Association of Knowledge and Health Habits with Physiological Hydration Status.

The association of hydration knowledge and health habits with hydration status and fluid intake is rarely examined. We sought to determine whether knowledge or physical health behaviors predict physiological hydration status and fluid intake. Ninety-six participants (59 female; 27 ± 10 year) completed the previously validated hydration survey. Participants then recorded total fluids consumed (TFC), collected urine, and tracked void frequency for 24 h. Hydration status was assessed via 24 h urine specific gravity (USG) and osmolality (Uosm). Health behaviors included self-reported physical activity, BMI, smoking, alcoholic drinking, and sleep status. TFC was significantly correlated with 24 h USG (r = -0.390; p < 0.001), Uosm (r = -0.486; p < 0.001), total urine volume (r = 0.675; p < 0.001), and void frequency (r = 0.518; p < 0.001). Hydration knowledge was not correlated with 24 h USG (r = 0.085; p = 0.420), Uosm (r = 0.087; p = 0.419), urine total volume (r = 0.019; p = 0.857), void frequency (r = 0.030; p = 0.771), or TFC (r = 0.027; p = 0.813). Hydration knowledge did not predict 24 h USG (LR+ = 1.10; LR- = 0.90), Uosm (LR+ = 0.81; LR- = 1.35), or TFC (LR+ = 1.00; LR- = 1.00). Health habits did not predict 24 h USG, Uosm, or TFC. In conclusion, self-reported 24 h diet and fluid log recording is comparable to hydration status verification via 24 h urine collection. Hydration knowledge and health habits are not related to, or predictive of, hydration status.

Optimizing Recovery in Elderly Patients: Anabolic Benefits of Glucose Supplementation during the Rehydration Period.

BACKGROUND: Since many acutely admitted older adults display signs of dehydration, treatment using balanced crystalloids is an important part of medical care. Additionally, many of these patients suffer from chronic malnutrition. We speculated that the early addition of glucose might ameliorate the hospital-related drop of caloric intake and modify their catabolic status. METHODS: We included patients 78 years and older, admitted acutely for non-traumatic illnesses. The patients were randomized into either receiving balanced crystalloid (PlasmaLyte; group P) or balanced crystalloid enriched with 100 g of glucose per liter (group G). The information about fluid balance and levels of minerals were collected longitudinally. RESULTS: In the G group, a significantly higher proportion of patients developed signs of refeeding syndrome, i.e., drops in phosphates, potassium and/or magnesium when compared to group P (83.3 vs. 16.7%, p < 0.01). The drop in phosphate levels was the most pronounced. The urinalysis showed no differences in the levels of these minerals in the urine, suggesting their uptake into the cells. There were no differences in the in-hospital mortality or in the 1-year mortality. CONCLUSION: The short-term administration of balanced crystalloids with glucose induced an anabolic shift of electrolytes in acutely admitted older adults.

Randomized Trial to Assess the Safety and Tolerability of Daily Intake of an Allulose Amino Acid-Based Hydration Beverage in Men and Women.

BACKGROUND: Maintaining adequate hydration is critical to optimal health, well-being, and performance. Those who are physically active in stressful environments, such as warm and/or humid scenarios, may be at particular risk for dehydration with ensuing loss of electrolytes, leading to sluggishness and impaired physical performance. METHODS: We evaluated an electrolyte and amino acid product containing L-alanine and L-glutamine, as well as select vitamins [B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B12 (cobalamin), and vitamin C (ascorbic acid)]. Subjects (n = 40; four groups, n = 10) were randomized to consume either a placebo packet or one, two, or three packets daily of the test product for 4 weeks with site visits at 0, 2, and 4 weeks. We tested safety and tolerability by analyzing hematological parameters (complete blood counts), metabolic parameters (hepatic, renal, acid-base balance), urinalysis end products, thyroid status [T3 (triiodothyronine), T4 (thyroxine), TSH (thyroid-stimulating hormone)], tolerability (via questionnaire), vital signs, and dietary intake. RESULTS: Statistical analyses displayed ten significant main effects (p < 0.05) with white blood cells, lymphocytes, neutrophils, urinary pH, thyroxine, urination frequency, calcium, calories, fat, and cholesterol. Interactions for time and group (p < 0.05) were observed for MCV, eGFR, potassium, overall tolerability, bloating, and cramping-demonstrating mild GA disturbances. Little to no change of physiological relevance was noted for any outcome variable, regardless of dosing level. CONCLUSIONS: Our results indicate the product was well-tolerated at all dosing levels and no significant adverse changes occurred in any of the test parameters compared to the placebo group, indicating relative safety of ingestion over a 4-week treatment period, at the volumes used, and outside the context of physical stress.

Trends and Missing Links in (De)Hydration Research: A Narrative Review.

Despite decades of literature on (de)hydration in healthy individuals, many unanswered questions remain. To outline research and policy priorities, it is fundamental to recognize the literature trends on (de)hydration and identify current research gaps, which herein we aimed to pinpoint. From a representative sample of 180 (de)hydration studies with 4350 individuals, we found that research is mainly limited to small-scale laboratory-based sample sizes, with high variability in demographics (sex, age, and level of competition); to non-ecological (highly simulated and controlled) conditions; and with a focus on recreationally active male adults (e.g., Tier 1, non-athletes). The laboratory-simulated environments are limiting factors underpinning the need to better translate scientific research into field studies. Although, consistently, dehydration is defined as the loss of 2% of body weight, the hydration status is estimated using a very heterogeneous range of parameters. Water is the most researched hydration fluid, followed by alcoholic beverages with added carbohydrates (CHO). The current research still overlooks beverages supplemented with proteins, amino acids (AA), and glycerol. Future research should invest more effort in "real-world" studies with larger and more heterogeneous cohorts, exploring the entire available spectrum of fluids while addressing hydration outcomes more harmoniously.

Beyond blood pressure, fluid and electrolyte homeostasis - Role of the renin angiotensin aldosterone system in the interplay between metabolic diseases and breast cancer.

The classical renin angiotensin aldosterone system (RAAS), as well as the recently described counter-regulatory or non-canonical RAAS have been well characterized for their role in cardiovascular homeostasis. Moreover, extensive research has been conducted over the past decades on both paracrine and the endocrine roles of local RAAS in various metabolic regulations and in chronic diseases. Clinical evidence from patients on RAAS blockers as well as pre-clinical studies using rodent models of genetic manipulations of RAAS genes documented that this system may play important roles in the interplay between metabolic diseases and cancer, namely breast cancer. Some of these studies suggest potential therapeutic applications and repurposing of RAAS inhibitors for these diseases. In this review, we discuss the mechanisms by which RAAS is involved in the pathogenesis of metabolic diseases such as obesity and type-2 diabetes as well as the role of this system in the initiation, expansion and/or progression of breast cancer, especially in the context of metabolic diseases.

Identifying novel clinical phenotypes of acute respiratory distress syndrome using trajectories of daily fluid balance: a secondary analysis of randomized controlled trials.

BACKGROUND: Previously identified phenotypes of acute respiratory distress syndrome (ARDS) could not reveal the dynamic change of phenotypes over time. We aimed to identify novel clinical phenotypes in ARDS using trajectories of fluid balance, to test whether phenotypes respond differently to different treatment, and to develop a simplified model for phenotype identification. METHODS: FACTT (conservative vs liberal fluid management) trial was classified as a development cohort, joint latent class mixed models (JLCMMs) were employed to identify trajectories of fluid balance. Heterogeneity of treatment effect (HTE) for fluid management strategy across phenotypes was investigated. We also constructed a parsimonious probabilistic model using baseline data to predict the fluid trajectories in the development cohort. The trajectory groups and the probabilistic model were externally validated in EDEN (initial trophic vs full enteral feeding) trial. RESULTS: Using JLCMM, we identified two trajectory groups in the development cohort: Class 1 (n = 758, 76.4% of the cohort) had an early positive fluid balance, but achieved negative fluid balance rapidly, and Class 2 (n = 234, 24.6% of the cohort) was characterized by persistent positive fluid balance. Compared to Class 1 patients, patients in Class 2 had significantly higher 60-day mortality (53.5% vs. 17.8%, p < 0.001), and fewer ventilator-free days (0 vs. 20, p < 0.001). A significant HTE between phenotypes and fluid management strategies was observed in the FACTT. An 8-variables model was derived for phenotype assignment. CONCLUSIONS: We identified and validated two novel clinical trajectories for ARDS patients, with both prognostic and predictive enrichment. The trajectories of ARDS can be identified with simple classifier models.

Personalized Hydration Strategy to Improve Fluid Balance and Intermittent Exercise Performance in the Heat.

Sweat rate and electrolyte losses have a large inter-individual variability. A personalized approach to hydration can overcome this issue to meet an individual's needs. This study aimed to investigate the effects of a personalized hydration strategy (PHS) on fluid balance and intermittent exercise performance. Twelve participants conducted 11 laboratory visits including a VO2max test and two 5-day trial arms under normothermic (NOR) or hyperthermic (HYP) environmental conditions. Each arm began with three days of familiarization exercise followed by two random exercise trials with either a PHS or a control (CON). Then, participants crossed over to the second arm for: NOR+PHS, NOR+CON, HYP+PHS, or HYP+CON. The PHS was prescribed according to the participants' fluid and sweat sodium losses. CON drank ad libitum of commercially-available electrolyte solution. Exercise trials consisted of two phases: (1) 45 min constant workload; (2) high-intensity intermittent exercise (HIIT) until exhaustion. Fluids were only provided in phase 1. PHS had a significantly greater fluid intake (HYP+PHS: 831.7 ± 166.4 g; NOR+PHS: 734.2 ± 144.9 g) compared to CON (HYP+CON: 369.8 ± 221.7 g; NOR+CON: 272.3 ± 143.0 g), regardless of environmental conditions (p < 0.001). HYP+CON produced the lowest sweat sodium concentration (56.2 ± 9.0 mmol/L) compared to other trials (p < 0.001). HYP+PHS had a slower elevated thirst perception and a longer HIIT (765 ± 452 s) compared to HYP+CON (548 ± 283 s, p = 0.04). Thus, PHS reinforces fluid intake and successfully optimizes hydration status, regardless of environmental conditions. PHS may be or is an important factor in preventing negative physiological consequences during high-intensity exercise in the heat.

Integrating water balance mechanisms into predictions of insect responses to climate change.

Efficient water balance is key to insect success. However, the hygric environment is changing with climate change; although there are compelling models of thermal vulnerability, water balance is often neglected in predictions. Insects survive desiccating conditions by reducing water loss, increasing their total amount of water (and replenishing it) and increasing their tolerance of dehydration. The physiology underlying these traits is reasonably well understood, as are the sources of variation and phenotypic plasticity. However, water balance and thermal tolerance intersect at high temperatures, such that mortality is sometimes determined by dehydration, rather than heat (especially during long exposures in dry conditions). Furthermore, water balance and thermal tolerance sometimes interact to determine survival. In this Commentary, we propose identifying a threshold where the cause of mortality shifts between dehydration and temperature, and that it should be possible to predict this threshold from trait measurements (and perhaps eventually a priori from physiological or -omic markers).

Cardiorenal Syndromes and Their Role in Water and Sodium Homeostasis.

Sodium is the main osmotically active ion in the extracellular fluid and its concentration goes hand in hand with fluid volume. Under physiological conditions, homeostasis of sodium and thus amount of fluid is regulated by neural and humoral interconnection of body tissues and organs. Both heart and kidneys are crucial in maintaining volume status. Proper kidney function is necessary to excrete regulated amount of water and solutes and adequate heart function is inevitable to sustain renal perfusion pressure, oxygen supply etc. As these organs are bidirectionally interconnected, injury of one leads to dysfunction of another. This condition is known as cardiorenal syndrome. It is divided into five subtypes regarding timeframe and pathophysiology of the onset. Hemodynamic effects include congestion, decreased cardiac output, but also production of natriuretic peptides. Renal congestion and hypoperfusion leads to kidney injury and maladaptive activation of renin-angiotensin-aldosterone system and sympathetic nervous system. In cardiorenal syndromes sodium and water excretion is impaired leading to volume overload and far-reaching negative consequences, including higher morbidity and mortality of these patients. Keywords: Cardiorenal syndrome, Renocardiac syndrome, Volume overload, Sodium retention.

Conceptual Approach to Body Fluids and Edema, Education Determines Clinical Outcomes in Heart Failure.

In this brief communication, we reemphasize the importance of critical thinking in clinical practice using the example of edema. The common practice of thinking and inquiry by practicing clinicians has beneficial implications for healthcare by improving outcomes and patient care while alleviating the burden of misconceptions in practice. We provide an in-depth and interactive investigation of physiological concepts as a foundation for understanding body fluid dynamics. Finally, we offer a new classification of symptoms of heart failure. DOI: 10.52547/ijkd.8171.

Effects of low protein diets on acid-base balance, electrolyte balance, intestinal structure, and amino acid transport in piglets.

Reducing the dietary crude protein (CP) could effectively reduce pressure on protein ingredient supplies. However, few data have been reported about the extent to which CP can be reduced and whether limiting the use of soybean meal leads to electrolyte imbalance. In this experiment, using the low protein (LP) diet [2% lower than NRC (2012)], seventy-two piglets (35 days old) were randomly divided into 2 groups with 6 replicates of 6 piglets each: CON group (CP = 18.5%) and LP group (CP = 16.5%), to investigate the effect of the LP diet on electrolyte balance, acid-base balance, intestinal structure and amino acid transport in piglets. The results revealed that the LP diet decreased the average daily gain and dietary CP digestibility, and damaged the villi structure of the small intestine. Compared with the CON diet, the potassium content decreased and the chlorine content increased in the LP diet, and similar trends were shown in piglet serum. The arterial pH, pCO2, HCO3 -, and base excess of piglets in the LP group were lower than those in the CON group, while pO2 was higher than those in the CON group. Interestingly, the LP diet significantly increased the lysine content in piglet serum and significantly decreased the levels of arginine, leucine, and glutamic acid. Furthermore, the LP diet significantly affected the expression of some amino acid transport vectors (B0AT1, EAAC1, and y+LAT1). In summary, these findings suggested that the LP diet leads to acid-base imbalance, amino acid transport disorder and amino acids imbalance in piglets, and the dietary electrolyte may be a key factor in the impact of the LP diet on piglet growth performance and intestinal health.

Evaluating fluid overload in critically ill children.

PURPOSE OF REVIEW: To review the evaluation and management of fluid overload in critically ill children. RECENT FINDINGS: Emerging evidence associates fluid overload, i.e. having a positive cumulative fluid balance, with adverse outcome in critically ill children. This is most likely the result of impaired organ function due to increased extravascular water content. The combination of a number of parameters, including physical, laboratory and radiographic markers, may aid the clinician in monitoring and quantifying fluid status, but all have important limitations, in particular to discriminate between intra- and extravascular water volume. Current guidelines advocate a restrictive fluid management, initiated early during the disease course, but are hampered by the lack of high quality evidence. SUMMARY: Recent advances in early evaluation of fluid status and (tailored) restrictive fluid management in critically ill children may decrease complications of fluid overload, potentially improving outcome. Further clinical trials are necessary to provide the clinician with solid recommendations.

Fluid balance versus weighing: A comparison in ICU patients: A single center observational study.

BACKGROUND: The fluid balance is a critical parameter in intensive care units (ICU) as it provides information about the patient's volume status. However, the accuracy of fluid balance measurements is often compromised due to the complexity and repetition of actions involved. Additionally, the fluid balance could be recalculated for insensible fluid loss. Weighing is an alternative method to estimate the patient's volume status. Built-in scales in beds make patient weighing easier and less time-consuming, allowing clinicians to intervene more quickly on existing treatments. AIM: This study compares fluid balance, and body weight changes over time in ICU patients. Furthermore, it seeks to determine the degree of congruence between the fluid balance corrected for insensible fluid loss and daily body weight in ICU patients. METHODS: A single-center observational study was conducted in an ICU of a university hospital. All consecutive patients admitted to a bed with an integrated weighing scale were eligible. Exclusion criteria were (1) body weight ≥254,4 kilograms; (2) oral nutrition; (3) a flush catheter or balance; (4) only a single weight measurement; (5) delta body weight change of ≥5kg in 12 hours. Weights and fluid balances were obtained every 12 hours. RESULTS: We obtained 2282 measurements (n = 187 patients). The correlation between weight and fluid balance was weak (r = 0.274). After adjusting the fluid balance for insensible fluid loss, the correlation remained weak (r = 0,268). Bland Altman analysis revealed a wide confidence interval for both the fluid balance and corrected fluid balance versus weight. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: This study shows a weak correlation between weight and fluid balance. Therefore, when monitoring the volume status in the ICU, fluid balance and weight should both be taken into account. This two-pronged approach is crucial because it provides more control over erroneous fluid balance or weighing measurements.

Examining the significance of arginine vasopressin release to elucidate the often multifactorial etiology of hypotonic hyponatremia: A novel criterion.

Clinical hyponatremia guidelines, protocols and flowcharts are a convenient means for clinicians to quickly establish an etiological diagnosis for hyponatremia, and facilitate its often complex analysis. Unfortunately, they often erroneously attribute multifactorial hyponatremia to a single cause, which is potentially dangerous. In this manuscript, a novel criterion is proposed to quickly determine the physiological relevance of non-osmotic arginine vasopressin (AVP) release, and to add nuance to hyponatremia analysis. While analyzing hypotonic hyponatremia, it is imperative to not only verify whether or not a certain degree of inappropriate AVP release is present, but also to ascertain whether it-in itself-could sufficiently explain the observed hyponatremia, as these two are not always synonymous. Using well-known concepts from renal physiology to combine the electrolyte-free water balance and solute-free water balance, a novel physiological criterion is derived mathematically to easily distinguish three common hyponatremia scenarios, and to further elucidate the underlying etiology. The derived criterion can hopefully facilitate the clinician's and physiologist's interpretation of plasma and urine parameters in a patient presenting with hyponatremia, and warn against the important clinical pitfall of attributing hyponatremia too readily to a single cause.

How a positive fluid balance develops in acute kidney injury: A binational, observational study.

PURPOSE: A positive fluid balance (FB) is associated with harm in intensive care unit (ICU) patients with acute kidney injury (AKI). We aimed to understand how a positive balance develops in such patients. METHODS: Multinational, retrospective cohort study of critically ill patients with AKI not requiring renal replacement therapy. RESULTS: AKI occurred at a median of two days after admission in 7894 (17.3%) patients. Cumulative FB became progressively positive, peaking on day three despite only 848 (10.7%) patients receiving fluid resuscitation in the ICU. In those three days, persistent crystalloid use (median:60.0 mL/h; IQR 28.9-89.2), nutritional intake (median:18.2 mL/h; IQR 0.0-45.9) and limited urine output (UO) (median:70.8 mL/h; IQR 49.0-96.7) contributed to a positive FB. Although UO increased each day, it failed to match input, with only 797 (10.1%) patients receiving diuretics in ICU. After adjustment, a positive FB four days after AKI diagnosis was associated with an increased risk of hospital mortality (OR 1.12;95% confidence intervals 1.05-1.19;p-value <0.001). CONCLUSION: Among ICU patients with AKI, cumulative FB increased after diagnosis and was associated with an increased risk of mortality. Continued crystalloid administration, increased nutritional intake, limited UO, and minimal use of diuretics all contributed to positive FB. KEY POINTS: Question How does a positive fluid balance develop in critically ill patients with acute kidney injury? Findings Cumulative FB increased after AKI diagnosis and was secondary to persistent crystalloid fluid administration, increasing nutritional fluid intake, and insufficient urine output. Despite the absence of resuscitation fluid and an increasing cumulative FB, there was persistently low diuretics use, ongoing crystalloid use, and a progressive escalation of nutritional fluid therapy. Meaning Current management results in fluid accumulation after diagnosis of AKI, as a result of ongoing crystalloid administration, increasing nutritional fluid, limited urine output and minimal diuretic use.

Inhibition of pannexin-1 does not restore electrolyte balance in precystic Pkd1 knockout mice.

Mutations in PKD1 and PKD2 cause autosomal dominant polycystic kidney disease (ADPKD), which is characterized by the formation of fluid-filled cysts in the kidney. In a subset of ADPKD patients, reduced blood calcium (Ca2+) and magnesium (Mg2+) concentrations are observed. As cystic fluid contains increased ATP concentrations and purinergic signaling reduces electrolyte reabsorption, we hypothesized that inhibiting ATP release could normalize blood Ca2+ and Mg2+ levels in ADPKD. Inducible kidney-specific Pkd1 knockout mice (iKsp-Pkd1-/-) exhibit hypocalcemia and hypomagnesemia in a precystic stage and show increased expression of the ATP-release channel pannexin-1. Therefore, we administered the pannexin-1 inhibitor brilliant blue-FCF (BB-FCF) every other day from Day 3 to 28 post-induction of Pkd1 gene inactivation. On Day 29, both serum Ca2+ and Mg2+ concentrations were reduced in iKsp-Pkd1-/- mice, while urinary Ca2+ and Mg2+ excretion was similar between the genotypes. However, serum and urinary levels of Ca2+ and Mg2+ were unaltered by BB-FCF treatment, regardless of genotype. BB-FCF did significantly decrease gene expression of the ion channels Trpm6 and Trpv5 in both control and iKsp-Pkd1-/- mice. Finally, no renoprotective effects of BB-FCF treatment were observed in iKsp-Pkd1-/- mice. Thus, administration of BB-FCF failed to normalize serum Ca2+ and Mg2+ levels.

Use of thoracic fluid content for prediction of fluid balance and postoperative pulmonary complications after major abdominal surgery: an observational study.

BACKGROUND AND OBJECTIVES: The harmful effects of excess fluids frequently manifest in the lungs. Thoracic fluid content (TFC) is a variable provided by the STARLINGTM bioreactance monitor, which represents the total volume of fluid in the chest. The objective is to analyse the association between the variation in TFC values (TFCd0%) at 24 h postoperatively, postoperative fluid balance, and postoperative pulmonary complications. MATERIAL AND METHODS: Prospective and analytical observational study. Patients scheduled for major abdominal surgery at a tertiary teaching hospital were included. They were monitored during the intervention and the first 24 postoperative hours with the monitor. STARLINGTM, measuring TFC and its variation in different stages of the perioperative period. Serial lung ultrasounds were performed and postoperative pulmonary complications were recorded. Logistic regression was performed to predict the occurrence of atelectasis and pulmonary congestion. The Pearson correlation coefficient was calculated to verify the association between TFC and fluid balance. RESULTS: 50 patients were analyzed. TFCd0% measured on the morning of the first postoperative day increased by a median of 27.1% [IQR: 20.3-37.5] and was correlated at r = 0.44 with the postoperative balance of 677 ml [IQR: 125.5-1,412]. Increased TFC was related to a higher risk of atelectasis (OR = 1.24) and pulmonary congestion (OR = 1.3). CONCLUSIONS: TFCd0% measured 24 h after surgery presents a moderate correlation with postoperative fluid balance. Its increase is a risk factor for the appearance of postoperative pulmonary complications.

Effect of dietary electrolyte balance and arginine to lysine ratio on hematological, antioxidant and immunological traits in dual-purpose breeding hens under cyclic heat stress condition.

A total of 245 hens and 35 cocks (32 weeks age) were assigned to seven treatment groups (five replicates with seven hens and one cock) to investigate the effect of dietary electrolyte balance (DEB) and arginine to lysine ratio (Arg/Lys) on birds' physiological and biochemical traits under cyclic heat stress (CHS) condition. Birds were housed in an environmentally controlled facility having four sectors. The first group (positive control, PC) was kept under thermoneutral conditions and fed diet with DEB of 180 mEq and Arg/Lys of 1.25, whereas the other six treatments were kept in the second sector under CHS and fed diet with DEB and Arg/Lys equal to: 180 mEq and 1.25 (negative control, NC); 250 mEq and 1.25; 320 mEq and 1.25; 180 mEq and 1.37; 250 mEq and 1.37; 320 mEq and 1.37, respectively. Hens on NC group had significantly decreased red blood cells (RBCs), white blood cells (WBCs) and its fractions. The groups fed different DEB and Arg/Lys in diet significantly enhanced the blood parameters and plasma lipid profile compared NC group. Hens under CHS fed on 250 and 320 DEB with 1.37 Arg/Lys recorded the lowest concentration of low-density lipoprotein (LDL) compared with the other groups. Triiodothyronine (T3) activity was not differed among groups, while T4 activity in layer exposed to CHS (NC group) recorded the highest activity compared to PC. From findings, it can be concluded that laying hens fed a diet having DEB 250 mEq with 1.37 Arg/Lys could be successfully applied to counteract the adverse effect of CHS and to improve blood hematological and biochemical traits, antioxidants, and immunity response.

[Clinical significance of negative fluid balance and infection management in the treatment of acute respiratory distress syndrome caused by severe novel coronavirus infection].

OBJECTIVE: To explore the clinical significance of negative fluid balance and infection management in the treatment of acute respiratory distress syndrome (ARDS) caused by severe novel coronavirus infection. METHODS: A retrospective survey was conducted. Patients with ARDS caused by severe novel coronavirus infection who were hospitalized in the department of critical care medicine of the Third Affiliated Hospital of Gansu University of Chinese Medicine and received non-invasive ventilator assisted ventilation were selected as the research objects. The fluid intake and output of all patients were accurately counted every day, and the fluid intake of the next day was adjusted according to the output of the previous day. According to the fluid negative balance, and whether the hospital infection management measures were complied with during the treatment and inspection of the patients, 45 patients with a negative fluid balance of more than 200 mL/d and strict management of nosocomial infection were taken as the observation group, and 48 patients with a negative fluid balance of less than 200 mL/d and no strict management of nosocomial infection were taken as the control group. The general data, weaning success rate, endotracheal intubation rate, mortality, as well as laboratory indicators such as white blood cell count (WBC), procalcitonin (PCT), C-reactive protein (CRP) after treatment were compared between the two groups. RESULTS: There were no significant differences in gender (male: 51.1% vs. 52.1%), age (years old: 66.31±15.92 vs. 67.50±13.59), acute physiology and chronic health evaluation II (APACHE II: 18.98±4.81 vs. 18.54±4.35) between the observation group and the control group (all P > 0.05), indicating that the baseline data were balanced and comparable. Compared with the control group, the weaning success rate of the observation group significantly increased [53.3% (24/45) vs. 31.2% (15/48), P = 0.031], endotracheal intubation rate significantly decreased [22.2% (10/45) vs. 43.8% (21/48), P = 0.028], mortality significantly reduced [20.0% (9/45) vs. 41.7% (20/48), P = 0.024], laboratory indicators WBC, PCT and CRP levels were significantly reduced [WBC (×109/L): 8.085±4.136 vs. 16.898±7.733, CRP (mg/L): 82.827±52.680 vs. 150.679±74.625, PCT (µg/L): 3.142±2.323 vs. 7.539±5.939, all P < 0.01]. CONCLUSIONS: Fluid negative balance and infection management have significant clinical significance in the treatment of severe novel coronavirus infection with ARDS.

Fluid Management in Acute Respiratory Failure.

Fluid management in acute respiratory failure is an area of uncertainty requiring a delicate balance of resuscitation and fluid removal to manage hypoperfusion and avoidance of hypoxemia. Overall, a restrictive fluid strategy (minimizing fluid administration) and careful attention to overall fluid balance may be beneficial after initial resuscitation and does not have major side effects. Further studies are needed to improve our understanding of patients who will benefit from a restrictive or liberal fluid management strategy.