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1.
Medicine (Baltimore) ; 99(40): e22641, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019489

RESUMO

RATIONALE: Rotavirus is routinely diagnosed by the detection of antigens or the viral genome. However, these tests have limitations, in that they do not detect all rotavirus strains. PATIENT CONCERNS: We present a case of a 27-month-old girl who was hospitalized for 4 days with severe gastroenteritis, including high fever, vomiting, diarrhea, mild dehydration, and periumbilical pain. Notably, the patient previously received the Rotarix vaccine. DIAGNOSES: The laboratory tests were negative for rotavirus, astrovirus, adenovirus, and norovirus as well as common diarrhea-causing bacteria. Human-bovine recombinant rotavirus was detected by MinION sequencing. INTERVENTIONS: To investigate the cause agents from the unexplained severe gastroenteritis infant, the stool sample was prepared by random amplification for Nanopore MinION sequencing. OUTCOMES: Treatment through the administration of ORS solution and galtase powder with probiotics was successful after the diagnosis of unusual rotavirus infection. LESSONS: This case report is the first detection of an unusual human-bovine recombinant rotavirus in an idiopathic gastroenteritis using Nanopore MinION sequencing.


Assuntos
Gastroenterite/virologia , Sequenciamento por Nanoporos/métodos , Infecções por Rotavirus/diagnóstico , Vacinas contra Rotavirus/efeitos adversos , Rotavirus/genética , Dor Abdominal , Doença Aguda , Pré-Escolar , Desidratação/etiologia , Diarreia/etiologia , Fezes/virologia , Feminino , Febre/etiologia , Hidratação/métodos , Gastroenterite/patologia , Gastroenterite/terapia , Humanos , Probióticos/uso terapêutico , Rotavirus/isolamento & purificação , Infecções por Rotavirus/complicações , Infecções por Rotavirus/virologia , Índice de Gravidade de Doença , Resultado do Tratamento , Vacinação/efeitos adversos , Vacinas Atenuadas/efeitos adversos , Vômito/etiologia
2.
Medicine (Baltimore) ; 99(40): e21987, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019391

RESUMO

Intravenous fluid prescription is an essential part of postoperative care and may play a causal role in postoperative complications. The objective of the present study was to evaluate the relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of pediatric patients.This analysis included a retrospective review of 172 patients who underwent gastroenterological surgery from January 2012 to September 2018 at an academic tertiary care hospital. Patients were evaluated based on the median amount of corrected crystalloids and subsequently dichotomized as low (<25.89 mL/kg h) versus high (>25.89 mL/kg h). The primary outcome measure was the postoperative length of hospital stay (pLOS). Secondary outcome measures included the postoperative time to restore gastroenterological functions and postoperative complications.Patients who received larger amounts of crystalloids were more likely to have a lower intraoperative level of hemoglobin (P = .78) and an intraoperative blood transfusion (P = .27). There were trends toward lower incidence rates of hyperchloremic acidosis (P = .375) and metabolic acidosis (P = .54) in the high crystalloid administration cohort. The incidence of postoperative complications increased as the amount of administered fluid decreased (P = .046). The total length of hospital stay was shorter in patients who received high volumes of crystalloid fluid (19.5 [15.75-32.25] days) than in patients who received low volumes (22 [16-29.5] days, P = .283).Significant and multifaceted variability in crystalloid administration was noted among pediatric patients undergoing major surgery. High fluid administration was associated with favorable postoperative outcomes; these findings could be applied to improve patient safety and facilitate better quality of care.


Assuntos
Soluções Cristaloides/administração & dosagem , Enterocolite Necrosante/terapia , Hidratação/métodos , Administração Intravenosa , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Laparotomia/efeitos adversos , Laparotomia/métodos , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
3.
PLoS One ; 15(10): e0239770, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052974

RESUMO

Microcirculatory disorders have been consistently linked to the pathophysiology of sepsis. One of the major organs affected is the kidneys, resulting in sepsis-associated acute kidney injury (SA-AKI) that correlates considerably with mortality. However, the potential role of clinical assessment of peripheral perfusion as a possible tool for SA-AKI management has not been established. To address this gap, the purpose of this study was to investigate the prevalence of peripheral hypoperfusion in SA-AKI, its association with mortality, and fluid balance. This observational cohort study enrolled consecutive septic patients in the Intensive Care Unit. After fluid resuscitation, peripheral perfusion was evaluated using the capillary filling time (CRT) and peripheral perfusion index (PI) techniques. The AKI was defined based on both serum creatinine and urine output criteria. One hundred and forty-one patients were included, 28 (19%) in the non-SA-AKI group, and 113 (81%) in the SA-AKI group. The study revealed higher peripheral hypoperfusion rates in the SA-AKI group using the CRT (OR 3.6; 95% CI 1.35-9.55; p < 0.05). However, this result lost significance after multivariate adjustment. Perfusion abnormalities in the SA-AKI group diagnosed by both CRT (RR 1.96; 95% CI 1.25-3.08) and PI (RR 1.98; 95% CI 1.37-2.86) methods were associated to higher rates of 28-day mortality (p < 0.01). The PI's temporal analysis showed a high predictive value for death over the first 72 h (p < 0.01). A weak correlation between PI values and the fluid balance was found over the first 24 h (r = - 0.20; p < 0.05). In conclusion, peripheral perfusion was not different intrinsically between patients with or without SA-AKI. The presence of peripheral hypoperfusion in the SA-AKI group has appeared to be a prognostic marker for mortality. This evaluation maintained its predictive value over the first 72 hours. The fluid balance possibly negatively influences peripheral perfusion in the SA-AKI.


Assuntos
Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/fisiopatologia , Microcirculação/fisiologia , Sepse/fisiopatologia , Lesão Renal Aguda/sangue , Estudos de Coortes , Creatinina/sangue , Feminino , Hidratação/métodos , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Perfusão/métodos , Prognóstico , Sepse/sangue , Sepse/mortalidade , Equilíbrio Hidroeletrolítico/fisiologia
4.
BMC Infect Dis ; 20(1): 696, 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32962669

RESUMO

BACKGROUND: Dengue fever usually presents as a self-limiting acute febrile illness with worsening thrombocytopenia, with a small minority of patients developing hemorrhagic or life-threatening complications. Organ specific manifestations like myocarditis, acalculous cholecystitis, encephalitis has been described but are uncommon presentations. Even more rarely, such manifestations are the presenting complaint of Dengue fever. In this case report, we highlight a case of Dengue fever where unrelated neuropathies were the presenting complaint. CASE PRESENTATION: An elderly man presents with 1 day of diplopia and left foot drop, associated with 2 days history of fever. A decreasing white cell count (WBC) and platelet on the 2nd day of admission prompted Dengue virus to be tested and a positive NS-1 antigen was detected, confirming the diagnosis of Dengue fever. He was treated with supportive treatment with a short duration of intravenous fluids recovered uneventfully and was discharged 6 days after admission with almost full resolution of diplopia and partial resolution of left foot drop. Left foot drop recovered completely 2 weeks later. CONCLUSION: Neurological manifestations can be the presenting symptoms in Dengue fever, a diagnosis which should be borne in mind when such symptoms present in patients from endemic areas or in returning travellers from these areas.


Assuntos
Dengue/complicações , Mononeuropatias/etiologia , Administração Intravenosa , Idoso , Dengue/tratamento farmacológico , Dengue/etiologia , Diplopia/etiologia , Febre/complicações , Hidratação/métodos , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/virologia , Humanos , Masculino , Mononeuropatias/tratamento farmacológico , Mononeuropatias/virologia , Fatores de Tempo , Viagem
6.
Br J Anaesth ; 125(5): 672-679, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32863016

RESUMO

BACKGROUND: From a physiological viewpoint, changes in end-tidal carbon dioxide (EtCO2) could be a simple, noninvasive, and inexpensive way to monitor changes in cardiac index. This study aimed to assess the utility of changes in EtCO2 as a marker of fluid responsiveness after volume expansion in the operating room. METHODS: A prospective observational study was conducted in a tertiary university teaching hospital, from August 2018 to February 2019. A total of 109 non-consecutive, mechanically ventilated adults undergoing neurosurgery in the supine position with cardiac output monitors were included. Patients with major respiratory disease, arrhythmia, or heart failure were excluded. Volume expansion with 250 ml of saline 0.9% was performed over 10 min to maximise cardiac output during surgery, according to current guidelines. A positive fluid challenge was defined as an increase in stroke volume index of more than 10% from baseline. Changes in stroke volume index (monitored using pulse contour analysis) and EtCO2 were recorded before and after infusion. RESULTS: A total of 242 fluid challenges in 114 patients were performed, of which 26.9% were positive. Changes in EtCO2 > 1.1% induced by infusions had utility for identifying fluid responsiveness, with a sensitivity of 62.9% (95% confidence interval [CI], 62.5-63.3%) and a specificity of 77.8% (95% CI, 77.6-78.1%). The area under the receiver operating characteristic curve for changes in EtCO2 after volume expansion was 0.683 (95% CI, 0.680-0.686). CONCLUSIONS: Changes in EtCO2 induced by rapid infusion of 250 ml saline 0.9% lacked accuracy for identifying fluid responsiveness in mechanically ventilated patients in the operating room. CLINICAL TRIAL REGISTRATION: NCT03635307.


Assuntos
Volume Sanguíneo , Dióxido de Carbono/sangue , Hidratação/métodos , Idoso , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Salas Cirúrgicas , Valor Preditivo dos Testes , Estudos Prospectivos , Respiração Artificial , Volume Sistólico , Decúbito Dorsal
7.
Br J Anaesth ; 125(5): 693-703, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32892982

RESUMO

BACKGROUND: Buffered crystalloid solutions are increasingly recommended as first-line intravenous resuscitation fluids. However, guidelines do not distinguish between the different types of buffered solutions. The aim of this scoping review was to assess the evidence on the use of lactate- vs acetate-buffered crystalloid solutions and their potential benefits and harms. METHODS: We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We searched PubMed, Embase, Epistemonikos, and the Cochrane Library for studies assessing the effect of lactate- vs acetate-buffered crystalloid solutions on any outcome in adult hospitalised patients. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: We included a total of 29 studies, 25 of which were clinical trials and four were observational studies. Most studies were conducted in surgical settings and indications for use were poorly described. The most commonly administered solutions were Ringer's lactate vs Ringer's acetate or Plasma-Lyte™. Outcomes included acid/base and electrolyte status; haemodynamic variables; and markers of renal and liver function, metabolism, and coagulation. Only a few studies reported patient-centred outcomes. Overall, the data provided no firm evidence for benefit or harm of either solution, and the quantity and quality of evidence were low. CONCLUSIONS: The quantity and quality of evidence on the use of different buffered crystalloid intravenous solutions were low, data were derived primarily from surgical settings, and patient-important outcomes were rarely reported; thus, the balance between benefits and harms between these solutions is largely unknown.


Assuntos
Tampões (Química) , Soluções Cristaloides/uso terapêutico , Hidratação/métodos , Soluções Isotônicas/uso terapêutico , Substitutos do Plasma/uso terapêutico , Lactato de Ringer/uso terapêutico , Soluções Cristaloides/química , Humanos , Infusões Intravenosas , Soluções Isotônicas/química , Substitutos do Plasma/química , Lactato de Ringer/química
8.
Medicine (Baltimore) ; 99(38): e22311, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957394

RESUMO

Diabetes mellitus results in an attenuated inflammatory response, reduces pulmonary microvascular permeability, and may decrease the risk of developing acute respiratory distress syndrome (ARDS). Studies have shown that patients with ARDS are better managed by a conservative as compared to liberal fluid management strategy. However, it is not known if the same fluid management principles hold true for patients with comorbid diabetes mellitus and ARDS.As diabetes mellitus results in reduced pulmonary microvascular permeability and an attenuated inflammatory response, we hypothesize that in the setting of ARDS, diabetic patients will be able to tolerate a positive fluid balance better than patients without diabetes.The Fluid and Catheter Treatment Trial (FACTT) randomized patients with ARDS to conservative versus liberal fluid management strategies. In a secondary analysis of this trial, we calculated the interaction of diabetic status and differing fluid strategies on outcomes. Propensity score subclassification matching was used to control for the differing baseline characteristics between patients with and without diabetes.Nine hundred fifty-six patients were analyzed. In a propensity score matched analysis, the difference in the effect of a conservative as compared to liberal fluid management strategy on ventilator free days was 2.23 days (95% CI: -0.97 to 5.43 days) in diabetic patients, and 2.37 days (95% CI: -0.21 to 4.95 days) in non-diabetic patients. The difference in the effect of a conservative as compared to liberal fluid management on 60 day mortality was 2% (95% CI: -11.8% to 15.8%) in diabetic patients, and -7.9% (95% CI: -21.7% to 5.9%) in non-diabetic patients.When comparing a conservative fluid management strategy to a liberal fluid management strategy, diabetic patients with ARDS did not have a statistically significant difference in outcomes than non-diabetic patients.


Assuntos
Diabetes Mellitus/terapia , Hidratação/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Adulto , Idoso , Cateteres , Tratamento Conservador , Diabetes Mellitus/congênito , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Síndrome do Desconforto Respiratório do Adulto/complicações
9.
A A Pract ; 14(9): e01295, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32909725

RESUMO

We report for the first time therapy-resistant hypernatremia (plasma sodium concentration ≥150 mmol per liter) developing in 6 of 12 critically ill coronavirus disease 2019 (COVID-19) patients age 57-84 years requiring mechanical ventilation. There was no correlation between plasma sodium concentrations and sodium input. Plasma concentrations of chloride were elevated, those of potassium decreased. These findings are consistent with abnormally increased renal sodium reabsorption, possibly caused by increased angiotensin II activity secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced downregulation of angiotensin-converting enzyme 2 (ACE2) receptors. As hypernatremia was associated with increased length of intensive care unit stay, special attention should be paid to the electrolyte status of COVID-19 patients.


Assuntos
Infecções por Coronavirus/complicações , Hidratação/métodos , Hipernatremia/complicações , Natriuréticos/uso terapêutico , Pneumonia Viral/complicações , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Casos e Controles , Cloretos/sangue , Estudos de Coortes , Infecções por Coronavirus/sangue , Feminino , Hidratação/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Hipernatremia/sangue , Hipernatremia/epidemiologia , Hipernatremia/terapia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Diálise Renal , Respiração Artificial , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos
10.
Am Surg ; 86(9): 1169-1174, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862663

RESUMO

BACKGROUND: Dehydration drives a significant proportion of readmissions following bariatric surgery. Routinely performed body composition testing and total body water (TBW) calculations may present a novel method for diagnosing dehydration for outpatient intervention. We sought to determine if a change in TBW from preoperative baseline could help identify bariatric patients requiring outpatient intravenous fluid (IVF) administration for dehydration. METHODS: The VUMC Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was retroactively queried for all patients undergoing bariatric surgery at an accredited bariatric surgery center from January 1, 2017 to May 31, 2018. Body composition test results presurgery and postsurgery were extracted from the electronic health record. Change in TBW was compared between patients requiring outpatient IVF and those who did not use multivariable logistic regression. RESULTS: 583 patients underwent surgery over the study period (388 laparoscopic Roux-en-Y gastric bypass, 195 sleeve). 62 (10.6%) required outpatient fluid administration for dehydration. After multivariable analysis, patients with an increased hospital length of stay at index operation were more likely to require outpatient IVF (odds ratio [OR] 1.65, 95% CI 1.22-2.2). Preexisting diabetes diagnosis was protective (OR 0.35, 95% CI 0.16-0.74). Neither 1-week nor 1-month change in TBW from preoperative baseline was significantly different between patients receiving outpatient IVF and those who did not. CONCLUSION: Increased hospital length of stay predicts patients at risk of postoperative dehydration requiring IVF administration. Body composition testing and TBW were not useful in distinguishing between populations. Further research is needed to examine the efficacy of outpatient IVF in preventing hospital readmissions for dehydration.


Assuntos
Cirurgia Bariátrica/métodos , Água Corporal/fisiologia , Hidratação/métodos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Pacientes Ambulatoriais , Complicações Pós-Operatórias/terapia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/metabolismo , Complicações Pós-Operatórias/metabolismo , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos
11.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32788268

RESUMO

BACKGROUND: Studies have increasingly challenged the traditional management of acute pancreatitis (AP) with bowel rest. However, these studies used a low-fat diet or transgastric feeding and only included adults. Aiming to generate higher-quality prospective pediatric data, we compared the traditional approach of fasting and intravenous fluids and early enteral feeding with standard diet or formula. METHODS: Randomized controlled trial of children (2-18 years) with mild-moderate AP. Patients were randomly assigned 1:1 to initial fasting and intravenous fluids or an immediate, unrestricted diet. Pain scores, blood measures, and cross-sectional imaging were recorded throughout admission and follow-up. The primary outcome was time to discharge, and secondary outcomes were clinical and biochemical resolution and local and systemic complication rates. RESULTS: Of 33 patients (17 [52%] boys, mean age of 11.5 [±4.8] years), 18 (55%) were randomly assigned to early feeding and 15 (45%) were randomly assigned to initial fasting. We recorded the median (interquartile range [IQR]) time to discharge (2.6 [IQR 2.0 to 4.0] vs 2.9 [IQR 1.8 to 5.6]; P = .95), reduction in serum lipase levels by day 2 (58% [IQR 2% to 85%] vs 48% [IQR 3% to 71%]; P = .65), and readmission rates (1 of 18 [6%] vs 2 of 15 [13%]; P = .22) between the early feeding and fasting cohorts, respectively. Immediate or delayed complication rates did not differ. Patients randomly assigned to early feeding had weight gain of 1.3 kg (IQR 0.29 to 3.6) at follow-up, compared with weight loss of 0.8 kg (IQR -2.1 to 0.7) in fasted patients (P = .028). CONCLUSIONS: This is the first randomized controlled trial in pediatric AP. There was no difference between early commencement of a standard oral diet and initial fast in any of the major outcome measures.


Assuntos
Dieta/normas , Nutrição Enteral , Jejum , Hidratação/métodos , Fórmulas Infantis , Pancreatite/terapia , Doença Aguda , Adolescente , Amilases/sangue , Criança , Pré-Escolar , Feminino , Humanos , Lipase/sangue , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pancreatite/sangue , Readmissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , Ganho de Peso
12.
PLoS One ; 15(8): e0237503, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810154

RESUMO

BACKGROUND: Intraoperative restrictive fluid management strategies might improve postoperative outcomes in liver transplantation. Effects of vasopressors within any hemodynamic management strategy are unclear. METHODS: We conducted an observational cohort study on adult liver transplant recipients between July 2008 and December 2017. We measured the effect of vasopressors infused at admission in the intensive care unit (ICU) and total intraoperative fluid balance. Our primary outcome was 48-hour acute kidney injury (AKI) and our secondary outcomes were 7-day AKI, need for postoperative renal replacement therapy (RRT), time to extubation in the ICU, time to ICU discharge and survival up to 1 year. We fitted models adjusted for confounders using generalized estimating equations or survival models using robust standard errors. We reported results with 95% confidence intervals. RESULTS: We included 532 patients. Vasopressors use was not associated with 48-hour or 7-day AKI but modified the effects of fluid balance on RRT and mortality. A higher fluid balance was associated with a higher need for RRT (OR = 1.52 [1.15, 2.01], p<0.001 for interaction) and lower survival (HR = 1.71 [1.26, 2.34], p<0.01 for interaction) only among patients without vasopressors. In patients with vasopressors, higher doses of vasopressors were associated with a higher mortality (HR = 1.29 [1.13, 1.49] per 10 µg/min of norepinephrine). CONCLUSION: The presence of any vasopressor at the end of surgery was not associated with AKI or RRT. The use of vasopressors might modify the harmful association between fluid balance and other postoperative outcomes. The liberal use of vasopressors to implement a restrictive fluid management strategy deserves further investigation.


Assuntos
Lesão Renal Aguda , Hemodinâmica/fisiologia , Cuidados Intraoperatórios/métodos , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/prevenção & controle , Adulto , Idoso , Estudos de Coortes , Feminino , Hidratação/métodos , Humanos , Transplante de Fígado/métodos , Transplante de Fígado/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Quebeque/epidemiologia , Terapia de Substituição Renal/estatística & dados numéricos , Fatores de Risco , Resultado do Tratamento , Equilíbrio Hidroeletrolítico/fisiologia
13.
Niger J Clin Pract ; 23(8): 1044-1047, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788479

RESUMO

Introduction: Delivery of accurate volumes of fluid in surgical neonates and children is crucial for the good outcome of treatment. But how accurate are the calibrations on the fluid delivery devices? Aims: This study seeks to verify the accuracy of these devices in common use in our practice. Materials and Methods: This is a cross-sectional experimental study carried out in our center; a tertiary health facility in Southern Nigeria in May 2019. Fluid delivery devices (FDDs) used in the course of treatment of our pediatric patients were randomly included in the study. The number of drops per ml of each device was obtained by counting while the fluid dropped until a 1 ml volume was delivered. The data was then collated and analyzed. Results: A total of 215 FDDs were included in this study. They comprised infusion giving set, Soluset (Burette) giving set, and blood giving set. The rate of delivery was 20 drops/ml (infusion giving sets), 60 drops/min (Burette/Soluset), and 15 drops/ml (Blood giving set). They were all in keeping with the labeled/assumed calibration in each of the types of FDDs P < 0.05. Therefore, the mean, median, and mode were the same. Conclusion: This study has demonstrated that the FDDs used our center are accurately calibrated and safe as they deliver volumes of fluid as labeled. The findings in this study reassure us of the dependability and accuracy of delivery of the FDDs we use in children in our center.


Assuntos
Segurança de Equipamentos/normas , Hidratação/instrumentação , Bombas de Infusão/normas , Administração Oral , Criança , Estudos Transversais , Feminino , Hidratação/métodos , Humanos , Recém-Nascido , Nigéria
14.
PLoS One ; 15(8): e0237572, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833979

RESUMO

OBJECTIVE: To synthesize the current evidence for subcutaneous hydration and medication infusions from systematic reviews and to assess their methodological quality. INTRODUCTION: Peripheral intravascular cannula/catheter insertion is a common invasive procedure for administering fluids and medications. Venous depletion is a growing concern for several patient populations. Subcutaneous access for the administration of isotonic solutions and medications is an alternative; however, vascular access assessment and planning guidelines rarely consider this route. METHODS: Systematic review of systematic reviews (PROSPERO CRD42018046504). We searched 6 databases published in English language from 1990 to June 2020, identifying subcutaneous infusions an alternate route for fluids or medication. Methodological quality was evaluated using AMSTAR 2 criteria and data for mechanisms of infusion and outcomes related to effectiveness, safety, efficiency and acceptability extracted. The Johanna Briggs Institute's grades of recommendation informed the strength of recommendation. RESULTS: The search yielded 1042 potential systematic reviews; 922 were excluded through abstract and duplicate screen. Of the remaining articles, 94 were excluded, and 26 were included. Overall, evidence is strong for recommending subcutaneous hydration infusions for older adults, weak for pediatric patients and inconclusive for palliative patients. There is strong evidence for 10 medications; weak evidence supporting 28 medications; however, there are eight medications with inconclusive evidence to make a recommendation and four medications not appropriate for subcutaneous delivery. CONCLUSION: Subcutaneous access should be considered alongside intravenous therapy for hydration in older adults, and several medications. There are additional benefits in terms of ease of use and cost-effectiveness of this mode. Inclusion of subcutaneous access in clinical guidelines may promote uptake of this route to help preserve vessel health of vulnerable patients. Further high-quality research is needed to inform subcutaneous infusion therapy in a variety of populations (including pediatrics and palliative care) and medications and clarifying the mechanism of delivery.


Assuntos
Desidratação/terapia , Hidratação/métodos , Hipodermóclise/métodos , Humanos , Infusões Subcutâneas
15.
Br J Anaesth ; 125(2): 122-132, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32711724

RESUMO

BACKGROUND: Despite several clinical trials on haemodynamic therapy, the optimal intraoperative haemodynamic management for high-risk patients undergoing major abdominal surgery remains unclear. We tested the hypothesis that personalised haemodynamic management targeting each individual's baseline cardiac index at rest reduces postoperative morbidity. METHODS: In this single-centre trial, 188 high-risk patients undergoing major abdominal surgery were randomised to either routine management or personalised haemodynamic management requiring clinicians to maintain personal baseline cardiac index (determined at rest preoperatively) using an algorithm that guided intraoperative i.v. fluid and/or dobutamine administration. The primary outcome was a composite of major complications (European Perioperative Clinical Outcome definitions) or death within 30 days of surgery. Secondary outcomes included postoperative morbidity (assessed by a postoperative morbidity survey), hospital length of stay, mortality within 90 days of surgery, and neurocognitive function assessed after postoperative Day 3. RESULTS: The primary outcome occurred in 29.8% (28/94) of patients in the personalised management group, compared with 55.3% (52/94) of patients in the routine management group (relative risk: 0.54, 95% confidence interval [CI]: 0.38 to 0.77; absolute risk reduction: -25.5%, 95% CI: -39.2% to -11.9%; P<0.001). One patient assigned to the personalised management group, compared with five assigned to the routine management group, died within 30 days after surgery (P=0.097). There were no clinically relevant differences between the two groups for secondary outcomes. CONCLUSIONS: In high-risk patients undergoing major abdominal surgery, personalised haemodynamic management reduces a composite outcome of major postoperative complications or death within 30 days after surgery compared with routine care. CLINICAL TRIAL REGISTRATION: NCT02834377.


Assuntos
Abdome/cirurgia , Débito Cardíaco/fisiologia , Hidratação/métodos , Hemodinâmica/fisiologia , Cuidados Intraoperatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Idoso , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Risco
16.
Yakugaku Zasshi ; 140(7): 929-936, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32612058

RESUMO

Cisplatin therapy induces kidney injury as a side effect. Thus, replacement fluid must be administered to prevent kidney injury. In our hospital, we use a Gemcitabine and Cisplatin combination chemotherapy (GC) at a total volume of approximately 500 mL for biliary tract cancer. We investigated the safety of GC with a small amount of replacement fluid. As a result, no serious adverse events and renal injury occurred that required discontinuation of treatment. The median overall survival time was 260 d (95% confidence interval, 154-367 d). This study suggests that GC with a small amount of replacement fluid could be performed tolerability. But we need to be careful about choosing patients such as patients who can drink 1 L orally and patients who can be treated as outpatients.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/prevenção & controle , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Sistema Biliar/tratamento farmacológico , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Desoxicitidina/análogos & derivados , Hidratação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Desoxicitidina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Z Gerontol Geriatr ; 53(5): 463-472, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32691149

RESUMO

The aim of this continuing medical education (CME) article (part II) is to describe the particular challenge of the treatment of hyponatremia, which occurs in older patients. This part II follows on from part I concerning the diagnosis in the previous volume. A staged approach is necessary. The best treatment is always when the underlying cause can be eliminated. Hyponatremia in older patients is mainly induced by the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. The authors use a concept for the first, second and third line strategy: (1) changing or discontinuation of drugs, (2) fluid restriction and (3) tolvaptan medication. The algorithm for treatment should be simple. It also contains recommendations for the correction rate. Caution is also needed in order to avoid the occurrence of an osmotic demyelination syndrome (ODS).


Assuntos
Antagonistas dos Receptores de Hormônios Antidiuréticos/uso terapêutico , Hidratação/métodos , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/complicações , Solução Salina Hipertônica/uso terapêutico , Tolvaptan/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Terapia Combinada , Humanos , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/diagnóstico , Infusões Intravenosas , Resultado do Tratamento
18.
Am J Obstet Gynecol ; 223(4): 475-485, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32717257

RESUMO

This is the first collaborative Enhanced Recovery After Surgery Society guideline for optimal perioperative care for vulvar and vaginal surgeries. An Embase and PubMed database search of publications was performed. Studies on each topic within the Enhanced Recovery After Surgery vulvar and vaginal outline were selected, with emphasis on meta-analyses, randomized controlled trials, and prospective cohort studies. All studies were reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. All recommendations on the Enhanced Recovery After Surgery topics are based on the best available evidence. The level of evidence for each item is presented.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Procedimentos Cirúrgicos em Ginecologia/métodos , Vagina/cirurgia , Vulva/cirurgia , Antibioticoprofilaxia/métodos , Bandagens , Feminino , Hidratação/métodos , Humanos , Dor Pós-Operatória/tratamento farmacológico , Educação de Pacientes como Assunto/métodos , Assistência Perioperatória , Tromboembolia/prevenção & controle , Cateterismo Urinário/métodos
19.
Rev Assoc Med Bras (1992) ; 66(4): 521-527, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32578790

RESUMO

Severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2 infection) is a new challenge for all countries, and children are predisposed to acquire this disease. Some studies have demonstrated more severe diseases in adults, but critically ill pediatric patients have been described in all ages. Pulmonary involvement is the major feature, and ventilatory support is common in critical cases. Nevertheless, other very important therapeutic approaches must be considered. In this article, we reviewed extensively all recent medical literature to point out the main clinical attitudes to support these pediatric patients during their period in respiratory support. Radiologic findings, fluid therapy, hemodynamic support, use of inotropic/vasopressors, nutritional therapy, antiviral therapy, corticosteroids, antithrombotic therapy, and immunoglobulins are analyzed to guide all professionals during hospitalization. We emphasize the importance of a multi-professional approach for adequate recovery.


Assuntos
Infecções por Coronavirus/terapia , Medicina Geral/métodos , Pneumonia Viral/terapia , Respiração Artificial/métodos , Adolescente , Betacoronavirus , Criança , Estado Terminal , Hidratação/métodos , Monitorização Hemodinâmica/métodos , Humanos , Terapia Nutricional/métodos , Pandemias , Modalidades de Fisioterapia
20.
PLoS One ; 15(6): e0234343, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32589637

RESUMO

BACKGROUND: Severe acute malnutrition (SAM) affects about 13 million under-five children (U5), with an estimated one million dying every year. In this study we aimed at determining the in hospital mortality and its associated factors among U5s admitted with SAM. METHODS: This was a prospective cohort study of children 6 months to 5 years with SAM admitted at Mbarara Regional Referral Hospital (MRRH) between June and August 2015. Care-takers were interviewed to collect socio-demographic and clinical information. Children under-went physical examination and had blood drawn for HIV, serum glucose, malaria, full blood count, culture and serum electrolytes investigation. Children were managed according to WHO treatment guidelines for SAM. All participants were followed up for a maximum period of 30 days. The proportion of U5 deaths within the first 48 hours and during the entire admission period was calculated. Using Poisson regression analysis, predictors of in-hospital mortality were analyzed with STATA/IC 11.0. RESULTS: We enrolled 122 children, median age of 15 months [IQR:11-24], 58.2% males, 90% immunized, 81% ill for more than 2 weeks before admission, 71% from lower health facilities and majority with unknown HIV status(76%). Overall, 13 (10.7%) children died in hospital. Seven (5.7%) died within the first 48 hours. Intravenous (IV) fluid administration significantly predicted in-hospital mortality (adjusted IRR: 7.2, 95%CI: 2.14-24.08, p = 0.001). CONCLUSION: The in-hospital mortality in U5s with SAM was lower than that previously reported in central Uganda. Intravenous fluid administration significantly predicted overall in-hospital mortality. While Administration of intravenous fluids is still the main stay of managing severely malnourished children with shock, more research needs to be conducted in order to review the parameters presently used to assess children for shock with a view of diagnosing and managing shock in these children when it is still early. Adequate guidance on use of IV fluids in management of severely malnourished children should be prioritized during continuous medical education for healthcare workers and in the treatment guidelines.


Assuntos
Transtornos da Nutrição Infantil/mortalidade , Previsões/métodos , Desnutrição Aguda Grave/mortalidade , Pré-Escolar , Estudos de Coortes , Feminino , Hidratação/métodos , Mortalidade Hospitalar , Hospitalização , Humanos , Lactente , Infusões Intravenosas , Masculino , Prognóstico , Estudos Prospectivos , Uganda/epidemiologia
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