miércoles, 11 de mayo de 2016

Líquidos en UCI / IV fluids in intensive care

Abril 30, 2016. No. 2312



Meta-análisis de la resucitación hídrica con contenido alto o bajo de cloro en el perioperatorio y en UCI
Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation.
Br J Surg. 2015 Jan;102(1):24-36. doi: 10.1002/bjs.9651. Epub 2014 Oct 30.
Abstract
BACKGROUND: The objective of this systematic review and meta-analysis was to assess the relationship between the chloride content ofintravenous resuscitation fluids and patient outcomes in the perioperative or intensive care setting.CONCLUSION: A weak but significant association between higher chloride content fluids and unfavourable outcomes was found, but mortality was unaffected by chloride content.
PDF 
¿Qué hay de Nuevo en el manejo de volumen en terapia intensiva?
What's new in volume therapy in the intensive care unit?
Best Pract Res Clin Anaesthesiol. 2014 Sep;28(3):275-83. doi: 10.1016/j.bpa.2014.06.004. Epub 2014 Jul 17.
Abstract
The administration of intravenous fluid to critically ill patients is one of the most common but also one of the most fiercely debated interventions in intensive care medicine. During the past decade, a number of important studies have been published which provide clinicians with improved knowledge regarding the timing, the type and the amount of fluid they should give to their critically ill patients. However, despite the fact that many thousands of patients have been enrolled in these trials of alternative fluid strategies, consensus remains elusive and practice is widely variable. Early adequate resuscitation of patients in shock followed by a restrictive strategy may be associated with better outcomes. Colloids such as modern hydroxyethyl starch are more effective than crystalloids in early resuscitation of patients in shock, and are safe when administered during surgery. However, these colloids may not be beneficial later in the course of intensive care treatment and should best be avoided in intensive carepatients who have a high risk of developing acute kidney injury. Albumin has no clear benefit over saline and is associated with increased mortality in neurotrauma patients. Balanced fluids reduce the risk of hyperchloraemic acidosis and possibly kidney injury. The use of hypertonic fluids in patientswith sepsis and acute lung injury warrants further investigation and should be considered experimental at this stage. Fluid therapy impacts relevant patient-related outcomes. Clinicians should adopt an individualized strategy based on the clinical scenario and best available evidence. One size does not fit all.
KEYWORDS: albumin; colloid; crystalloid; fluid; hypertonic; intensive care; resuscitation; shock
 Uso de líquidos en terapia intensiva de adultos
Fluid use in adult intensive care.
Anaesthesiol Intensive Ther. 2012 Aug 8;44(2):92-5.
Abstract
Methods for the restoration of circulating blood volume, including the use of intravenous fluids, have been widely discussed over many years. There are no clear guidelines regarding the type of solutions, the total volume that should be transfused, or time schedules. Colloid solutions, usually hydroxyethyl starch compositions, are probably the most commonly used volume expanders in resuscitation, despite the lack of convincing trials and possible nephrotoxicity.In 2012, a task force of ESICM published a consensus statement on colloid use in critically ill adult patients. They stressed that infusion of an inappropriate volume may worsen the outcome of critically ill patients. Static parameters of cardiac filling volume, such as CVP or PCWP, commonly used in clinical practice, were found to be useless in the prediction of fluid responsiveness; volumetric or dynamic parameters, like global end diastolic volume (GEDV) or stroke volume variations (SVV), obtained by PICCO meters, seemed be much more appropriate. The dynamic fluid challenge test, which is transfusion of approx. 200 cc (or 3 mL kg-1) of any fluid over 5-10 min resulting in an increase of stroke volume, has also been recommended for the identification of those patients who may benefit from fluid resuscitation. The old passive leg raising test can also be used for this purpose.Despite prolonged discussion about fluid therapy in specific groups of critically ill patients, there is no convincing data to indicate the superiority of colloids over crystalloids. The choice of fluids is usually based on personal preference and hospital policy. Among crystalloid solutions, balanced preparations such as acetates, lactates, malates or citrates are recommended to avoid hyperchloraemia, a common side effect of saline infusion. There is no agreement regarding colloid solutions.The fluid transfusion regimen in criticallyill patients should therefore be based on clinical assessment and patient responses.
Committee for European Education in Anaesthesiology (CEEA)
Colegio de Anestesiólogos de León AC
MÓDULO V: Sistema nervioso, fisiología, anestesia locoregional y dolor.
Reconocimientos de: CEEA, CLASA, Consejo Nacional Mexicano de Anestesiología.  
En la Ciudad de Léon, Guanajuato. México del 6 al 8 de Mayo, 2016.
Informes en el tel (477) 716 06 16 y con el Dr. Enrique Hernández kikinhedz@gmail.com
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Anestesiología y Medicina del Dolor

52 664 6848905

Copyright © 2015

Líquidos en UCI / IV fluids in intensive care

Abril 30, 2016. No. 2312



Meta-análisis de la resucitación hídrica con contenido alto o bajo de cloro en el perioperatorio y en UCI
Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation.
Br J Surg. 2015 Jan;102(1):24-36. doi: 10.1002/bjs.9651. Epub 2014 Oct 30.
Abstract
BACKGROUND: The objective of this systematic review and meta-analysis was to assess the relationship between the chloride content ofintravenous resuscitation fluids and patient outcomes in the perioperative or intensive care setting.CONCLUSION: A weak but significant association between higher chloride content fluids and unfavourable outcomes was found, but mortality was unaffected by chloride content.
PDF 
¿Qué hay de Nuevo en el manejo de volumen en terapia intensiva?
What's new in volume therapy in the intensive care unit?
Best Pract Res Clin Anaesthesiol. 2014 Sep;28(3):275-83. doi: 10.1016/j.bpa.2014.06.004. Epub 2014 Jul 17.
Abstract
The administration of intravenous fluid to critically ill patients is one of the most common but also one of the most fiercely debated interventions in intensive care medicine. During the past decade, a number of important studies have been published which provide clinicians with improved knowledge regarding the timing, the type and the amount of fluid they should give to their critically ill patients. However, despite the fact that many thousands of patients have been enrolled in these trials of alternative fluid strategies, consensus remains elusive and practice is widely variable. Early adequate resuscitation of patients in shock followed by a restrictive strategy may be associated with better outcomes. Colloids such as modern hydroxyethyl starch are more effective than crystalloids in early resuscitation of patients in shock, and are safe when administered during surgery. However, these colloids may not be beneficial later in the course of intensive care treatment and should best be avoided in intensive carepatients who have a high risk of developing acute kidney injury. Albumin has no clear benefit over saline and is associated with increased mortality in neurotrauma patients. Balanced fluids reduce the risk of hyperchloraemic acidosis and possibly kidney injury. The use of hypertonic fluids in patientswith sepsis and acute lung injury warrants further investigation and should be considered experimental at this stage. Fluid therapy impacts relevant patient-related outcomes. Clinicians should adopt an individualized strategy based on the clinical scenario and best available evidence. One size does not fit all.
KEYWORDS: albumin; colloid; crystalloid; fluid; hypertonic; intensive care; resuscitation; shock
 Uso de líquidos en terapia intensiva de adultos
Fluid use in adult intensive care.
Anaesthesiol Intensive Ther. 2012 Aug 8;44(2):92-5.
Abstract
Methods for the restoration of circulating blood volume, including the use of intravenous fluids, have been widely discussed over many years. There are no clear guidelines regarding the type of solutions, the total volume that should be transfused, or time schedules. Colloid solutions, usually hydroxyethyl starch compositions, are probably the most commonly used volume expanders in resuscitation, despite the lack of convincing trials and possible nephrotoxicity.In 2012, a task force of ESICM published a consensus statement on colloid use in critically ill adult patients. They stressed that infusion of an inappropriate volume may worsen the outcome of critically ill patients. Static parameters of cardiac filling volume, such as CVP or PCWP, commonly used in clinical practice, were found to be useless in the prediction of fluid responsiveness; volumetric or dynamic parameters, like global end diastolic volume (GEDV) or stroke volume variations (SVV), obtained by PICCO meters, seemed be much more appropriate. The dynamic fluid challenge test, which is transfusion of approx. 200 cc (or 3 mL kg-1) of any fluid over 5-10 min resulting in an increase of stroke volume, has also been recommended for the identification of those patients who may benefit from fluid resuscitation. The old passive leg raising test can also be used for this purpose.Despite prolonged discussion about fluid therapy in specific groups of critically ill patients, there is no convincing data to indicate the superiority of colloids over crystalloids. The choice of fluids is usually based on personal preference and hospital policy. Among crystalloid solutions, balanced preparations such as acetates, lactates, malates or citrates are recommended to avoid hyperchloraemia, a common side effect of saline infusion. There is no agreement regarding colloid solutions.The fluid transfusion regimen in criticallyill patients should therefore be based on clinical assessment and patient responses.
Committee for European Education in Anaesthesiology (CEEA)
Colegio de Anestesiólogos de León AC
MÓDULO V: Sistema nervioso, fisiología, anestesia locoregional y dolor.
Reconocimientos de: CEEA, CLASA, Consejo Nacional Mexicano de Anestesiología.  
En la Ciudad de Léon, Guanajuato. México del 6 al 8 de Mayo, 2016.
Informes en el tel (477) 716 06 16 y con el Dr. Enrique Hernández kikinhedz@gmail.com
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905

Copyright © 2015

Cirugía bariatrica / Bariatric surgery

Mayo 11, 2016. No. 2323


 



Implementación mejorada del protocolo de recuperación después de la cirugía bariátrica: un estudio retrospectivo.
Implementing enhanced recovery after bariatric surgery protocol: a retrospective study.
J Anesth. 2016 Feb;30(1):170-3. doi: 10.1007/s00540-015-2089-6. Epub 2015 Oct 24.
Abstract
While the demand for bariatric surgery is increasing, hospital capacity remains limited. The ERABS (Enhanced Recovery After Bariatric Surgery) protocol has been implemented in a number of bariatric centers. We retrospectively compared the operating room logistics and postoperative complications between pre-ERABS and ERABS periods in an academic hospital. The primary endpoint was the length of stay in hospital. The secondary endpoints were turnover times-the time required for preparing the operating room for the next case, induction time (from induction ofanesthesia until a patient is ready for surgery), surgical time (duration of surgery), procedure time (duration of stay in the operating room), and the incidence of re-admissions, re-operations and complications during admission and within 30 days after surgery. Of a total of 374 patients, 228 and 146 received surgery following the pre-ERABS and ERABS protocols, respectively. The length of hospital stay was significantly shortened from 3.7 (95 % confidence interval [CI] 3.1-4.7) days to 2.1 (95 % CI 1.6-2.6) days (P < 0.001). Procedure (surgical) times were shortened by 15 (7) min and 12 (5) min for gastric bypass and gastric sleeve surgery, respectively (P < 0.001 for both), by introducing the ERABS protocol. Induction times were reduced from 15.2 (95 % CI 14.3-16.1) min to 12.5 (95 % CI 11.7-13.3) min (P < 0.001).Turnover times were shortened significantly from 38 (95 % CI 44-32) min to 11 (95 % CI 8-14) min. The incidence of re-operations, re-admissions and complications did not change.
KEYWORDS: Bariatric surgery; Early recovery after bariatric surgery; Gastric bypass; Sleeve gastrectomy and morbid obesity
PDF 
VIII Foro Internacional de Medicina del Dolor y Paliativa 
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Junio 9-11, Ciudad de México
Dra. Argelia Lara Solares
Tel. 5513 3782  www.dolorypaliativos.org 
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Anestesiología y Medicina del Dolor

52 664 6848905

Copyright © 2015