the ratio between pulsatile blood flow and non-pulsatile blood flow in the peripheral tissue. (2) We aimed to investigate the blood pressure perfusion of tissues and organs in ethnobotanical, synthetic cannabinoid and cannabis derivative consumers through the value of perfusion index. (3) Results: The patients enrolled were divided into two groups: group A, which included all patients who presented in the ED within the first three hours after consumption, and group B, which included those patients who presented more than three hours and up to 12 h after drug consumption. The average values of the PI in the case of group A/group B were 1.51 ± 1.07/4.55 ± 3.66. Statistically significant correlations in both groups were recorded between the drug intake ED admission, respiratory rate, peripheral blood oxygen saturation and tissue perfusion index (p < 0.001). The average value of the PI measured in group A was significantly lower compared to that measured in patients in group B. Therefore, we concluded that the perfusion of peripheral organs and tissues was lower in the first 3 h after drug administration. (4) Conclusions: PI plays an important role in the early detection of impaired organ perfusion and in monitoring tissue hypoxia. A decreased PI value may be an early indication of decreased perfusion organ damage.

Pediatric Emergency Department Management in Acute Poisoning-A 2-Year Retrospective Study.

(1) Background: Poisonings in children are common reasons for addressing ED and can potentially have serious complications. Our research aims to review risk factors leading to poisoning in children. (2) Methods: A retrospective review of all pediatric poisoning cases addressing the Children's emergency department of St Mary Hospital over a two-year period was performed. (3) Results: We collected data on 797 children admitted for acute poisoning. The highest incidence identified was in the 12-18 and 1-3-year-old age groups. The distribution of voluntary versus unintentional poisonings was relatively balanced: 50.19% versus 47.43% (for some cases the type of intoxication remained unknown). Exposure to the toxic substance by ingestion was significant compared to the other routes, with an incidence of 87.1%. Acute poisoning happened at home in 70.4% of cases. A known risk factor before reaching the ED was present in 13.04%. (4) Conclusions: Our study showed a greater risk for acute poisoning in children between 1-3 years of age, and adolescents over 12 years. Identifying and documenting epidemiological aspects and other variables is important for establishing preventive measures and for therapeutic conduct. Adequate risk stratification and preventive measures involving closer supervision of minors or cognitive-behavioral programs can prevent voluntary intoxication.

Outcomes of death and prolonged renal insufficiency in ethylene glycol poisoned patients.

BACKGROUND: Despite the severity of ethylene glycol intoxication, there is a paucity of studies that analyze prognostic factors. This study aims to determine prognostic factors with impact on core outcomes like death and prolonged kidney injury (KI) in ethylene glycol poisoned patients. METHODS: We retrospectively assessed prevalence, clinical and biochemical features in one large data set from two regional hospitals from the North-East region of Romania, between January 2012 and October 2017. Secondly, we compared prognostic factors of cases treated with dialysis plus antidote (N = 28 patients) with cases who received antidote only and supportive therapy (N = 28 patients). RESULTS: Of the 56 cases included, 16 deaths (28.57%) were recorded. The symptomatology at admission was more severe among patients requiring hemodialysis: a lower mean value for initial pH, lower initial alkaline reserve (AR) and higher mean values for initial serum creatinine (Cr1). The data analysis (survivors/deceased) showed a correlation between pH, Glasgow Coma Score (GCS), and increased mortality. In addition, we found a correlation between initial mean values for pH, AR (mmol/L), Cr1 (mg/dL), and peak Cr24 (mg/dL) with outcomes of RI or death. CONCLUSIONS: Compared with survivors, patients who died or had prolonged kidney injury were more likely to exhibit clinical signs such as coma, seizures, and acidosis. Hemodialysis and antidote should be started early and continued until acidosis is corrected.