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At least 1,081 records · Page 60Linked to original sources
PubMed1996

[Venovenous extracorporeal membrane oxygenation (ECMO) with a heparin-lock bypass system. An effective addition in the treatment of acute respiratory failure (ARDS)].

Mortality of severe acute respiratory distress syndrome (ARDS) in Germany is about 60%. Respiratory therapy can make the lung injury worse by high positive airway pressures, high tidal volumes and high inspiratory oxygen concentrations. Extracorporeal membrane oxygenation (ECMO) was employed to reduce aggressive mechanical ventilation, but it has not been proved to be superior to conventional ventilation. However, encouraged by recently developed improvements in the technique and concept of ECMO, we introduced this therapy into our program for the treatment of ARDS. PATIENTS AND METHODS. All patients with severe ARDS (lung injury score > 2.5) admitted to our multidisciplinary intensive care unit from March 1992 to March 1995 were evaluated prospectively. After admission, the patients first underwent a conventional therapeutic approach, including pressure-controlled inverse-ratio ventilation, permissive hypercapnia, changes in body position (in particular, the prone position), negative fluid balance, anti-biotics, and low-dose hydrocortisone infusion. ECMO via a covalently heparin-coated, venovenous bypass-system with a vortex pump and two membrane lungs was performed if ARDS did not improve after 24-96 h of conventional therapy and if two of three of the slow-entry criteria for ECMO were fulfilled: (1) PaO2/FiO2 < 150 mmHg at PEEP > 5 mbar; (2) semistatic compliance < 30 ml/mbar; (3) right-left shunt > 30%. Only in cases of life-threatening hypoxemia (PaO2 < 50 mmHg at FiO2 1.0 and PEEP > 5 mbar for > 2 h (fast-entry criteria) was ECMO instituted immediately. RESULTS. Sixty patients fulfilled the entry criteria for our study. Thirty-nine patients were treated with a conventional protocol, 37 after improvement of ARDS and 2 who had not improved but in whom there were contraindications to the use of ECMO. ECMO was performed in 10 patients who had not improved, but who fulfilled the slow-entry criteria and in 11 primarily hypoxemic patients who fulfilled the fast-entry criteria. The survival rate was 30/39 (77%) for the conventional therapy group, 6/10 (60%) for the slow-entry group, and 11/11 (100%) for the fast-entry group. The onset of ECMO allowed a significant decrease in peak and mean airway pressures, tidal volume, ventilatory rate, minute volume and inspiratory oxygen concentration. Sufficient gas exchange was provided, and pulmonary artery pressures significantly decreased on bypass. The most frequent complications on bypass were pneumothorax (15/21 patients) and bleeding (7/21 patients). CONCLUSION. In comparison with the historical results at our own institution, the present study demonstrates an improvement in the survival rate from 56% to 78% since ECMO has become available. We conclude that venovenous ECMO with a heparin-bonded bypass circuit is an effective additional option for the treatment of patients with severe ARDS.

Adolescent↗
PubMed1997

Multiple frequency bioimpedance: a bed-side technique for assessment of fluid shift patterns in a patient with severe dehydration.

This report describes the use of multiple frequency bioimpedance analysis (MFBIA) to monitor fluid changes in a patient who developed severe dehydration and recovered. Initially, the patient weighed 53.2 kg, his total body water (TBW; D(2)0 dilution) was 33.5 L, his extracellular water (ECW; Br dilution) was 19.5 L, and hydration of the fat-free mass (FFM; dual-energy X-ray absorptiometry) was normal (73%). The resistances at infinite and 0 frequency were R(inf) = 454 and R(0) = 580 ohm respectively, which predicted TBW = 33.1 L and ECW = 16.6 L. On day 7, when the weight loss was 7.2 kg, FFM had decreased by 7.4 kg, and R(inf) and R(0) had increased to 662 and 902 ohm respectively, predicting decreases of 5.8 L in TBW and 3.7 L in ECW. On recovery (day 14), all parameters had returned to baseline values. This study encourages the use of MFBIA as a bed-side technique for the serial assessment of body water compartments in patients with disturbances in fluid balance.

Journal Article↗
PubMed1995

Antidiuretic hormone levels and polyuria in spinal cord injury. A preliminary report.

Chronic cervical spinal cord injury is characterized by defects in sodium and water homeostasis and defects of adaptive hormonal responses. The plasma osmolality is maintained in a relatively narrow range, the lower limit of which is determined by osmotic threshold for vasopressin release and the upper limit by the third threshold. Antidiuretic hormone as an important mediator of fluid and electrolyte balance was well investigated in able bodied children comparing children with normal voiding pattern and children with enuresis. The normal subjects were found to have higher plasma ADH at night, not detected in the group with enuresis. The findings were similar in elderly patients with increased diuresis at night, suggesting an important role of ADH in nocturnal decrease of urine output. Investigators studied the effect of rapid tilt on plasma ADH in tetraplegic compared with normal subjects, but there are no data available in the literature regarding ADH and its effects on water and electrolyte balance in healthy tetraplegic subjects with a normal lifestyle. We decided to undertake a pilot study to attempt to establish baseline ADH levels in this subject group, to better understand and manage tetraplegic patients with water and electrolyte dysregulation. Our preliminary data suggest that these individuals lack the normal diurnal variation of ADH, a phenomenon similar to that demonstrated in enuretic children and elderly, and furthermore appear to have generally depressed ADH levels.

Adult↗
PubMed1976

[Physiopathology of arterial hypertension. Role of the nervous system and of the hormones].

Maintenance of normotension rests upon the overall salt and water balance, which, in the event of disequilibrium, modifies body fluid, cardiac output and total peripheral resistance. The kidneys play a central role in this hydro-saline regulation. The central and autonomous nervous systems, the renin-angiotensin system, the mineralocorticoids, the antidiuretic hormone and the kallikrein-bradykinin-prostaglandin system all affect this regulation and are closely interrelated. The role of each of these nervous and endocrine systems in hypertension, and their close interrelationship, is briefly reviewed.

Aldosterone↗
PubMed1988

[L-thiazolidine-4-carboxylic acid as a source of cysteine in parenteral nutrition].

In this study we investigated, whether L-thiazolidine-4-carboxylic acid (TAC), a cysteine derivative analogous to proline, may provide a useful nutrient in parenteral nutrition. Young male Sprague-Dawley rats were maintained entirely by parenteral nutrition for 15 days. Weight gain, nitrogen balance, taurine and cystine concentrations of the various body fluids and tissues were the criteria for establishing the availability of cysteine from TAC.

Animals↗
PubMed1996

[Discovery of genetic polymorphism of human nucleases].

Research into the use of new genetic markers is difficult and costly, but it is necessary for more accurate criminal individualization and paternity testing as well as for analysis of genetic diseases. Recently, we discovered that human ribonuclease (RNase), deoxyribonuclease I (DNase I) and deoxyribonuclease II (DNase II) are characteristic markers showing genetic polymorphism and useful for forensic investigation. DNase I is particularly well suited to practical use, since it shows a well-balanced gene frequency, a high concentration in several body fluids (blood, sweat, urine, breast milk and semen) and tissues (pancreas, liver and kidney), stability against severe conditions (exposure of test samples to high temperature, high humidity and long-term storage), and easy and accurate detectability.

Exoribonucleases↗
PubMed1998

[Overview of the current status of measurable parameters of cartilage metabolism in various body fluids].

The human cartilage and bone is characterized by a remodeling during the life, well balanced by neosynthesis and degradation of matrix components. In different joint diseases, it becomes imbalanced and the destruction of the cartilage supersedes the repair. In tissue processes in disease and in normal turnover of the matrix, these molecules are fragmented and released into surrounding fluids, in the synovial fluid, and then in the blood and the urine, where they can be detected. The quantitative measurement in the synovial fluid is more specific than in the other body fluids. The research process in recent years has suggested that these molecular markers of cartilage and bone matrix metabolism can be used to determine diagnosis, the disease severity rather than its presence or absence, the prognosis, and the response to therapy. They should help to identify the disease mechanism in different joint diseases not only on the tissue but also on the molecular level. The specific cartilage matrix markers promise to become useful tools in the future in clinical use. The research in this area is still in the early stages, with most results dated from the end of the 1980s and the 1990s.

Aggrecans↗
PubMed2001

[A new concept to explain dysnatremia: the tonicity balance of entries and exits].

Plasma sodium concentration, or natremia, results from three main factors: exchangeable sodium (Na+), exchangeable potassium (K+) and total body water (H2O). Its alterations often imply a change in cell volume. Understanding dysnatremias is essential for the treatment and prevention of hydromineral disorders. Extra-cellular fluid tonomoles consist almost exclusively of Na+ salts. Their dilution is the tonicity. K+ is an essential tonomole for intra-cellular fluid tonicity. The balance between intra and extracellular tonicities depends on water movements and is responsible for changes in intra- and extracellular fluid volumes. Cell volume is therefore depending on the tonicity balance. A change in body tonicity (which is not osmolality) can be correctly and rapidly appreciated by measuring the (Na+ + K+) and H2O balances. Clinical cases emphasize the misleadings resulting from the free-water clearance calculation or the only measurements of urinary losses. They also demonstrate that tonicity balance provides indications for therapy whereas analyses based upon electrolyte-free water do not. Intakes should be quantified with the same care than losses. The units used must be coherent to allow a quick and easy understanding at the bedside. Tonicity balance should be taught and Na+ + K+ and H2O balances should be routinely utilized by practitioners, dieticians and nurses in the concerned pediatrics, in particular intensive care, internal medicine, nephrology, pediatry and anesthesiology.

Adolescent↗
PubMed1978

The relationship between body fluid volume, sodium ion concentration, and sensitivity to pressor effect of angiotensin II in dogs.

Extracellular fluid volume, plasma electrolyes, and plasma angiotensin II (A II) were individually controlled to determine their influence on the acute pressor responsiveness to A II. Hemodialysis of nephrectomized dogs was used to simulate and control the changes of major variables which occur in the intact state during changes in sodium balance. A II dose-pressure response curves were determined in 11 dogs at three volume states with plasma [Na+] maintained constant and in five dogs at low, normal, and high plasma [Na+] with body fluid volume maintained constant. Parallel shifts of the log dose-response curves were obtained in the three volume states. The same rise in arterial pressure with identical doses of A II was obtained at normal, contracted, and expanded volume states, with the change of arterial pressure based on the uncompensated basal pressure level at each volume state. When the fall in pressure observed during volume depletion was returned to control levels with norepinephrine, there was no change in the A II dose-response relationship from the control state. No difference in the A II dose-pressure response relationship was obtained between states of 140, 146, and 156 mEq/liter plasma [Na+] with body fluid volume held constant. The studies indicate that short-term alterations in either sodium or water balance do not alter the "real" vascular sensitivity to A II. The "apparent" changes normally observed result from preexisting endogenous levels of circulating A II present at the time the dose-response curve is determined which probably alter the availability of receptor sites to A II.

Angiotensin II↗
PubMed1954

The chloride-water balance sheet; an aid in the management of difficult fluid balance problems.

In cases in which there is massive loss of fluids or electrolytes or prolonged decreased urinary output, an absolutely accurate knowledge of all water and chloride intake and output by all routes is necessary to avert large and often fatal errors in water and electrolyte therapy based on estimates made from nurses' notes alone. By use of the Scribner water-chloride balance sheet method of recording data, it is possible to determine with the necessary accuracy how much fluid and what kind of electrolytes to administer to achieve and maintain balance. The method is simple and can be put into effect in any hospital with the cooperation of an educated nursing and laboratory staff.

Acid-Base Imbalance↗
PubMed2004

Fresh whole blood versus reconstituted blood for pump priming in heart surgery in infants.

BACKGROUND: In an attempt to reduce the coagulopathic and inflammatory responses seen after cardiopulmonary bypass, the use of fresh whole blood during heart operations has become the standard of care for neonates and infants at many institutions. We compared the use of fresh whole blood with the use of a combination of packed red cells and fresh-frozen plasma (reconstituted blood) for priming of the cardiopulmonary bypass circuit. METHODS: We conducted a single-center, randomized, double-blind, controlled trial involving children less than one year of age who underwent open-heart surgery. Patients were assigned to receive either fresh whole blood that had been collected not more than 48 hours previously (96 patients) or reconstituted blood (104 patients) for bypass-circuit priming. Clinical outcomes and serologic measures of systemic inflammation and myocardial injury were compared between the groups. RESULTS: The group that received reconstituted blood had a shorter stay in the intensive care unit than the group that received fresh whole blood (70.5 hours vs. 97.0 hours, P=0.04). The group that received reconstituted blood also had a smaller cumulative fluid balance at 48 hours (-6.9 ml per kilogram of body weight vs. 28.8 ml per kilogram, P=0.003). Early postoperative chest-tube output, blood-product transfusion requirements, and levels of serum mediators of inflammation and cardiac troponin I were similar in the two groups. CONCLUSIONS: The use of fresh whole blood for cardiopulmonary bypass priming has no advantage over the use of a combination of packed red cells and fresh-frozen plasma during surgery for congenital heart disease. Moreover, circuit priming with fresh whole blood is associated with an increased length of stay in the intensive care unit and increased perioperative fluid overload.

Acute-Phase Proteins↗
PubMed1986

Transcapillary colloid osmotic gradient and body fluid volumes in renal failure.

The aim was to study the transcapillary fluid balance in dialysis patients during and after ultrafiltration. Plasma and subcutaneous interstitial fluid (wick technique) colloid osmotic pressure, plasma volume (I125-albumin space) and extracellular fluid volume (radiosulfate space) were measured in nine patients on maintenance hemodialysis before (pre-dialysis state) and after (dry-weight state) ultrafiltration. In the pre-dialysis state, interstitial colloid osmotic pressure was reduced compared to normal controls (12.7 +/- 3.5 versus 15.8 +/- 2.7 mmHg, mean values +/- SD) and transcapillary colloid osmotic gradient increased (15.3 +/- 3.0 versus 12.8 +/- 2.7 mmHg). Ultrafiltration resulted in a parallel decrease of plasma volume and interstitial fluid volume of 19 to 20%, and an increase in mean interstitial colloid osmotic pressure of 3.4 mmHg and in mean transcapillary colloid osmotic gradient of 1.9 mmHg. The mean ultrafiltration rate was 21.9 +/- 1.9 ml/min and the plasma refilling rate was 16.5 +/- 2.7 ml/min. It is concluded that the changes in plasma and interstitial fluid colloid osmotic pressure tend to preserve plasma volume and limit the interdialytic increase in interstitial fluid volume.

Aged↗