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Spontaneous diuresis and negative fluid balance predicting recovery and survival in patients with trauma-hemorragic shock

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Chinese Journal of Traumatology 2003年第6期6卷 382-384页

作者：缑东元朱雅芳金燕陈丽英 ICU Affiliated Sir Run Run Shaw Hospital Zhejiang University

Most patients with trauma-hemorragic shock, prior to ICU admission, have been resuscitated and stabilized in the emergency room (ER) and/or operation room (OR). Many of them suffer from systemic edema. This extra-vascular fluid is caused by massive infusion of fluid and blood for the maintenance of blood pressure. During the recovery stage, the patients exhibit spontaneous diuresis followed by negative fluid balance. Urine volumes of some patients are more than 10000 ml/d. Do we need to maintain a balance between daily input and output of water at this situation? There are many references in the medical literature and textbooks about fluid resuscitation and the principles in maintaining the balance between input and output of water, but rarely about when and how to restrict it, that is, when and how to permit a negative balance. In this retrospective review, we examined the resuscitation records of 205 patients with systemic edema after trauma-hemorragic shock.

关键词： Cause of Death water-electrolyte balance Adolescent Adult Aged Aged, 80 and over Child Critical Care Diuresis Female Fluid Therapy Humans Injury Severity Score Intensive Care Units Male Middle Aged Multiple Trauma Predictive Value of Tests Probability Prognosis Retrospective Studies Risk Assessment Shock, Hemorrhagic Survival Rate

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Body Fluid Changes, Cardiovascular Deconditioning and Metabolic Impairment Are Reversed 24 Hours after a 5-Day Dry Immersion

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Open Journal of Nephrology 2013年第1期3卷 13-24页

作者： Mickael Coupe Elena Tomilovskaya Francoise Larcher Bertrand Diquet Liudmila KhPastushkova Inesa BKozlovskaya Irina MLarina Guillemette Gauquelin-Koch Vladimir AKulchitsky Marc-Antoine Custaud Nastassia MNavasiolava CNRS UMR 6214 INSERM U1083Angers UniversityAngersFrance Associated French-Russian Laboratory CaDyWEC AngersFrance&MoscowRussia Institute of Biomedical Problems RAS SSC MoscowRussia Biochemistry Laboratory Angers University HospitalAngersFrance Pharmacokinetics Laboratory Angers University HospitalAngersFrance French Space Agency(CNES) ParisFrance Institute of Physiology National Academy of SciencesMinskBelarus

Dry immersion is an effective and useful model for research in physiology and physiopathology. The focus of this study was to provide integrative insight into renal, endocrine, circulatory, autonomic and metabolic effects of dry immersion. We assessed if the principal changes were restored within 24 h of recovery, and determined which changes were mainly associated with immersion-induced orthostatic intolerance. Five-day dry immersion without countermeasures, and with ad libitum water intake, standardized diet and a permitted short daily rise was performed in a relatively large sample for this experiment type (14 healthy young men). Reduction of total body water derived mostly from extracellular compartment, and stabilized rapidly at the new operating point. Decrease in plasma volume was estimated at 20% - 25%. Five-day immersion was sufficient to impair metabolism with a decrease in glucose tolerance and hypercholesterolemia, but was not associated with pronounced autonomic changes. Five-day immersion induced marked cardiovascular impairment. Immediately after immersion, over half of the subjects were unable to accomplish the 20-min 70° tilt;during tilt, heart rate and total peripheral resistance were increased, and stroke volume was decreased. However, 24 hours of normal physical activity appeared sufficient to reverse orthostatic tolerance and all signs of cardiovascular impairment, and to restitute plasma volume and extracellular fluid volume. Similarly, metabolic impairment was restored. In our study, the major factor responsible for orthostatic intolerance appeared to be hypovolemia. The absence of pronounced autonomic dysfunction might be explained by relatively short duration of dry immersion and daily short-time orthostatic stimulation.

关键词： Physical Inactivity Modeled Weightlessness water-electrolyte balance Body Fluid Compartments Orthostatic Intolerance

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