China
Africa
Explore chapters and articles related to this topic
Diabetic Ketoacidosis
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Volume resuscitation is a mainstay of therapy. Recommendations include 15–20 mL/kg intravenous bolus of isotonic crystalloid in first hour followed by 250 mL/h, but the appropriate resuscitation should be guided by the hemodynamic status of the patient, other significant compromising conditions (e.g., renal or congestive heart failure), and frequent bedside assessment of response. Fluid resuscitation alone improves hyperglycemia and acidosis via decreased plasma osmolality, diminished counterregulatory hormones, and enhanced renal perfusion promoting glucose and acid excretion. The optimal resuscitation fluid is controversial; most guidelines recommend initial 0.9% sodium chloride followed by 0.45% sodium chloride when corrected sodium is normal or high (see equation below). When hyperchloremic nonanion gap metabolic acidosis is a concern, a balanced electrolyte solution may be administered instead of 0.9% sodium chloride. Findings from small studies indicate that as compared to 0.9% sodium chloride, Plasma-Lyte showed less hyperchloremia, higher bicarbonate, and more rapid acidosis resolution [3, 4]. Lactated Ringer's (LR) compared to 0.9% sodium chloride showed non-significant trends in improved pH and sodium bicarbonate levels in the LR group [5]. Definitive evidence for superior performance of balanced electrolyte solutions in clinically important outcomes is lacking such that the decision of which resuscitation fluid to use should be guided by individual patient characteristics, institutional formulary, and clinician familiarity.
Transfusion practice in resuscitation and critical illness
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
The most important feature of this crystalloid is the added buffer capacity that results in a pH equivalent to that of plasma. Magnesium is also a constituent, and may well be of benefit since hypomagnesaemia frequently accompanies critical illness. However, excessive administration of Plasma-Lyte to patients with renal insufficiency can cause hypermagnesaemia that may lead to vasodilatation and hypotension.
Perioperative fluids
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Manual of Neuroanesthesia, 2017
Intraoperative fluid requirement (resuscitative, maintenance, and replacement fluid) for neurosurgical procedures is usually achieved with 0.9% sodium chloride or Hartmann's solution/Ringer's lactate, both solutions having a long history of use. These solutions are relatively isoosmolar with respect to plasma and should not exacerbate cerebral edema. The balanced solutions (Hartmann's solution, Plasma-Lyte®, Isolyte® S) more closely resemble plasma in their electrolyte composition and presence of a buffer to maintain the body's acid–base balance. Sodium chloride 0.9% with its high sodium and chloride contents and lower pH is far from “normal” as it is often described; however in some centers, it is used in preference to Hartmann's solution based on its comparative hyperosmolarity, which may have a beneficial effect on cerebral water content.
Comparison of Centrifugal and Pulsatile Perfusion to Preserve Donor Kidneys Using Ex Vivo Subnormothermic Perfusion
Published in Journal of Investigative Surgery, 2022
Patrick P. W. Luke, Larry Jiang, Aushanth Ruthirakanthan, Daniel Lee, Qizhi Sun, Mahms Richard-Mohamed, Justin Kwong, Shahid Aquil, Rafid Alogaili, Aaron Haig, Alp Sener, Rabindra N. Bhattacharjee
Under general anesthesia, kidneys were subjected to 30 min warm ischemia in situ by cross-clamping the renal pedicles. After retrieval and flush with HTK solution, the paired kidneys were randomly assigned to undergo either: a) pulsatile perfusion or b) centrifugal perfusion with a hemoglobin oxygen carrier, HBOC-201, containing no vasodilators and nutrients at 22 °C. Oxygenation was achieved by an oxygenator and was set at 40%. Bicarbonate was added to adjust pH to physiologic levels. Urinary loss was replenished by equivalent volumes of PlasmaLyte solution (Baxter Corporation, USA) every half hour. A mean pressure of 70 mmHg was maintained during perfusion and perfusate oxygenation. Pump parameters such as flow rate and pressure were recorded every hour during preservation stage as well as reperfusion stage. After 4 hr perfusion with HBOC-201 at 22 °C, the function of both kidneys was assessed by reperfusion with autologous blood on pulsatile pump at 37 °C for another 4 hr to mimic post-storage transplantation conditions. Pump pressure, pH and oxygenation were maintained as if in perfusion. Blood pO2, pH and osmolality were monitored during reperfusion. To evaluate renal function, creatinine (10 mg/L) was added to the circuit. Figure 1B is a summary of the experimental procedure for our pump comparison.
Establishing a model system for evaluating CAR T cell therapy using dogs with spontaneous diffuse large B cell lymphoma
Published in OncoImmunology, 2020
M. Kazim Panjwani, Matthew J. Atherton, Martha A. MaloneyHuss, Kumudhini P. Haran, Ailian Xiong, Minnal Gupta, Irina Kulikovsaya, Simon F. Lacey, Nicola J. Mason
The purpose of the trial was to determine the safety, persistence and efficacy of lentiviral transduced, autologous T cells. Dogs with high-grade lymphoma that were refractory to multi-agent chemotherapy (or dogs for which standard-of-care multi-agent induction chemotherapy was not elected by owner) were eligible for screening following full written informed owner consent. Expression of cCD20 on malignant lymphocytes was confirmed by flow cytometry. Thorough physical examination, serum chemistry, CBC, urinalysis, thoracic radiographs and abdominal ultrasound were performed during screening to identify any co-morbidities and determine the extent of disease. Patients received intravenous CAR T cells in 0.9% PlasmaLyte A (Baxter) 13–16 d following T cell isolation and activation. Patients were eligible for multi-agent rescue chemotherapy following disease progression after CAR T therapy.
Identification of risk factors associated with postoperative acute kidney injury after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a retrospective study
Published in International Journal of Hyperthermia, 2018
Juan P. Cata, Acsa M. Zavala, Antoinette Van Meter, Uduak U. Williams, Jose Soliz, Mike Hernandez, Pascal Owusu-Agyemang
Preoperative oral tramadol (300 mg), celecoxib (400 mg) or pregabalin (75 mg) was typically administered within two hours of anaesthesia induction according to anaesthesiologist clinical judgement. All patients had general anaesthesia using a combination of opioids, volatile anaesthetic (i.e. desflurane) in oxygen or total intravenous anaesthesia (propofol) and muscle relaxation with a non-depolarising or a depolarising muscle relaxant. Intraoperative fluid therapy consisted of a combination of crystalloids (Plasmalyte®, Baxter International, Deerfield, IL) and colloids (6% hetastarch, Hextend®, BioTime, Inc., Berkeley, CA; or albumin 5%, Buminate®, Baxter, San Juan, Puerto Rico) that was administered according to the attending anaesthesiologist’s clinical judgement. Ureteral stents were placed before surgical incision at discretion of primary surgery. Intraperitoneal chemotherapy was administered according to tumour type and surgeon’s choice. Perioperative blood product transfusions were given to maintain a haemoglobin (Hb) concentration between 8 and 10 g/dL. Postoperative analgesia consisted of either patient-controlled epidural analgesia and/or intravenous patient-controlled analgesia.