RESUMO
Introduction: The medium for avulsed teeth storage until their reimplantation is key to the preservation of human periodontal ligament fibroblasts (HPLF). Objective: Our purpose was to compare the cytotoxic effect of milk and isotonic solution, used for the storage of avulsed teeth, on the preservation of HPLF. Method: A subculture of periodontal ligament fibroblasts was carried out with a density of 1:2 (3 ×105 cells/mL) and was incubated for 48 hours. The cells were divided in two groups, which were placed either in milk or isotonic solution for 24 hours at 5% CO2, 37 ºC and 95% humidity. The number of viable cells was determined with a colorimetric fast assay by the reduction of MTT and mitochondrial activity. Data were processed with the Shapiro-Wilk normality test, Student's t-test and paired Student's t-test (with significance set at 0.05). Results: The cells exposed to milk for 24 hours showed statistically significant cytotoxicity at concentrations of 0.09, 0.39, 0.78, 1.56, 3.125, 6.25 and 50%. HPLFs exposed to isotonic solution showed no significant reduction in the number of cells at concentrations of 25 and 50%. Conclusion: Isotonic solution appears to be better for HPLF 24-hour storage in comparison with whole milk.
Introducción: El medio de almacenamiento de los dientes avulsionados hasta su reimplante es vital para conservar los fibroblastos del ligamento periodontal humano (HPLF). Objetivo: Comparar el efecto citotóxico para conservar los HPLF de la leche y la solución isotónica para almacenamiento de dientes avulsionados. Método: Se realizó subcultivo de fibroblastos del ligamento periodontal con una densidad de 1:2 (3 × 105 células/mL), que fueron incubados por 48 horas. Se integraron dos grupos de células, que se colocaron en leche y solución isotónica durante 24 horas a 5 % de CO2, a 37°C y 95 % de humedad. El número de células viables fue determinado por colorimetría rápida por reducción de MTT y actividad mitocondrial. Los datos fueron sometidos a pruebas de normalidad de Shapiro-Wilk, t de Student y t de Student pareada (significación de 0.05). Resultados: Las células expuestas a la leche por 24 horas mostraron citotoxicidad estadísticamente significativa a concentraciones de 0.09, 0.39, 0.78, 1.56, 3.125, 6.25 y 50 %. Los HPLF expuestos a solución isotónica no mostraron reducción significativa del número de células a concentraciones de 25 y 50 %. Conclusión: La solución isotónica parece mejor para el almacenamiento de HPLF en 24 horas, comparada con la leche entera.
Assuntos
Citotoxinas/efeitos adversos , Fibroblastos/efeitos dos fármacos , Soluções Isotônicas/efeitos adversos , Leite/efeitos adversos , Soluções para Preservação de Órgãos/efeitos adversos , Ligamento Periodontal/citologia , Avulsão Dentária , Animais , Células Cultivadas , HumanosRESUMO
BACKGROUND: Tetrastarch can cause acute kidney injury (AKI) in humans with sepsis, but less likely to result in tissue edema than lactated Ringer's solution (LRS). OBJECTIVES: Compare effects of volume replacement (VR) with LRS and 6% tetrastarch solution (TS) on extravascular lung water (EVLW) and markers of AKI in hemorrhaged dogs. ANIMALS: Six healthy English Pointer dogs (19.7-35.3 kg). METHODS: Prospective crossover study. Animals underwent anesthesia without hemorrhage (Control). Two weeks later, dogs hemorrhaged under anesthesia on 2 occasions (8-week washout intervals) and randomly received VR with LRS or TS at 3 : 1 or 1 : 1 of shed blood, respectively. Anesthesia was maintained until 4 hour after VR for EVLW measurements derived from transpulmonary thermodilution cardiac output. Neutrophil gelatinase-associated lipocalin (NGAL) and creatinine concentrations in plasma and urine were measured until 72 hour after VR. RESULTS: The EVLW index (mL/kg) was lower at 1 hour after TS (10.0 ± 1.9) in comparison with controls (11.9 ± 3.4, P = 0.04), and at 4 hour after TS (9.7 ± 1.9) in comparison with LRS (11.8 ± 2.7, P = 0.03). Arterial oxygen partial pressure-to-inspired oxygen fraction ratio did not differ among treatments from 0.5 to 4 hour after VR. Urine NGAL/creatinine ratio did not differ among treatments and remained below threshold for AKI (120,000 pg/mg). CONCLUSIONS AND CLINICAL IMPORTANCE: Although TS causes less EVLW accumulation than LRS, neither fluid produced evidence of lung edema (impaired oxygenation). Both fluids appear not to cause AKI when used for VR after hemorrhage in healthy nonseptic dogs.
Assuntos
Água Extravascular Pulmonar/efeitos dos fármacos , Derivados de Hidroxietil Amido/farmacologia , Soluções Isotônicas/farmacologia , Anestésicos Inalatórios/administração & dosagem , Animais , Débito Cardíaco/efeitos dos fármacos , Creatinina/sangue , Creatinina/urina , Estudos Cross-Over , Cães , Feminino , Hemorragia , Derivados de Hidroxietil Amido/efeitos adversos , Isoflurano/administração & dosagem , Soluções Isotônicas/efeitos adversos , Lipocalina-2/sangue , Lipocalina-2/urina , Masculino , Substitutos do Plasma/efeitos adversos , Substitutos do Plasma/farmacologia , Estudos Prospectivos , Lactato de RingerRESUMO
RESUMO A administração de fluidos em tempo adequado é crucial para a manutenção da perfusão tissular nos pacientes com choque séptico. Entretanto, a questão da escolha do fluido a ser utilizado para ressuscitação no choque séptico ainda é um assunto em debate. É crescente o corpo de evidência que sugere que o tipo, a quantidade e o momento da administração de fluidos durante a evolução da sepse podem afetar os desfechos do paciente. Os cristaloides têm sido recomendados como fluidos a serem administrados em primeira linha na ressuscitação do choque. No entanto, à luz da natureza inconclusiva da literatura disponível, não se podem fazer recomendações definitivas quanto à solução cristaloide mais apropriada. A ressuscitação de pacientes críticos sépticos e não sépticos com cristaloides não balanceados, principalmente a solução salina a 0,9%, tem sido associada a uma maior incidência de desordens do equilíbrio ácido-base e a distúrbios eletrolíticos, além de poder se associar à maior incidência de lesão renal aguda, à maior necessidade de terapia de substituição renal e à mortalidade. Foi proposto o uso de soluções cristaloides balanceadas como uma alternativa às soluções de cristaloides não balanceados, para mitigar seus efeitos deletérios. Entretanto, a segurança e a eficácia dos cristaloides balanceados para ressuscitação do choque séptico necessitam ser mais bem exploradas em estudos clínicos bem delineados, randomizados e controlados, multicêntricos e pragmáticos.
ABSTRACT Timely fluid administration is crucial to maintain tissue perfusion in septic shock patients. However, the question concerning which fluid should be used for septic shock resuscitation remains a matter of debate. A growing body of evidence suggests that the type, amount and timing of fluid administration during the course of sepsis may affect patient outcomes. Crystalloids have been recommended as the first-line fluids for septic shock resuscitation. Nevertheless, given the inconclusive nature of the available literature, no definitive recommendations about the most appropriate crystalloid solution can be made. Resuscitation of septic and non-septic critically ill patients with unbalanced crystalloids, mainly 0.9% saline, has been associated with a higher incidence of acid-base balance and electrolyte disorders and might be associated with a higher incidence of acute kidney injury. This can result in greater demand for renal replacement therapy and increased mortality. Balanced crystalloids have been proposed as an alternative to unbalanced solutions in order to mitigate their detrimental effects. Nevertheless, the safety and effectiveness of balanced crystalloids for septic shock resuscitation need to be further addressed in a well-designed, multicenter, pragmatic, randomized controlled trial.
Assuntos
Humanos , Ressuscitação/métodos , Choque Séptico/terapia , Soluções Isotônicas/administração & dosagem , Ressuscitação/efeitos adversos , Equilíbrio Ácido-Base , Estado Terminal , Sepse/terapia , Hidratação/efeitos adversos , Hidratação/métodos , Soluções Cristaloides , Soluções Isotônicas/efeitos adversosRESUMO
We investigated the influence of different fluid resuscitation techniques on the number of myeloid-derived suppressor cells (MDSCs) in rats. Seventy-two healthy Sprague-Dawley rats were randomly divided into groups that received sham operation (Sham group), hypertonic saline (HRS group), lactated ringer's solution (LRS group), or crystalloid solution (LCRS group). Six rats from each group were sacrificed by cervical dislocation at 12, 24, and 48 h after resuscitation. The spleens were harvested under sterile conditions and spleen cell suspension was prepared. The number of MDSCs was detected using flow cytometry. The number of MDSCs in the Sham group did not differ significantly among the different time points. Compared with the Sham group, the number of MDSCs after the use of the different fluid resuscitation techniques increased to varying extents and the differences among the groups were significant. The number of MDSCs in the HRS group was much lower than that of the LRS and LCRS groups at both 24 and 48 h (P < 0.05). At 12 h, the number of MDSCs in the HRS group was significantly lower than that of the LRS group (P < 0.05). The differences between the HRS and LCRS groups were not statistically significant. Shortly after hemorrhagic shock resuscitation, the immune function of rats was suppressed to a varying extent and was gradually restored over time. Resuscitation with HRS alleviated the immunosuppression at the early stage after shock.
Assuntos
Soluções Isotônicas/efeitos adversos , Células Supressoras Mieloides/efeitos dos fármacos , Soluções para Reidratação/efeitos adversos , Ressuscitação/métodos , Solução Salina Hipertônica/efeitos adversos , Animais , Soluções Cristaloides , Ratos , Ratos Sprague-Dawley , Ressuscitação/efeitos adversos , Lactato de Ringer , Baço/citologia , Baço/efeitos dos fármacosRESUMO
Timely fluid administration is crucial to maintain tissue perfusion in septic shock patients. However, the question concerning which fluid should be used for septic shock resuscitation remains a matter of debate. A growing body of evidence suggests that the type, amount and timing of fluid administration during the course of sepsis may affect patient outcomes. Crystalloids have been recommended as the first-line fluids for septic shock resuscitation. Nevertheless, given the inconclusive nature of the available literature, no definitive recommendations about the most appropriate crystalloid solution can be made. Resuscitation of septic and non-septic critically ill patients with unbalanced crystalloids, mainly 0.9% saline, has been associated with a higher incidence of acid-base balance and electrolyte disorders and might be associated with a higher incidence of acute kidney injury. This can result in greater demand for renal replacement therapy and increased mortality. Balanced crystalloids have been proposed as an alternative to unbalanced solutions in order to mitigate their detrimental effects. Nevertheless, the safety and effectiveness of balanced crystalloids for septic shock resuscitation need to be further addressed in a well-designed, multicenter, pragmatic, randomized controlled trial.
Assuntos
Soluções Isotônicas/administração & dosagem , Ressuscitação/métodos , Choque Séptico/terapia , Equilíbrio Ácido-Base , Estado Terminal , Soluções Cristaloides , Hidratação/efeitos adversos , Hidratação/métodos , Humanos , Soluções Isotônicas/efeitos adversos , Ressuscitação/efeitos adversos , Sepse/terapiaRESUMO
Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to renal failure. The objective of this systematic review and meta-analysis is to compare the use of last-generation colloids, derived from corn, with crystalloids in GDFT to determine associated complications and mortality. A bibliographic research was carried out in MEDLINE PubMed, EMBASE and Cochrane Library, corroborating randomized clinical trials where crystalloids are compared to colloids in GDFT for major non-cardiac surgery in adults. One hundred thirty references were found and among those 38 were selected and 29 analyzed; of these, six were included for systematic review and meta-analysis, including 390 patients. It was observed that the use of colloids is not associated with the increase of complications, but rather with a tendency to a higher mortality (RR [95% CI] 3.87 [1.121-13.38]; Because of the limitations of this meta-analysis due to the small number of randomized clinical trials and patients included, the results should be taken cautiously, and the performance of new randomized clinical trials is proposed, with enough statistical power, comparing balanced and unbalanced colloids to balanced and unbalanced crystalloids, following the protocols of GDFT, considering current guidelines and suggestions made by groups of experts.
Foram feitos múltiplos ensaios clínicos em fluidoterapia guiada por objetivos (FGO), muitos deles com o uso de coloides para aprimoramento da pré-carga. Após a decisão da Agência Europeia de Medicamentos, existe ainda controvérsia sobre seu uso, seus benefícios e sua possível contribuição para a falência renal. O objetivo desta revisão sistemática e metanálise é comparar o uso de coloides de última geração, derivados de milho, com cristaloides em FGO para determinar as complicações e a mortalidade associadas. Busca bibliográfica em Medline, Pubmed, Embase e Biblioteca Cochrane de ensaios clínicos aleatórios nos quais se comparam cristaloides com coloides dentro de FGO para cirurgia não cardíaca de grande porte em adultos. Foram obtidas 130 referências das quais se selecionaram 38 e 29 foram analisadas; dessas, seis foram incluídas para revisão sistemática e metanálise, incluindo 390 pacientes. Observou-se que o uso de coloides não está associado a um aumento de complicações, mas sim a uma tendência a maior mortalidade (RR [IC 95%] 3,87 [1,121-13,38]; I2 = 0,0%; p = 0,635). Devido às limitações desta metanálise em decorrência do número escasso de ensaios clínicos aleatórios e pacientes incluídos, os resultados devem ser usados com cautela e propõe-se a feitura de novos ensaios clínicos aleatórios, com potência estatística suficiente naqueles em que se comparam coloides balanceados e não balanceados com cristaloides balanceados e não balanceados, dentro de protocolos de FGO, que respeitem as indicações atuais e as sugestões emitidas pelos grupos de especialistas.
Se han realizado múltiples ensayos clínicos en fluidoterapia guiada por objetivos (FGO), muchos de ellos con el uso de coloides para la optimización de la precarga. Tras la decisión de la Agencia Europea del Medicamento, existe cierta controversia en cuanto a su utilización, beneficios y su posible contribución al fallo renal. El objetivo de esta revisión sistemática y metaanálisis es comparar el uso de coloides de última generación, derivados del maíz, con cristaloides en FGO para determinar las complicaciones y la mortalidad asociadas. Se realiza una búsqueda bibliográfica en MEDLINE Pubmed, EMBASE y Cochrane Library comprobando ensayos clínicos aleatorizados en los que se comparan cristaloides con coloides dentro de FGO para cirugía mayor no cardíaca de adultos. Se obtuvieron 130 referencias de las que se seleccionaron 38 y 29 fueron analizadas; de ellas 6 fueron incluidas para revisión sistemática y metaanálisis, incluyendo a 390 pacientes. Se apreció que el uso de coloides no se asocia con un aumento de complicaciones pero sí con una tendencia a mayor mortalidad (RR [IC 95%] 3,87 [1,121-13,38]; I2 = 0,0%; p = 0,635). Debido a las limitaciones de este metaanálisis por el escaso número de ensayos clínicos aleatorizados y pacientes incluidos, los resultados deben tomarse con cautela, y se propone la realización de nuevos ensayos clínicos aleatorizados, con suficiente potencia estadística en los que se comparen coloides balanceados y no balanceados con cristaloides balanceados y no balanceados, dentro de protocolos de FGO, respetando las indicaciones actuales y las sugerencias emitidas por los grupos de expertos.
Assuntos
Humanos , Adulto , Coloides/administração & dosagem , Hidratação/métodos , Soluções Isotônicas/administração & dosagem , Procedimentos Cirúrgicos Operatórios/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Coloides/efeitos adversos , Hidratação/efeitos adversos , Soluções Cristaloides , Soluções Isotônicas/efeitos adversosRESUMO
INTRODUCTION: Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to renal failure. The objective of this systematic review and meta-analysis is to compare the use of last-generation colloids, derived from corn, with crystalloids in GDFT to determine associated complications and mortality. METHODS: A bibliographic research was carried out in MEDLINE PubMed, EMBASE and Cochrane Library, corroborating randomized clinical trials where crystalloids are compared to colloids in GDFT for major non-cardiac surgery in adults. RESULTS: One hundred thirty references were found and among those 38 were selected and 29 analyzed; of these, six were included for systematic review and meta-analysis, including 390 patients. It was observed that the use of colloids is not associated with the increase of complications, but rather with a tendency to a higher mortality (RR [95% CI] 3.87 [1.121-13.38]; I(2)=0.0%; p=0.635). CONCLUSIONS: Because of the limitations of this meta-analysis due to the small number of randomized clinical trials and patients included, the results should be taken cautiously, and the performance of new randomized clinical trials is proposed, with enough statistical power, comparing balanced and unbalanced colloids to balanced and unbalanced crystalloids, following the protocols of GDFT, considering current guidelines and suggestions made by groups of experts.
Assuntos
Coloides/administração & dosagem , Hidratação/métodos , Soluções Isotônicas/administração & dosagem , Adulto , Coloides/efeitos adversos , Soluções Cristaloides , Hidratação/efeitos adversos , Humanos , Soluções Isotônicas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Operatórios/métodosRESUMO
OBJECTIVE: To determine whether the use of hypotonic vs isotonic maintenance fluids confers an increased risk of hyponatremia in hospitalized children. STUDY DESIGN: A search of MEDLINE (1946 to January 2013), the Cochrane Central Registry (1991 to December 2012), Cumulative Index for Nursing and Allied Health Literature (1990 to December 2012), and Pediatric Academic Societies (2000-2012) abstracts was conducted using the terms "hypotonic fluids/saline/solutions" and "isotonic fluids/saline/solutions," and citations were reviewed using a predefined protocol. Data on the primary and secondary outcomes were extracted from original articles by 2 authors independently. Meta-analyses of the primary and secondary outcomes were performed when possible. RESULTS: A total of 1634 citations were screened. Ten studies (n = 893) identified as independent randomized controlled trials were included. Five studies examined subjects in the intensive care unit setting, including 4 on regular wards and 1 in a mixed setting. In hospitalized children receiving maintenance intravenous fluids, hyponatremia was seen more often in those receiving hypotonic fluids than in those receiving isotonic fluids, with an overall relative risk of 2.37 (95% CI, 1.72-3.26). Receipt of hypotonic fluids was associated with a relative risk of moderate hyponatremia (<130 mmol/L) of 6.1 (95% CI, 2.2-17.3). A subgroup analysis of hypotonic fluids with half-normal saline found a relative risk of hyponatremia of 2.42 (95% CI, 1.32-4.45). CONCLUSION: In hospitalized children in intensive care and postoperative settings, the administration of hypotonic maintenance fluids increases the risk of hyponatremia when compared with administration of isotonic fluids. For patients on general wards, insufficient data are available based on the reviewed studies, and individual risk factors must be assessed.
Assuntos
Criança Hospitalizada , Hidratação/métodos , Hiponatremia/etiologia , Soluções Hipotônicas/efeitos adversos , Soluções Isotônicas/efeitos adversos , Criança , Pré-Escolar , Humanos , Soluções Hipotônicas/administração & dosagem , Lactente , Infusões Intravenosas , Soluções Isotônicas/administração & dosagem , Risco , Medição de RiscoRESUMO
OBJECTIVE: To evaluate whether the administration of hypotonic fluids compared with isotonic fluids is associated with a greater risk for hyponatremia in hospitalized children. STUDY DESIGN: Informatics-enabled cohort study of all hospitalizations at Lucile Packard Children's Hospital between April 2009 and March 2011. Extraction and analysis of electronic medical record data identified normonatremic hospitalized children who received either hypotonic or isotonic intravenous maintenance fluids upon admission. The primary exposure was the administration of hypotonic maintenance fluids, and the primary outcome was the development of hyponatremia (serum sodium <135 mEq/L). RESULTS: A total of 1048 normonatremic children received either hypotonic (n = 674) or isotonic (n = 374) maintenance fluids upon admission. Hyponatremia developed in 260 (38.6%) children who received hypotonic fluids and 104 (27.8%) of those who received isotonic fluids (unadjusted OR 1.63; 95% CI 1.24-2.15, P < .001). After we controlled for intergroup differences and potential confounders, patients receiving hypotonic fluids remained more likely to develop hyponatremia (aOR 1.37, 95% CI 1.03-1.84). Multivariable analysis identified additional factors associated with the development of hyponatremia, including surgical admission (aOR 1.44, 95% CI 1.09-1.91), cardiac admitting diagnosis (aOR 2.08, 95% CI 1.34-3.20), and hematology/oncology admitting diagnosis (aOR 2.37, 95% CI 1.74-3.25). CONCLUSIONS: Hyponatremia was common regardless of maintenance fluid tonicity; however, the administration of hypotonic maintenance fluids compared with isotonic fluids was associated with a greater risk of developing hospital-acquired hyponatremia. Additional clinical characteristics modified the hyponatremic effect of hypotonic fluid, and it is possible that optimal maintenance fluid therapy now requires a more individualized approach.
Assuntos
Hidratação/efeitos adversos , Hiponatremia/epidemiologia , Hiponatremia/etiologia , Soluções Hipotônicas/efeitos adversos , Soluções Isotônicas/efeitos adversos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Hospitalização , Humanos , Lactente , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVES: To analyze the mechanism of acid-base disorders in liver transplant recipients and to examine the relationship between these disorders and the fluids administered during surgery. METHODS: This prospective study in a university-affiliated hospital intensive care unit (ICU) included 52 patients admitted to the ICU from December 2009 to January 2011. We examined the contributions of inorganic ion differences, lactate, unmeasured anions, phosphate, and albumin to metabolic acidosis. In addition to laboratory variables, we collected demographic and clinical data. RESULTS: Metabolic acidosis (standard base excess ≤ -2.0 mmol/L) was identified in 37 (71.2%) patients during the immediate postoperative period. The inorganic ion difference was the main determinant of acidosis, accounting for -6.17 mEq/L of acidifying effect. The acidemia was attenuated mainly by the alkalinizing effect of albumin reduction, which contributed +6.03 mEq/L. There was an inverse proportional relationship between the quantity of saline solution used during surgery and the inorganic ion difference during the immediate postoperative period. CONCLUSIONS: Hyperchloremia is the primary contributor to metabolic acidosis in liver transplant recipients. Possibly the use of chloride-rich solutions increases the incidence of this disorder.
Assuntos
Equilíbrio Ácido-Base , Acidose/etiologia , Substitutos Sanguíneos/efeitos adversos , Hidratação/efeitos adversos , Transplante de Fígado/efeitos adversos , Acidose/sangue , Acidose/fisiopatologia , Adulto , Albuminas/efeitos adversos , Alcalose/sangue , Alcalose/etiologia , Alcalose/fisiopatologia , Biomarcadores/sangue , Cloretos/sangue , Feminino , Gelatina/efeitos adversos , Hospitais Universitários , Humanos , Concentração de Íons de Hidrogênio , Derivados de Hidroxietil Amido/efeitos adversos , Unidades de Terapia Intensiva , Soluções Isotônicas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Lactato de Ringer , Cloreto de Sódio/efeitos adversos , Resultado do TratamentoRESUMO
OBJECTIVE: Intravenous infusion of crystalloid solutions is a cornerstone of the treatment of hemorrhagic shock. However, crystalloid solutions can have variable metabolic acid-base effects, perpetuating or even aggravating shock-induced metabolic acidosis. The aim of this study was to compare, in a controlled volume-driven porcine model of hemorrhagic shock, the effects of three different crystalloid solutions on the hemodynamics and acid-base balance. METHODS: Controlled hemorrhagic shock (40% of the total blood volume was removed) was induced in 18 animals, which were then treated with normal saline (0.9% NaCl), Lactated Ringer's Solution or Plasma-Lyte pH 7.4, in a blinded fashion (n = 6 for each group). Using a predefined protocol, the animals received three times the volume of blood removed. RESULTS: The three different crystalloid infusions were equally capable of reversing the hemorrhage-induced low cardiac output and anuria. The Lactated Ringer's Solution and Plasma-Lyte pH 7.4 infusions resulted in an increased standard base excess and a decreased serum chloride level, whereas treatment with normal saline resulted in a decreased standard base excess and an increased serum chloride level. The Plasma-Lyte pH 7.4 infusions did not change the level of the unmeasured anions. CONCLUSION: Although the three tested crystalloid solutions were equally able to attenuate the hemodynamic and tissue perfusion disturbances, only the normal saline induced hyperchloremia and metabolic acidosis.
Assuntos
Equilíbrio Ácido-Base/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Soluções Isotônicas/efeitos adversos , Choque Hemorrágico/tratamento farmacológico , Animais , Soluções Cristaloides , Modelos Animais de Doenças , Métodos Epidemiológicos , Gluconatos/efeitos adversos , Concentração de Íons de Hidrogênio , Soluções Isotônicas/classificação , Cloreto de Magnésio/efeitos adversos , Masculino , Cloreto de Potássio/efeitos adversos , Lactato de Ringer , Choque Hemorrágico/induzido quimicamente , Acetato de Sódio/efeitos adversos , Cloreto de Sódio/efeitos adversos , SuínosRESUMO
Desde que aparecieron los tratamientos médicos efectivos en el adenoma de próstata, tales como las nuevas generaciones de .-bloqueantes en las que han desaparecido sus principales inconvenientes y el Finasteride y sobre todo desde que se popularizo su uso conjunto, los tratamientos quirúrgicos se han visto muy disminuidos en su indicación por parte de los urólogos, a expensa de los tratamientos farmacológico. Pero esta situación ha traído consigo nuevos retos, pues si bien una importante cantidad de pacientes no ha necesitado tratamiento quirúrgico, muchos de ellos o no responden al tratamiento o con el tiempo se hacen refractarios al mismo no dejando otra solución que la cirugía. Desde hace muchos años la resección endoscópica-transuretral es el Gold Standard para el tratamiento quirúrgico de la Hipertrofia Benigna de la próstata. Pero en la actualidad, merced a que el tamaño de la glándula prostática que requiere cirugía es mayor que el que nos enfrentábamos con anterioridad y tratando de no volver a épocas y técnicas quirúrgicas que se consideraban superadas, se revisó todas las posibilidades tecnológicas para que la RTU con sus ya reconocidas ventajas pueda continuar siento la opción quirúrgica de elección.
Since the effective medical treatments appeared in the adenoma of prostate, such as the new generations of .-blockers in those that their main inconveniences and the Finasteride have disappeared and mainly since have popularizes their combined use, the surgical treatments have been very diminished, to the expense of the pharmacological treatments, in their indication on the part of the urologist. But this situation had brought new challenges, because although an important quantity of patients has not needed surgical treatment, many of them or they don't respond to the treatment or with the time they become refractory to the same one not leaving another solution except the surgery. For many years the transurethral endoscope resection is the Standard Gold for the surgical treatment of the Benign Hypertrophy of the prostate. But at the present time, thanks to that the size of the gland prostatic that requires surgery is, bigger than the one that we faced previously and trying not to return to times and technical surgical that were considered overcome, we revise all the technological possibilities so that the RTU with their grateful advantages can already continue, I believe he the surgical option to be election.
Assuntos
Humanos , Masculino , Próstata/cirurgia , Ressecção Transuretral da Próstata/instrumentação , Ressecção Transuretral da Próstata/métodos , Cirurgia Endoscópica por Orifício Natural/instrumentação , Cirurgia Endoscópica por Orifício Natural/métodos , Hiperplasia Prostática/cirurgia , Hiperplasia Prostática/tratamento farmacológico , Pressão Osmótica , Soluções Isotônicas/administração & dosagem , Soluções Isotônicas/efeitos adversos , Sorbitol/administração & dosagemRESUMO
Bleeding that requires massive blood transfusion is one of the main causes of cardiac arrest and death in the operating room. Its mortality varies widely between 15 and 54%, and it is strongly related to multiple factors such as acidosis, hypothermia and hypocoagulation. We undertook this study to describe the mechanisms that perpetuate bleeding during massive hemorrhage and the particular issues under the different clinical conditions of controlled and uncontrolled tissue damage. Laboratory tests for coagulation status diagnosis as well as treatment guidelines for usage of different fluid replacement solutions and hemoderivatives are described. A well-established response plan is needed by the surgical team and the blood bank in order to quickly facilitate blood products to the patient. Measures to avoid hypothermia and availability of rapid infusion systems are also necessary.
Assuntos
Transfusão de Sangue , Gerenciamento Clínico , Hemorragia/fisiopatologia , Técnicas Hemostáticas , Antifibrinolíticos/uso terapêutico , Testes de Coagulação Sanguínea , Perda Sanguínea Cirúrgica , Proteínas Sanguíneas/análise , Transfusão de Sangue/instrumentação , Coloides/uso terapêutico , Soluções Cristaloides , Coagulação Intravascular Disseminada/complicações , Procedimentos Cirúrgicos Eletivos , Emergências , Hidratação , Hemorragia/sangue , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Hipotermia/complicações , Soluções Isotônicas/efeitos adversos , Soluções Isotônicas/uso terapêutico , Substitutos do Plasma/uso terapêutico , Guias de Prática Clínica como Assunto , Choque Hemorrágico/etiologia , Choque Hemorrágico/fisiopatologia , Choque Hemorrágico/terapia , Ácido Tranexâmico/uso terapêutico , Reação Transfusional , Ferimentos e Lesões/complicações , Ferimentos e Lesões/fisiopatologiaRESUMO
OBJECTIVE: Intravenous infusion of crystalloid solutions is a cornerstone of the treatment of hemorrhagic shock. However, crystalloid solutions can have variable metabolic acid-base effects, perpetuating or even aggravating shock-induced metabolic acidosis. The aim of this study was to compare, in a controlled volume-driven porcine model of hemorrhagic shock, the effects of three different crystalloid solutions on the hemodynamics and acid-base balance. METHODS: Controlled hemorrhagic shock (40 percent of the total blood volume was removed) was induced in 18 animals, which were then treated with normal saline (0.9 percent NaCl), Lactated Ringer's Solution or Plasma-Lyte pH 7.4, in a blinded fashion (n = 6 for each group). Using a predefined protocol, the animals received three times the volume of blood removed. RESULTS: The three different crystalloid infusions were equally capable of reversing the hemorrhage-induced low cardiac output and anuria. The Lactated Ringer's Solution and Plasma-Lyte pH 7.4 infusions resulted in an increased standard base excess and a decreased serum chloride level, whereas treatment with normal saline resulted in a decreased standard base excess and an increased serum chloride level. The Plasma-Lyte pH 7.4 infusions did not change the level of the unmeasured anions. CONCLUSION: Although the three tested crystalloid solutions were equally able to attenuate the hemodynamic and tissue perfusion disturbances, only the normal saline induced hyperchloremia and metabolic acidosis.
Assuntos
Animais , Masculino , Equilíbrio Ácido-Base/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Soluções Isotônicas/efeitos adversos , Choque Hemorrágico/tratamento farmacológico , Modelos Animais de Doenças , Métodos Epidemiológicos , Gluconatos/efeitos adversos , Concentração de Íons de Hidrogênio , Soluções Isotônicas/classificação , Cloreto de Magnésio/efeitos adversos , Cloreto de Potássio/efeitos adversos , Suínos , Choque Hemorrágico/induzido quimicamente , Acetato de Sódio/efeitos adversos , Cloreto de Sódio/efeitos adversosRESUMO
CONTEXT AND OBJECTIVE: among burn patients, it is common to use colloidal substances under the justification that it is necessary to correct the oncotic pressure of the plasma, thereby reducing the edema in the burnt area and the hypotension. The aim here was to assess the risk of hospital mortality, comparing the use of albumin and crystalloid solutions for these patients. DESIGN AND SETTING: non-concurrent historical cohort study at Faculdade de Medicina de Marília; within the Postgraduate program on Internal and Therapeutic Medicine, Universidade Federal de São Paulo; and at the Brazilian Cochrane Center. METHODS: burn patients hospitalized between 2000 and 2001, with registration in the Hospital Information System, who received albumin, were compared with those who received other types of volume replacement. The primary outcome was the hospital mortality rate. The data were collected from files within the Datasus software. RESULTS: 39,684 patients were included: 24,116 patients with moderate burns and 15,566 patients with major burns. Among the men treated with albumin, the odds ratio for the risk of death was 20.58 (95% confidence interval, CI: 11.28-37.54) for moderate burns and 6.24 (CI 5.22-7.45) for major burns. Among the women, this risk was 40.97 for moderate burns (CI 21.71-77.30) and 7.35 for major burns (CI 5.99-9.01). The strength of the association between the use of albumin and the risk of death was maintained for the other characteristics studied, with statistical significance. CONCLUSION: the use of albumin among patients with moderate and major burns was associated with considerably increased mortality.