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Role of fluid management on Renal Failure in Hospitalized COVID-19 Patients

Open Journal of Nephrology 2021年第2期11卷 230-241页

作者： Angelie Santos Hillary Grainer Joseph Scarano Majed Samarneh Department of Internal Medicine St. John’s Riverside Hospital New York USA

Introduction: The reported incidence of AKI with COVID-19 varies from 0.5% to 22%. Several mechanisms were postulated as a cause of AKI in patients infected with COVID-19. The appropriate management of AKI in patients with COVID-19 remains unclear at this time. One point of absolute importance, is the consideration of volume status. Given the paucity of knowledge with regards to the role of different strategies for fluid management during an episode of AKI in patients with COVID-19, this retrospective study aims to compare renal outcome and overall prognosis in patients who received conservative versus liberal fluid management. Methods: This is a single-center retrospective observational cohort study at a community hospital in Westchester County, NY. All adult patients who tested positive for the COVID-19 infection by PCR testing of a nasopharyngeal swab and were hospitalized from March 22, 2020 to May 25, 2020 are eligible. Among those identified with AKI, patients were divided into two groups: conservative fluid administration versus liberal fluid administration. Results: Of the 136 patients, 84 (61.76%) were admitted to the ICU, with 60% of patients under the conservative fluid strategy and 40% receiving liberal fluid management. On the other hand, 52 (38.23%) patients were admitted on the medical floors, with more patients (67.31%) receiving liberal fluid management. Discussion: In our cohort of 136 patients with COVID-19 respiratory illness and AKI, there was a significant difference in renal outcome, in terms of improvement of renal function in patients receiving liberal fluid management (55.07%) versus conservative fluid management (16.41%, p ≤ 0.001), with more patients in the liberal group having lower peak creatinine before levels improved. This, as well, was associated with improvement in oxygenation, characterized by improvement in respiratory status, facilitating weaning of oxygen suppl

关键词： Acute Kidney Injury COVID-19 fluid management

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Advances in acute and chronic pancreatitis

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World Journal of Gastroenterology 2023年第7期29卷 1194-1201页

作者： Williamson B Strum Clement Richard Boland Department of Gastroenterology Scripps ClinicLa JollaCA 92037United States Department of Medicine University of California San DiegoLa JollaCA 92037United States

Acute pancreatitis(AP)and chronic pancreatitis are the third leading gastrointestinal causes for admissions and readmissions to hospitals in the United *** review of articles published between 2019-2022(December)from international sources identified four categories of crucial new findings:The report includes(1)New genetic pathogenic mutations(TRPV6);expected genetic outcomes in a Northern European population;(2)a new serum diagnostic marker for AP-fatty acid ethyl esters-distinguishing acute pancreatitis associated with alcohol;explanations of the impact of monocytes/macrophages on the inflammatory process that defines their future in diagnosis,staging,and treatment;(3)innovations in timing of per os low-fat,solid food intake immediately on admission;resolution of concepts of aggressive parenteral fluid intake;dramatic shifts to nonoperative from operative treatment of infected pancreatic *** modification reduced interventions,complications,and lengths-of-stay;and(4)authoritarian recommendations for medical treatment of chronic *** advances offer opportunities to initiate newly proven treatments to enhance outcomes,alter the natural history,and envision the future of two diseases that have no known cure.

关键词： Genetics New diagnostics Macrophage regulation New approaches to early feeding fluid management

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Optimization of central venous pressure during the perioperative period is associated with improved prognosis of high-risk operation patients

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Journal of Intensive Medicine 2023年第2期3卷 165-170页

作者： Jiafang Wu Jun Li Han Chen Xiuling Shang Rongguo Yu The Third Department of Critical Care Medicine Shengli Clinical Medical College of Fujian Medical UniversityFujian Provincial HospitalFujian Provincial Center for Critical Care MedicineFujian Provincial Key Laboratory of Critical Care MedicineFuzhouFujian 350001China

Background:While central venous pressure(CVP)measurement is used to guide fluid management for high-risk surgical patients during the perioperative period,its relationship to patient prognosis is ***:This single-center,retrospective observational study enrolled patients undergoing high-risk surgery from February 1,2014 to November 31,2020,who were admitted to the surgical intensive care unit(ICU)directly after *** were divided into the following three groups according to the first CVP measurement(CVP1)after admission to the ICU:low,CVP112 *** fluid balance,28-day mortality,length of stay in the ICU,and hospitalization and surgical complications were compared across ***:Of the 775 high-risk surgical patients enrolled in the study,228 were included in the ***(interquartile range)positive fluid balance during surgery was lowest in the low CVP1 group and highest in the high CVP1 group(low CVP1:770[410,1205]mL;moderate CVP1:1070[685,1500]mL;high CVP1:1570[1008,2000]mL;all Pfluid balance during the perioperative period was correlated with CVP1(r=0.336,P12 mmHg were risk factors for AKI within 72 h after surgery(adjusted odds ratio[aOR]=3.875,95%confidence inter

关键词： Perioperative Central venous pressure fluid management Acute renal injury

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Combining fluids and vasopressors:A magic potion?

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Journal of Intensive Medicine 2022年第1期2卷 3-7页

作者： Olfa Hamzaoui Department of Intensive Care Hôpital Antoine BéclèreUniversity Paris-SaclayClamart 92141France

Early detection and prompt reversal of sepsis-induced tissue hypoperfusion are key elements while treating pa-tients with septic *** administration is widely accepted as the first-line therapy followed by vasopressor use in persistently hypotensive patients or in those with insufficient arterial pressure to ensure adequate tissue *** evidence suggests a beneficial effect of combining fluids with vasopressors in the early phase of *** with fluids alone,combining fluids and vasopressors increases mean systemic pressure and venous return and corrects hypotension *** approach also limits fluid overload,which is an independent factor of poor outcomes in *** produces less hemodilution than fluids *** a consequence of these effects,combined treatment may improve outcomes in septic shock patients.

关键词： fluid management Norepinephrine Septic shock

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Diuretic combinations in critically ill patients with respiratory failure:A systematic review and meta-analysis

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World Journal of Critical Care Medicine 2022年第3期11卷 178-191页

作者： Jean Maxime Côté Nadir Goulamhoussen Blaithin A McMahon Patrick T Murray Division of Nephrology Department of MedicineCentre Hospitalier de l'Universitéde MontréalMontréal H2X0C1QuébecCanada Division of Nephrology Department of MedicineMedical University of South CarolinaCharlestonSC 29425United States Department of Medicine School of MedicineUniversity College DublinDublin D078NNIreland

BACKGROUND In patients with respiratory failure,loop diuretics remain the cornerstone of the treatment to maintain fluid balance,but resistance is *** To determine the efficacy and safety of common diuretic combinations in critically ill patients with respiratory *** We searched MEDLINE,Embase,Cochrane Library and PROSPERO for studies reporting the effects of a combination of a loop diuretic with another class of diuretic.A meta-analysis using mean differences(MD)with 95%confidence interval(CI)was performed for the 24-h fluid balance(primary outcome)and the 24-h urine output,while descriptive statistics were used for safety *** Nine studies totalling 440 patients from a total of 6510 citations were *** compared to loop diuretics alone,the addition of a second diuretic is associated with an improved negative fluid balance at 24 h[MD:-1.06 L(95%CI:-1.46;-0.65)],driven by the combination of a thiazide plus furosemide[MD:-1.25 L(95%CI:-1.68;-0.82)],while no difference was observed with the combination of a loop-diuretic plus acetazolamide[MD:-0.40 L(95%CI:-0.96;0.16)]or spironolactone[MD:-0.65 L(95%CI:-1.66;0.36)].Heterogeneity was high and the report of clinical and safety endpoints varied across *** Based on limited evidence,the addition of a second diuretic to a loop diuretic may promote diuresis and negative fluid balance in patients with respiratory failure,but only when using a *** larger trials to evaluate the safety and efficacy of such interventions in patients with respiratory failure are required.

关键词： Respiratory failure Diuretics fluid management Furosemide Thiazide Systematic review

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