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Goal-directed fluid therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

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Chinese Medical Journal 2015年第14期128卷 1922-1931页

作者： Wei Xiao Qing-Fang Duan Wen-Ya Fu Xin-Zuo Chi Feng-Ying Wang Da-Qing Ma Tian-Long Wang Lei Zhao Department of Anesthesiology Xuan Wu Hospital Capital Medical University Beijing 100053 China Department of Obstetrics and Gynecology Xuan Wu Hospital Capital Medical University Beijing 100053 China Department of Surgery and Cancer Pain Medicine and Intensive Care Faculty of Medicine Chelsea and Westminster Hospital Imperial College London United Kingdom

Background： Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy （HDP） can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy （GDFT） with LiDCOrapid system can improve well-being of both HDP parturient and their babies. Methods： Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer＇s solution （LR）, parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume （ASV） provided via LiDCO rapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events. Results： The severity of HDP was similar between two groups. The total LR infusion （P 〈 0.01） and urine output （P 〈 0.05） were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group （P 〈 0.01）. There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased （P 〈 0.05）, and the incidences of neonatal hypercapnia and hypoxemia were statistically increased （P 〈 0.05） than in the GDFT group. Conclusions： Dynamic responsiveness guided fluid therapy with the LiDCOrapid system may provide potential benefits to stable HDP parturient and th

关键词： Cesarean Delivery fluid therapy Hypertensive Disorders of Pregnancy LiDCOrapid System Parturient

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Effect of perioperative fluid therapy on early phase prognosis after liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2008年第4期7卷 367-372页

作者： Jiang, Guo-Qing Peng, Min-Hao Yang, Ding-Hua Guangxi Med Univ Affiliated Hosp 1 Dept Hepatobiliary Surg Nanning 530021 Peoples R China Peoples Hosp Subei Dept Hepatobiliary Surg Yangzhou 225001 Peoples R China

BACKGROUND: Although liver transplantation (LT) has made rapid progress, early pulmonary complications still occur. More attention should be paid to fluid therapy that may be an important factor leading to these complications. It is necessary to investigate the correlation between intraoperative and postoperative fluid therapy and early pulmonary complications after LT, then attempt to provide a reasonable fluid therapy in the perioperative period. METHODS: Sixty-two patients who had undergone Ff were enrolled and analyzed retrospectively. Based on early phase prognosis after LT, the 62 patients were divided into a non-pulmonary complication group and a pulmonary complication group. Twenty perioperative variables were analyzed in both groups to screen out several factors causing early pulmonary complications, then the parameters reflecting postoperative recovery were analyzed. RESULTS: The pulmonary complication group had 29 patients (46.77%), 3 (4.84%) of whom died during the perioperative period. Using monofactorial analysis for each variable, the two groups differed in the following variables: preoperative lung function, volume of intraoperative transfusion, volume of intraoperative bleeding, and volume of intraoperative net fluid retention and fluid balance (= 2 of the first 3 days after operation. Analysis of the relationship between multivariate factors and pulmonary complications after LT by logistic multivariate regression analysis showed that preoperative lung function, volume of intraoperative bleeding, and fluid balance (=-2 of the first 3 days after operation were influential factors. CONCLUSIONS: It is important to maintain fluid balance during the perioperative period of LT. If the hemodynamics are stable, appropriate negative fluid balance in the first 3 days after operation apparently decreases the incidence of early pulmonary complications after LT. These measures are associated with better postoperative recovery.

关键词： liver transplantation perioperative period fluid therapy fluid balance

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Bioreactance-guided fluid therapy for excision of a giant brain tumor in an infant under general anesthesia:A case report and literature review

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Brain Science Advances 2021年第3期7卷 199-206页

作者： Yao Chen Ting Fan Tsinghua University Yuquan Hospital Beijing 100040China

Pediatric patients are more likely to suffer from brain tumors.Surgical resection is often the optimal treatment.Perioperative management of pediatric brain tumor resection brings great challenges to anesthesiologists,especially for fluid therapy.In this case,the infant-patient was only 69-day-old,weighed 6 kg,but she was facing a gaint brain tumor(7.9 cm×8.1 cm×6.7 cm)excision.The infant was at great risks such as hemorrhagic shock,cerebral edema,pulmonary edema,congestive heart failure,coagulation dysfunction,etc.However,we tried to use the parameters obtained by bioreactance-based NICOM^(■)device(Cheetah Medical)to guide the infant’s intraoperative fluid therapy,and successfully avoided these complications and achieved a good prognosis.

关键词： fluid therapy bioreactance technology brain tumor excision infant

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Resuscitation fluids as drugs:targeting the endothelial glycocalyx

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Chinese Medical Journal 2022年第2期135卷 137-144页

作者： Guangjian Wang Hongmin Zhang Dawei Liu Xiaoting Wang Chinese Critical Ultrasound Study Group Department of Critical Care Medicine Peking Union Medical College HospitalPeking Union Medical College&Chinese Academy of Medical SciencesBeijing 100730China

fluid resuscitation is an essential intervention in critically ill patients,and its ultimate goal is to restore tissue perfusion.Critical illnesses are often accompanied by glycocalyx degradation caused by inflammatory reactions,hypoperfusion,shock,and so forth,leading to disturbed microcirculatory perfusion and organ dysfunction.Therefore,maintaining or even restoring the glycocalyx integrity may be of high priority in the therapeutic strategy.Like drugs,however,different resuscitation fluids may have beneficial or harmful effects on the integrity of the glycocalyx.The purpose of this article is to review the effects of different resuscitation fluids on the glycocalyx.Many animal studies have shown that normal saline might be associated with glycocalyx degradation,but clinical studies have not confirmed this finding.Hydroxyethyl starch(HES),rather than other synthetic colloids,may restore the glycocalyx.However,the use of HES also leads to serious adverse events such as acute kidney injury and bleeding tendencies.Some studies have suggested that albumin may restore the glycocalyx,whereas others have suggested that balanced crystalloids might aggravate glycocalyx degradation.Notably,most studies did not correct the effects of the infusion rate or fluid volume;therefore,the results of using balanced crystalloids remain unclear.Moreover,mainly animal studies have suggested that plasma may protect and restore glycocalyx integrity,and this still requires confirmation by high-quality clinical studies.

关键词： fluid resuscitation Resuscitation fluid fluid therapy Endothelial glycocalyx Glycocalyx

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Perioperative fluid management in major hepatic resection: an integrative review

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Hepatobiliary & Pancreatic Diseases International 2017年第5期16卷 458-469页

作者： Osamu Yoshino Marcos Vinicius Perini Christopher Christophi Laurence Weinberg Department of Surgery Austin Hospital and University of Melbourne Melbourne Victoria Australia Anaesthesia Perioperative Pain Medicine Unit University of Melbourne Melbourne Victoria Australia

BACKGROUND: fluid intervention and vasoactive pharmacological support during hepatic resection depend on the preference of the attending clinician, institutional resources, and practice culture. Evidence-based recommendations to guide perioperative fluid management are currently limited. Therefore, we provide a contemporary clinical integrative overview of the fundamental principles underpinning fluid intervention and hemodynamic optimization for adult patients undergoing major hepatic resection. DATA SOURCES: A literature review was performed of MEDLINE, EMBASE and the Cochrane Central Registry of Controlled Trials using the terms 'surgery', 'anesthesia', 'starch', 'hydroxyethyl starch derivatives', 'albumin', 'gelatin', 'liver resection', 'hepatic resection', 'fluids', 'fluid therapy', 'crystalloid', 'colloid', 'saline', 'plasma-Lyte', 'plasmalyte', 'hartmann's', 'acetate', and 'lactate'. Search results for MEDLINE and EMBASE were additionally limited to studies on human populations that included adult age groups and publications in English. RESULTS: A total of 113 articles were included after appropriate inclusion criteria screening. Perioperative fluid management as it relates to various anesthetic and surgical techniques is discussed.CONCLUSIONS: Clinicians should have a fundamental understanding of the surgical phases of the resection, hemodynamic goals, and anesthesia challenges in attempts to individualize therapy to the patient's underlying pathophysiological condition. Therefore, an ideal approach for perioperative fluid therapy is always individualized. Planning and designing large-scale clinical trials are imperative to define the optimal type and amount of fluid for patients undergoing major hepatic resection. Further clinical trials evaluating different intraoperative goal-directed strategies are also eagerly awaited.

关键词： hepatic resection liver resection fluid therapy anesthesia crystalloid colloid goal-directed therapy

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fluids administration and coagulation characteristics in patients with different model for end-stage liver disease scores undergoing orthotopic liver transplantation

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Chinese Medical Journal 2007年第22期120卷 1963-1968页

作者： LI Min ZHANG Li-ping YANG Lu Department of Anesthesiology Peking University Third Hospital Beijing 100083 China

Background There have been many studies investigating the impact of the model for end-stage liver disease （MELD） score on predicting post-transplant outcome. But it is unclear whether MELD is correlated to intraoperative fluid therapy and coagulation status. We investigated the relationship between the severity of liver diseases as measured by MELD score and intraoperative fluid requirements and the changes of coagulation characteristics. Methods Ninety patients were included in this retrospective study. The patients were stratified into three groups according to the MELD scores：〈15 （low）, 15-25 （medium） and 〉25 （high）. Intraoperatively, volume was restored with allogeneic and/or salvaged red blood cells （RBC）, fresh-frozen plasma （FFP）, platelet and other types of fluids according to hemodynamic data, hematocrit, and clotting data. Intraoperative coagulation data, blood requirements and other fluids administered were compared among the 3 groups. Results Before surgery, in addition to the three variables used to calculate MELD scores in other baseline laboratory values, including ratio of activated partial thromboplastin time （R-APTT）, D-Dimer, hematocrit, platelet and blood urea nitrogen （BUN） were significantly different among the 3 groups. The blood loss increased with increasing MELD. The volume of RBC （allogeneinc, salvaged and total）, FFP, platelet and the total volume of transfusion were also significantly different among the three groups （P〈0.01）. The requirements for prothrombin complex and fibrinogen showed a similar pattern. During operation, the changing trends of each coagulation variable were different. Compared with baseline, during each intraoperative stage, INR and R-APPT increased in the low MELD group. While in the medium MELD and high MELD groups, INR did not changed significantly during the operation, and R-APPT significantly increased only after reperfusion. Conclusions This study provided some useful information for perioperative management of patients undergoing liver transplantatio

关键词： liver transplantation fluid therapy coagulation, blood

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Perioperative"remote"acute lung injury:recent update

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The Journal of Biomedical Research 2017年第3期31卷 197-212页

作者： Zhaosheng Jin Ka Chun Suen Daqing Ma Anaesthetics Pain Medicine and intensive CareDepartment of Surgery and CancerFaculty of MedicineImperial College LondonChelsea&Westminster HospitalLondon SW10 9NHUK

Perioperative acute lung injury（ALI） is a syndrome characterised by hypoxia and chest radiograph changes.It is a serious post-operative complication,associated with considerable mortality and morbidity.In addition to mechanical ventilation,remote organ insult could also trigger systemic responses which induce ALI.Currently,there are limited treatment options available beyond conservative respiratory support.However,increasing understanding of the pathophysiology of ALI and the biochemical pathways involved will aid the development of novel treatments and help to improve patient outcome as well as to reduce cost to the health service.In this review we will discuss the epidemiology of peri-operative ALI;the cellular and molecular mechanisms involved on the pathological process;the clinical considerations in preventing and managing perioperative ALI and the potential future treatment options.

关键词： acute lung injury intraoperative care/adverse effects postoperative complications inflammation,anesthetics general fluid therapy

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