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PubMed2004

Impact of fluid balance on incidence of atrial fibrillation after cardiothoracic surgery.

Excessive fluid administration after cardiothoracic surgery has been proposed as a cause of postoperative atrial fibrillation. In this study, we observed that fluid balance and volume administered on postoperative day 2 was greater in patients who developed postoperative AF than in those who did not. We also found that net fluid balance on postoperative day 2 was an independent predictor of postoperative AF among patients not receiving prophylactic therapy.

Aged↗
PubMed2004

Postoperative fluid balance influences the need for antihypertensive therapy following coarctation repair.

OBJECTIVE: The purpose of the investigation was to determine the effect of fluid management on the need for perioperative antihypertensive therapy following coarctation repair. DESIGN: Retrospective case study. SETTING: Pediatric intensive care unit. PATIENTS: Infants and children with repaired coarctation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Hypertension was defined as a systolic blood pressure exceeding the 95th percentile for age. Echocardiographic variables included pre- and postoperative coarctation gradients, shortening fraction, left ventricular wall stress, and velocity of circumferential shortening. Clinical variables included age, fluid input, urine output (0-72 hrs), estimated creatinine clearance, intensive care unit stay, and diuretic use. Twenty-four patients were identified and divided into two groups. Group 1 consisted of six normotensive patients (19%, 1 wk to 2 yrs) and group 2 included 18 patients (75%, 3 wks to 12 yrs) with hypertension who required antihypertensive therapy. Group 2 patients were older (37 months vs. 3 months), received more intraoperative fluid, had lower urine output with fewer patients receiving diuretics, had diuretic therapy started later, and had longer intensive care unit stays (p < .05). When compared with group 2, 83% of group 2 patients had a net positive fluid balance between 36 and 72 hrs postoperatively. There were no differences in mean pre-/postoperative coarctation gradients, systolic function, postoperative fluids, estimated creatinine clearance, or aortic cross-clamp time. Using logistic regression analysis, we found that variables independently associated with the need for antihypertensive therapy included intraoperative fluid volume, 48- to 72-hr urine output, a positive fluid balance, and the use and timing diuretic therapy (p < .05). Subgroup analysis of infants <1 yr of age revealed similar findings. CONCLUSION: A net positive fluid balance caused by either the volume of intraoperative crystalloid infusion or a lower urine output contributes to the development of paradoxic hypertension following coarctation repair regardless of patient age. Limiting intraoperative fluids and early diuretic use may limit the need for antihypertensive therapy and shorten the intensive care unit stay.

Aortic Coarctation↗
PubMed1993

Effect of extracellular fluid volume expansion on avian lung fluid balance.

We examined the effects of acute expansion of extracellular fluid volume (ECFV) on lung fluid balance and the ultrastructure of the pulmonary air-blood barrier in chickens (Gallus domesticus). We compared changes in extravascular lung water content (EVLW) to the sum of mean pulmonary capillary blood pressure and plasma protein osmotic pressure (tau c), as a measure of net intravascular filtration pressure (NIFP), produced by graded infusion of avian Ringer's solution. NIFP increased with each volume load largely as a result of decreased tau c resulting in progressive increase in EVLW. Progressive interstitial edema occurred with fluid accumulation restricted to the inter air capillary septa, sparing the gas exchanging regions of the air-blood barrier. This was associated with increased thickness of the septa and increased pulmonary capillary endothelial vesiculation. The effect of increased ECFV on pulmonary hemodynamics and lung fluid balance in Gallus is similar to that in mammals.

Animals↗
PubMed1996

Restoration of fluid balance after exercise-induced dehydration: effects of food and fluid intake.

This study investigated the effects of post-exercise rehydration with fluid alone or with a meal plus fluid. Eight healthy volunteers (five men, three women) were dehydrated by a mean of 2.1 (SEM 0.0)% of body mass by intermittent cycle exercise in a warm [34 (SEM 0) degrees C], humid [55 (SEM 1)% relative humidity] environment. Over 60 min beginning 30 min after exercise, the subjects ingested a commercially-available sports drink (21 mmol.l-1 Na+, 3.4 mmol.l-1 K+, 12 mmol.l-1 Cl-) on trials A and B: on trial C a standard meal [63 kJ.kg-1 body mass (53% CHO, 28% fat, 19% protein; 0.118 mmol.kJ-1 Na+, 0.061 mmol.kJ-1 K+)] plus drink (1 mmol.l-1 Na+, 0.4 mmol.l-1 K+, 1 mmol.l-1 Cl-) were consumed. Water intake (in millilitres) was 150% of the mass loss (in grams). The trials took place after an overnight fast and were separated by 7 days. Blood and urine samples were collected at intervals throughout the study. Blood was analysed for haematocrit, haemoglobin concentration, serum osmolality, Na+, K+ and Cl- concentrations and plasma angiotensin II concentration. Urine volume, osmolality and electrolyte concentrations were measured. Dehydration resulted in a mean 5.2 (SEM 1.3)% reduction in plasma volume. With the exception of serum osmolality, which was higher on trial B than A at the end of the rehydration period, no differences were recorded for any of the measured parameters between trials A and B. Cumulative urine output following rehydration was lower (P < 0.01) on trial C [median 665 (range 396-1190)ml] than on trial B [median 934 (range 550-1403)ml] which was not different (P = 0.44) from trial A [median 954 (range 474-1501)ml]. Less urine was produced over the 1-h period ending 2 h after rehydration on trial C than on B (P = 0.01). On trials A and B the subjects were in net negative fluid balance by 337 (range 779-minus 306) ml and 373 (range 680-minus 173)ml, respectively (P < 0.01): on trial C the subjects were no different from their initial euhydrated state [median minus 29 (range minus 421-137)ml] 6 h after the end of rehydration (P = 1.00). A larger fraction of total water intake was retained when the standard meal plus drink was consumed. This may have been due to the larger quantities of Na+ and K+ ingested with the meal [mean 63 (SEM 4) mmol Na+, 21.3 (SEM 1.3)mmol K+] than with the drink [mean 42(SEM 2)mmol Na+, 6.8 (SEM 0.4)mmol K+]. There was no difference between trials B and C in any of the measured blood parameters, but urinary Na+ and K+ excretion were both higher on trial C and B. These results suggest that post-exercise fluid replacement can be achieved by ingestion of water if consumed in sufficient volume together with a meal providing significant amounts of electrolytes.

Adult↗
PubMed1991

The relationship between ARDS, pulmonary infiltration, fluid balance, and hemodynamics in critically ill surgical patients.

Hypervolemia from fluid overload with resultant pulmonary edema is thought to be a frequent cause of Adult Respiratory Distress Syndrome (ARDS). However, ARDS may also occur as a result of the hypovolemic shock of surgery or trauma. To develop an appropriate rationale for fluid therapy in high-risk surgical patients, the relationship between fluid balance, hemodynamics, the onset of ARDS by physiologic criteria (shunt greater than or equal to 20%, and/or PaO2/FiO2 ratio less than 250) and the onset of pulmonary infiltration (PI) associated with ARDS were examined. Fifty patients were prospectively followed from admission throughout their hospitalizations; 38 (76%) had trauma and 12 (24%) were postoperative. Cardiac index, central venous pressure (CVP), wedge pressure (WP), and shunt (Qsp) were measured. All chest x rays were read by one staff radiologist who was blinded to the patients' identities. PI was graded from "0" to "4" (0 = no PI, 4 = maximum PI). The first x ray reading of "2" or greater was used as the time of onset of PI. ARDS by physiologic criteria occurred in 29 of 50 (58%) patients; 27 of these 29 (94%) also developed +2 or greater PI. The mean onset times of ARDS and of +2 PI were 40 +/- 41 hours and 40 +/- 38 hours, respectively. The ARDS patients had a significantly smaller net positive fluid balance than the non-ARDS patients over the first 40 hours after admission (+6,831 ml +/- 4,909 ml vs 12,440 ml +/- 7,817 ml, (P less than 0.01)).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

Highly positive intraoperative fluid balance during cardiac surgery is associated with adverse outcome.

UNLABELLED: Hemodilution and increase in capillary permeability occurring with cardiopulmonary bypass (CPB) impose a risk for tissue edema and blood transfusion that may result in an increased complication rate after coronary artery bypass grafting (CABG). Of the 1280 consecutive patients undergoing isolated on-pump CABG, total fluid balance at the end of the operation was less than or equal to 500 mL in 1155 (Group 1) and more than 500 mL in 125 (Group 2). During CPB, blood was added to the reservoir only when the hematocrit fell to 17% or less and crystalloid solution only when the pump flow index fell below 2.0 L/min/m2. Anesthetic, surgical, and postoperative management and diagnoses were the same in all patients, and a single surgical and anesthesia team performed all operations. No patient was excluded from the study. RESULTS: Hypertension, diabetes, chronic obstructive pulmonary disease, New York Heart Association (NYHA) Class III-IV, use of angiotensin converting enzyme (ACE) inhibitors, chronic renal failure, and female gender were the significant preoperative risk factors for increased volume replacement during CPB. The groups were similar in body mass index, preoperative hematocrit values, total fluid balance in the intensive care unit (ICU), and total chest tube output. However, red blood cells' transfusion rate, readmission rate to the ICU and length of hospital stay were significantly higher in Group 2 patients. Multiple logistic regression revealed that age > 70 years (p < 0.001, Odds Ratio (OR): 2, 95% CI: 1.4-2.8), and total fluid balance > 500 mL at the end of the operation (p < 0.01, OR: 2.2, 95% CI: 1.5-3.2) were the predictors of increased length of stay. For transfusion of red blood cells, age > 70 years (p < 0.0001, OR: 2.3, 95% CI: 1.6-3.3), and total fluid balance > 500 mL at the end of the operation (p < 0.001, OR: 2, 95% CI: 1.3-2.9) were the only significant risk factors. This study suggests that intraoperative volume overload increases blood transfusion and length of hospital stay in patients undergoing CABG.

Aged↗
PubMed1989

Investigation of the effects of paralysis by pancuronium on heart rate variability, blood pressure and fluid balance.

The effects of pancuronium bromide on the cardiovascular system and fluid balance in preterm ventilated neonates was investigated. Infants were selectively paralysed if actively expiring. Their results were compared to a control group of similar gestational age, ventilated during the same study period, but who received no paralysing agent. There was no significant difference in the blood pressure of the two groups. Treatment with pancuronium was not associated with differences in blood pressure variability. All paralysed infants showed a significant reduction in heart rate variability which persisted during treatment. This was not present in the control infants. Paralysed infants, despite fluid restriction, had evidence of fluid retention, being significantly heavier than the control babies from day 3 onwards and above their birthweight by day 7. No paralysed or control infant developed a pneumothorax or renal failure. We conclude that selective treatment with pancuronium is without adverse effects on blood pressure but strict attention to fluid balance is essential.

Blood Pressure↗
PubMed1998

Myocardial fluid balance: pathophysiology and clinical implications.

Excess fluid in the myocardial interstitium is a common manifestation of many clinical states. Extracellular myocardial edema should be a concern for clinicians as it has been demonstrated to produce cardiac dysfunction. This paper will briefly discuss those factors governing myocardial fluid balance and review the evidence of myocardial edema in various diseases.

Animals↗
PubMed1994

Bacterial meningitis: fluid balance and therapy.

Fluid administration in children with meningitis should be conservative in an attempt to minimize cerebral edema and electrolyte disturbances that frequently complicate the course of meningitis. Since these complications have been shown to correlate with poor neurologic outcome, it is believed that appropriate fluid management will minimize the morbidity and mortality associated with bacterial meningitis in children.

Animals↗
PubMed2006

Fluid balance of pediatric hematopoietic stem cell transplant recipients and intensive care unit admission.

Fluid administration is essential in patients undergoing hematopoietic stem cell transplant (HSCT). Admission to pediatric intensive care unit (PICU) is required for 11-29% of pediatric HSCT recipients and is associated with high mortality. The objective of this study was to determine if a positive fluid balance acquired during the HSCT procedure is a risk factor for PICU admission. The medical records of 87 consecutive children who underwent a first HSCT were reviewed retrospectively for the following periods: from admission for HSCT to PICU admission for the first group (PICU group), and from admission for HSCT to hospital discharge for the second group (non-PICU group). Fluid balance was determined on the basis of weight gain (WG) and fluid overload (FO). PICU group consisted of 19 patients (21.8%). Among these, 13 (68.4%) developed>or=10% WG prior to PICU admission compared with 15 (22.1%) in the non-PICU group (p<0.001). Thirteen patients (68.4%) developed>or=10% FO prior to PICU admission compared with 31 (45.6%) in the non-PICU group (p=0.075). Following multivariate analysis, >or=10% WG (p=0.018) and cardiac dysfunction on admission for HSCT (p=0.036) remained independent risk factors for PICU admission. Smaller children (p=0.033) and patients with a twofold increase in serum creatinine (p=0.026) were at risk of developing>or=10% WG. This study shows that WG is a risk factor for PICU admission in pediatric HSCT recipients. Further research is needed to better understand the pathophysiology of WG in these patients and to determine the impact of WG prevention on PICU admission.

Adolescent↗
PubMed1985

Assessment of fluid balance in isolated sheep lungs.

In this study we demonstrate the validity and utility of an isolated lung preparation developed for the study of pulmonary fluid balance. Lungs of 2- to 3-mo-old sheep were perfused in situ with autologous blood treated with indomethacin (20 micrograms/ml). Lung lymph flow (QL), uncontaminated by systemic lymph, was measured from either the efferent duct of the caudomediastinal lymph node or the thoracic duct in the superior mediastinum. Lung weight change (delta W) was measured as the opposite of the change in weight of the extracorporeal blood reservoir. A unique feature of this experimental model is the ability to assess lung fluid balance from simultaneous measurements of delta W and QL. In addition, hemodynamic and blood gas variables can be tightly controlled. Our results show that changes in QL and the lymph-to-plasma oncotic pressure ratio caused by an increase in microvascular pressure were comparable with those seen previously in intact sheep. When microvascular pressure was returned to control levels, QL fell despite a sustained increase in the amount of extravascular lung water, suggesting compartmentalization of the filtrate and/or effects of intravascular volume on lymph-driving pressure or resistance. Lymph flow was directly proportional to respiratory frequency over the range of 0-30 min-1 when the change in frequency was maintained for periods as long as 30 min. This preparation should prove useful in the study of lung fluid balance, particularly when it is desired to use interventions which are precluded or difficult in intact animals.

Animals↗
PubMed1997

Coffee consumption and total body water homeostasis as measured by fluid balance and bioelectrical impedance analysis.

To investigate the impact of coffee consumption on fluid balance, 12 healthy volunteers were supplied with a standardized diet for 2 days after having abstained from consumption of methylxanthines for 5 days. During the first day, fluid requirement was met by mineral water. On the following day the same amount of fluid was supplied and the mineral water was in part replaced by 6 cups of coffee containing 642 mg of caffeine. This led to an increase in 24-hour urine excretion of 753 +/- 532 ml (p < 0.001), a corresponding negative fluid balance and a concomitant decrease in body weight of 0.7 +/- 0.4 kg (p < 0.001). Total body water as measured with bioelectrical impedance analysis decreased by 1.1 +/- 1.2 kg or 2.7% (p < 0.01). Urinary excretion of sodium and potassium was elevated by 80 +/- 62 mmol or 66% (p < 0.01) and 14 +/- 12 mmol or 28% (p < 0.01), respectively.

Adult↗
PubMed1978

Perioperative care: intraoperative fluid balance.

Rational intraoperative fluid therapy is based on an understanding of the pathophysiology of severe trauma and surgery. Fluids of suitable compositions are administered in sufficient quantities to form part of the daily maintenance requirement and also to replace blood and ECF lost during surgery.

Acute Kidney Injury↗
PubMed1994

[Anders Jahre-Award for young researchers 1993. Loose connective tissue and fluid balance. From static to dynamic tissue].

Rolf K Reed, recipient of the 1993 Anders Jahre Prize for younger medical researchers, describes some newer aspects of loose (areolar) connective tissue physiology and shows how research in recent years has changed our understanding of the involvement of these tissues in the regulation of fluid balance. There is a dynamic relationship between loose connective tissue and fluid balance, as a result of which the development of oedema is normally inhibited. However, certain inflammatory reactions are accompanied by changes in the activity of these tissues which then "absorb" fluid from the capillaries. This feature seems to be partly related to hyaluronidase+, the metabolism of which is also dependent on connective tissue fluid balance.

Awards and Prizes↗
PubMed2002

Hypoxic ventilatory response, ventilation, gas exchange, and fluid balance in acute mountain sickness.

To examine whether sea-level hypoxic ventilatory responses (HVR) predict acute mountain sickness (AMS) and document temporal changes in ventilation, HVR, gas exchange, and fluid balance, we measured these parameters at low altitude (100 m) and daily during 3 days at high altitude (4559 m). At low altitude, there were no significant differences in rest or exercise isocapnic HVR, poikilocapnic HVR at rest, and hypercapnic ventilatory response between 12 subjects without significant AMS and 11 subjects who fell sick. No low altitude ventilatory responses correlated with AMS or fluid balance at high altitude. On day 1, isocapnic HVR was significantly lower in the AMS group [0.86 +/- 0.43 (SD) vs. 1.43 +/- 0.63 L/min/% Sa(O2), p < 0.05). AMS was associated with higher AaD(O2), lower Pa(O2), and Sa(O2), while Pa(CO2) was not different between subjects with and without AMS. Both groups showed equivalent reductions in urine volume, sodium output, and gain in body weight on day 1 while climbing to 4559 m, but on day 2 only subjects without AMS had diuresis, natriuresis, and weight loss. We conclude that (1) susceptibility to AMS, fluid balance, and ventilation at high altitude cannot be predicted by low altitude HVR testing and (2) that the failure to increase HVR on arrival at high altitude and impaired gas exchange, possibly due to interstitial edema, may account for the more severe hypoxemia in AMS.

Acute Disease↗
PubMed1993

Poor ultrafiltration during nighttime dialysis in CAPD patients and its effects on fluid balance.

To evaluate fluid retention during the long nighttime peritoneal dwell in continuous ambulatory peritoneal dialysis (CAPD) patients, we measured remaining volumes in 70 patients. In only 50% of these patients were more than 2 L of fluid recovered; in 30% between 1.5 and 2 L were recovered; and in 17% of patients we retrieved less than 1.5 L of peritoneal fluid. In 3 of these patients, who were edematous and had marked pitting edema, we shortened the nighttime dwell by having the patients awaken after 4 hours and drain the dwell. This resulted in 3-5 kg of weight loss in each patient, when compared with each patient's previous use of long nighttime dwells. Finally, we propose in this report two automated methods whereby the period of nighttime dialysis can be controlled, while patients sleep, using a system of timer clamps.

Edema↗