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Fluid and electrolyte overload in critically ill patients: An overview

World Journal of Critical Care Medicine 2015年第2期4卷 116-129页

作者： Bruno Adler Maccagnan Pinheiro Besen André Luiz Nunes Gobatto Lívia Maria Garcia Melro alexandre toledo maciel Marcelo Park Intensive Care Unit Department of Medical Emergencies Hospital das Clínicas University of Sao Paulo Medical School Imed Research Group Intensive Care Unit Hospital Sao Camilo Pompéia

Fluids are considered the cornerstone of therapy for many shock states, particularly states that are associated with relative or absolute hypovolemia. Fluids are also commonly used for many other purposes, such as renalprotection from endogenous and exogenous substances, for the safe dilution of medications and as "maintenance" fluids. However, a large amount of evidence from the last decade has shown that fluids can have deleterious effects on several organ functions, both from excessive amounts of fluids and from their non-physiological electrolyte composition. Additionally, fluid prescription is more common in patients with systemic inflammatory response syndrome whose kidneys may have impaired mechanisms of electrolyte and free water excretion. These processes have been studied as separate entities(hypernatremia, hyperchloremic acidosis and progressive fluid accumulation) leading to worse outcomes in many clinical scenarios, including but not limited to acute kidney injury, worsening respiratory function, higher mortality and higher hospital and intensive care unit lengthof-stays. In this review, we synthesize this evidence and describe this phenomenon as fluid and electrolyte overload with potentially deleterious effects. Finally, we propose a strategy to safely use fluids and thereafter wean patients from fluids, along with other caveats to be considered when dealing with fluids in the intensive care unit.

关键词： Fluid therapy Critically Ill Oliguria Waterelectrolyte balance Central venous pressure Resuscitation Acute kidney injury Diuretics Multiple organ dysfunction syndrome Systemic inflammatory response syndrome

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Suiting Dynamic Models of Fixed-Bed Catalytic Reactors for Computer-Based Applications

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Engineering（科研） 2011年第7期3卷 778-785页

作者： Eduardo Coselli Vasco de toledo Edvaldo Rodrigo Morais Delba Nisi Cosme Melo Adriano Pinto Mariano Joao F.C.A.Meyer Rubens maciel Filho Petrobras Paulínia Refinery(Replan)PaulíniaBrazil Laboratory of Optimization Design and Advanced ControlSchool of Chemical EngineeringUniversity of CampinasCampinasBrazil Institute of Mathematics Statisticsand Scientific ComputationUniversity of CampinasCampinasBrazil

This work investigated the applicability of heterogeneous and pseudo-homogeneous models to predict the dynamic behavior of a fixed-bed catalytic reactor. Some issues concerning the dynamic behavior of the system were discussed, such as the prediction of the inverse response phenomenon. The proposed models (Het- erogeneous I and II and Pseudo-homogeneous) were able to predict with qualitative similarity the main characteristics of the dynamic behavior of a fixed-bed catalytic reactor, including the inverse response. The computational time demanded for the solution of the heterogeneous models was 10 to 50% longer than in the case of the pseudo-homogeneous model, making the use of the former suitable for applications where computational time is not the major restriction (off-line applications). On the other hand, when on-line applications are required, the simplified model (Pseudo-homogeneous model) showed to be a good alternative because this model was able to predict (qualitatively) the dynamics of the reactor using a faster and easier numerical solution.

关键词： Dynamic Models Inverse Response Fixed-Bed Catalytic Reactors Simulation

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