Summary Patients with burn injuries involving more than 20 percent of the total body surface area lose a lot of fluid and are in the risk of developing a severe hypovolemia. Fluid resuscitation is a corner stone in burn care and is important for preventingfurthercomplications. The most common resuscitation formula is the Parkland Formula. Hourly urine output is a measure used to evaluate if the fluid given is sufficient enough to maintain a sustainable tissue perfusion. Inhalation injury, abuse of alcohol and drugs are some of the factors that may increase the amountoffluid needed. The purposefor this study is to study thecompliance to fluid resuscitation guidelines at a burn unit and which factors lead to deviation from the guidelines. Patient charts for 38 patients with burn injury >20%, > 18 years of age with a length of stay >48 hours, were reviewed regarding size of burn injury, hourly amount of fluid given, hourly urine output and presence of inhalation injury.Statistic significancewas found between the mean values of the differences in percentage between actual and calculated fluid amount for the first 24 hours. The differences in percentage between actual and calculated hourly urine output did not reach statistic significance. The result shows complianceto the fluid resuscitation guidelines. A larger sample would be required in order to investigate which factors causing deviations from the guidelines.

Background: Arterial cannulation and intra-arterial (IA) fluid and blood resuscitation in the patients with severe shock is an easier approach compared with the intravenous (IV) access if concerns regarding the efficiency and safety of this approach are addressed. Objectives: We hypothesized that IA fluid resuscitation is more effective than IV resuscitation in restoring cardiac contractions (CC) of cardiac-arrested mice following severe hemorrhagic shock. Methods: Mice (N = 22) were anesthetized using ketamine/xylazine. Arterial and venous systems accessed through cannulation of the carotid artery and the Jugular vein, respectively. As much blood as possible was aspirated from the carotid artery access. Mice were observed until the complete cessation of chest wall motions. Following 30 seconds delay, IV (N = 5) and IA access (N = 6) were used for fluid resuscitation using Ringer Lactate (RL) in a similar volume to the aspirated blood. Mice were observed for restoration of chest wall motions. In phase-II of the study, after cessation of chest motions, mice (N = 11) underwent a thoracotomy and CCs were observed. In three mice, IV RL Infusion after cardiac arrest failed to restore CCs and was followed by IA RL infusion. In eight mice, following cardiac arrest intermittent IA RL infusion was performed. Results: While IV RL Infusion failed to restore chest motion in mice (N = 5), IA RL infusion restored chest motion in all mice examined (N = 6) (P = 0.0067). In three mice, IV RL infusion after cardiac arrest showed no effect on CC. After failure of venous infusion, IA RL infusion was performed which resulted in restoration of CC for 13.33 +/- 1.76 minutes. In eight mice, intermittent IA infusion of RL after cardiac arrest, sustained CC for 31.43 +/- 10.9 minutes (P = 0.017). Conclusions: IA fluid resuscitation is superior to IV resuscitation in hemorrhagic shock induced cardiac arrest.

Made available in DSpace on 2014-06-11T19:35:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-07-12Bitstream added on 2014-06-13T20:26:18Z : No. of bitstreams: 1 barros_jmp_dr_botfm.pdf: 645820 bytes, checksum: e0369b9c2f84abbf1ff69b061c6def53 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / As variáveis hemodinâmicas e de oxigenação sistêmica não refletem com precisão a hipoperfusão esplâncnica durante o choque hipovolêmico, dificultando o tratamento adequado. A expansão volêmica após a reposição fluídica é fundamental para promover a oxigenação sistêmica e regional após o choque hemorrágico. Em contraste com as soluções convencionais de reposição volêmica, a menor expansão plasmática proporcionada pela administração de hidroxietilamido em solução hipertônica de cloreto de sódio, durante o choque hemorrágico, poderia determinar uma menor oferta de oxigênio sistêmico, com prejuízo à oxigenação gástrica. O estudo teve como objetivo comparar a expansão volêmica e os efeitos imediatos na oxigenação sistêmica e da mucosa gástrica após a administração de hidroxietilamido a 6% (peso molecular de 130 kDa, grau de substituição de 0,4) em solução hipertônica de cloreto de sódio a 7,5% (HHEA), Ringer lactato (RL) e hidroxietilamido a 6% (130/0,4) em cloreto de sódio a 0,9% (HEA), em cães submetidos à choque hemorrágico. Trinta cães, sem raça definida, sob anestesia e esplenectomizados, foram submetidos a sangramento (30 ml/kg) visando manter a pressão arterial média de 40 a 50 mm Hg durante 45 9 Introdução e Literatura minutos, sendo feita a reposição volêmica após este período com RL (n=10), na razão de 3:1 para o sangue removido; HEA (n=10), na razão de 1:1 para o sangue removido; e HHEA (n=10), 4 ml/kg. A expansão do volume intravascular (através da diluição do azul de Evans e da hemoglobina), e os atributos hemodinâmicos, e de oxigenação sistêmica e gástrica (através da tonometria gástrica), foram determinados no momento basal, após 45 minutos de hemorragia, e aos 5, 45 e 90 minutos após a reposição volêmica. A solução de HHEA aumentou o volume sanguíneo, devido à alta eficiência na... / Hemodynamic and global oxygen transport variables have failed to reflect splanchnic hypoperfusion, resulting in a failure to recognize inadequately treated hemorrhagic shock. Volemic expansion after fluid resuscitation is essential to improve global and regional oxygen in hemorrhagic shock. We hypothesized that, in contrast with conventional plasma expanders, the smaller volemic expansion from hypertonic hydroxyethyl starch solution administration in hemorrhagic shock may determine lesser systemic oxygen delivery and gastric oxygenation. We used hemorrhaged dogs to compare the early intravascular volume expansion and systemic and gastric oxygenation effects of 7.5% NaCl 6% hydroxyethyl starch 130/0.4 (HHES), lactated Ringer’s (LR), and 0.9% NaCl 6% hydroxyethyl starch (HES) solutions. Thirty mongrel dogs anesthetized and submitted to splenectomy, were bled (30mL/kg) to hold mean arterial pressure at 40-50 mm Hg over 45 minutes and were randomly resuscitated in three groups: LR (n=10) at 3:1 ratio to shed blood; HES (n=10) at 1:1 to shed blood; and HHES (n=10), 4mL/kg. Intravascular volume expansion (Evans blue and hemoglobin dilution), hemodynamic, systemic oxygenation and gastric intramucosal- arterial PCO2 gradient (PCO2 gap) variables were measured at baseline, after 45 min of hemorrhage, and 5, 45, and 90 min after fluid resuscitation. HHES increased blood volume, due to the 11 Introdução e Literatura high volume expansion efficiency, but intravascular volume expansion with this solution was the smallest of the solutions. All three solutions induced a similar hemodynamic performance but HHES showed lower mixed venous oxygen saturation and higher systemic oxygenation extraction and PCO2 gap than LR and HES. In conclusion, the smaller volume state from HHES after resuscitation provides worse systemic and gastric oxygenation recovery compared to LR and HES in dogs submitted... (Complete abstract click electronic access below)

Orientador: José Reinaldo Cerqueira Braz / Banca: Luiz Antonio Vane / Banca: Jorge João Abrão / Banca: Luiz Marcelo Sá Malbonisson / Banca: Rosa Inês Costa Pereira / Resumo: As variáveis hemodinâmicas e de oxigenação sistêmica não refletem com precisão a hipoperfusão esplâncnica durante o choque hipovolêmico, dificultando o tratamento adequado. A expansão volêmica após a reposição fluídica é fundamental para promover a oxigenação sistêmica e regional após o choque hemorrágico. Em contraste com as soluções convencionais de reposição volêmica, a menor expansão plasmática proporcionada pela administração de hidroxietilamido em solução hipertônica de cloreto de sódio, durante o choque hemorrágico, poderia determinar uma menor oferta de oxigênio sistêmico, com prejuízo à oxigenação gástrica. O estudo teve como objetivo comparar a expansão volêmica e os efeitos imediatos na oxigenação sistêmica e da mucosa gástrica após a administração de hidroxietilamido a 6% (peso molecular de 130 kDa, grau de substituição de 0,4) em solução hipertônica de cloreto de sódio a 7,5% (HHEA), Ringer lactato (RL) e hidroxietilamido a 6% (130/0,4) em cloreto de sódio a 0,9% (HEA), em cães submetidos à choque hemorrágico. Trinta cães, sem raça definida, sob anestesia e esplenectomizados, foram submetidos a sangramento (30 ml/kg) visando manter a pressão arterial média de 40 a 50 mm Hg durante 45 9 Introdução e Literatura minutos, sendo feita a reposição volêmica após este período com RL (n=10), na razão de 3:1 para o sangue removido; HEA (n=10), na razão de 1:1 para o sangue removido; e HHEA (n=10), 4 ml/kg. A expansão do volume intravascular (através da diluição do azul de Evans e da hemoglobina), e os atributos hemodinâmicos, e de oxigenação sistêmica e gástrica (através da tonometria gástrica), foram determinados no momento basal, após 45 minutos de hemorragia, e aos 5, 45 e 90 minutos após a reposição volêmica. A solução de HHEA aumentou o volume sanguíneo, devido à alta eficiência na... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Hemodynamic and global oxygen transport variables have failed to reflect splanchnic hypoperfusion, resulting in a failure to recognize inadequately treated hemorrhagic shock. Volemic expansion after fluid resuscitation is essential to improve global and regional oxygen in hemorrhagic shock. We hypothesized that, in contrast with conventional plasma expanders, the smaller volemic expansion from hypertonic hydroxyethyl starch solution administration in hemorrhagic shock may determine lesser systemic oxygen delivery and gastric oxygenation. We used hemorrhaged dogs to compare the early intravascular volume expansion and systemic and gastric oxygenation effects of 7.5% NaCl 6% hydroxyethyl starch 130/0.4 (HHES), lactated Ringer's (LR), and 0.9% NaCl 6% hydroxyethyl starch (HES) solutions. Thirty mongrel dogs anesthetized and submitted to splenectomy, were bled (30mL/kg) to hold mean arterial pressure at 40-50 mm Hg over 45 minutes and were randomly resuscitated in three groups: LR (n=10) at 3:1 ratio to shed blood; HES (n=10) at 1:1 to shed blood; and HHES (n=10), 4mL/kg. Intravascular volume expansion (Evans blue and hemoglobin dilution), hemodynamic, systemic oxygenation and gastric intramucosal- arterial PCO2 gradient (PCO2 gap) variables were measured at baseline, after 45 min of hemorrhage, and 5, 45, and 90 min after fluid resuscitation. HHES increased blood volume, due to the 11 Introdução e Literatura high volume expansion efficiency, but intravascular volume expansion with this solution was the smallest of the solutions. All three solutions induced a similar hemodynamic performance but HHES showed lower mixed venous oxygen saturation and higher systemic oxygenation extraction and PCO2 gap than LR and HES. In conclusion, the smaller volume state from HHES after resuscitation provides worse systemic and gastric oxygenation recovery compared to LR and HES in dogs submitted... (Complete abstract click electronic access below) / Doutor

Trauma är den ledande dödsorsaken i Sverige för människor mellan 15 och 44 år och en stor andel dör till följd av blödning som uppkommer vid skadetillfället. Blödning fortsätter också vara den ledande orsaken till traumarelaterad död som kunde ha varit förebyggbar både civilt och militärt. Traumaomhändertagandet är komplext, ofta tidskritiskt och ambulanspersonalen är ofta de som först får vårda dessa patienter ute på skadeplats och därav blir ambulanspersonalens första bedömning och omhändertagande av stor betydelse. Vätskebehandling för kritiskt skadade traumapatienter i hemorragisk chock eller hotande hemorragisk chock är ett omdiskuterat ämne och Sverige saknar nationella riktlinjerna för omhändertagande och behandling prehospitalt vid hemorragisk chock och trauma och de regionala riktlinjer som finns skiljer sig ibland till viss del åt mellan länen. Syftet med studien var att undersöka effekten av ambulanssjuksköterskans vätskebehandling för patienter i hemorragisk chock vid trauma. Som metod har en litteraturöversikt genomförts där totalt 15 studier inkluderats som är publicerade mellan 2009 och 2019. I resultatet framkom två huvudteman – vätskebehandlingens effekt på mortalitet och vätskebehandlingens effekt på koagulation. Samtliga fyra studier som undersökt hur koagulationsförmågan påverkas av kristalloid hyperton och/eller isoton vätskebehandling hos patienter med eller med risk för hemorragisk chock utsatta för trauma har kommit fram till att den försämras desto mer vätska patienten får. Resultatet visade oklar evidens gällande vätskebehandlingens effekt för mortaliteten på patienter i hemorragisk chock vid trauma. Däremot påvisade ingen av studierna att mortaliteten minskade. Slutsats var att majoriteten av artiklarna talar för att stora mängder vätska prehospitalt minskar eller inte gör någon skillnad för överlevnaden för kritiskt skadade traumapatienter vid hemorragisk chock. Många faktorer spelar in och det är svårt att dra några slutsatser utifrån resultatet och mer forskning behövs inom området. / Trauma is the leading cause of death in Sweden for people between the age of 15 and 44 years and a large proportion of people die because of bleeding that occurs at the time of the injury. Bleeding also continues to be the leading cause of trauma-related death that could have been preventable both in a civilian and military setting. Trauma care is complex, often time-critical, and the ambulance nurses are often the first to care for these patients on the scene and therefore the first assessment and care of these patients is of great importance. Fluid resuscitation for critically injured trauma patients in hemorrhagic shock or threatening hemorrhagic shock is a debated topic and Sweden lacks national guidelines for trauma care and treatment prehospital. The regional guidelines sometimes for some manner differ between the counties in Sweden. The aim of this study was to determine the impact of fluid resuscitation for patients with hemorrhagic shock after trauma. As a method, a literature review was carried out, which included a total of 15 studies published between 2009 and 2019. The result revealed two main themes - the impact of fluid resuscitation on mortality and the impact of fluid resuscitation on coagulation. All four studies that examined how coagulation ability is affected by crystalloid hypertonic and/or isotonic fluid resuscitation in patients at risk of hemorrhagic shock after trauma, the severity seems to be dependent on the amount of fluid infused, the more fluid the more severe coagulation abnormalities. The result showed unclear evidence of the effect of fluid resuscitation in mortality for trauma patients in hemorrhagic shock. However, none of the studies showed it decreased in mortality. In conclusion, the majority of articles show that large amount of fluid given in prehospital care have no impact or did have a negative impact on survival of critically injured trauma patients in hemorrhagic shock. Many factors come into play and it is difficult to draw any conclusions based on the results and more research are needed.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The role of enzyme‐assisted subcutaneous fluid administration (EASFA) in treating mild to moderate dehydration in pediatrics, geriatrics, and palliative care has been studied in developed countries. However, it has historically been underutilized due to widely available health care and alternative treatments, namely peripheral intravenous (IV) fluid administration. Fluid infusions in the subcutaneous tissue have a low risk of infection, are easy to administer, and have wide potential use. The use of EASFA in low resource settings to treat those with difficult IV access or where skilled healthcare workers are not as readily available could prove to be a live saving measure in many situations, including the care of patients in remote areas of the world, mass casualty events, or other disasters. Our objective was to determine if EASFA is a valid and appropriate technique to utilize in pediatric and elderly patients, and evaluate if it could be a safe and efficient way to provide fluid resuscitation in low resource settings. For this systematic review MEDLINE and Cochrane Library were searched from January 1950 to December 2015 to recover all available literature relevant to this topic. Studies that met the inclusion criteria were analyzed using Cohen’s D. This was calculated using the mean difference between intervention and control divided by the pooled standard deviation. For dichotomous outcome of the placement success rate the odds ratios were calculated with 95% confidence intervals. In reviewing 7 articles using Cohen’s D to compare mean differences to determine effect size, we found that catheter placement success rates and infusion rates were similar between EASFA and peripheral intravenous fluid administration. Additionally, it was found that the odds of correct initial needle placement was 7.19 times higher in EASFA versus intravenous administration. EASFA is a comparable alternative to intravenous fluid administration when delivering fluids to pediatric and elderly patients with mild to moderate dehydration. While infusion rates and total volume of fluids administered were similar, the high rate of success with placement of the subcutaneous catheter proves it to be more useful in some situations. Venous cannulation is difficult, even for a trained healthcare provider, and the ease of placement of subcutaneous catheters makes training lay people to administer subcutaneous fluids a possibility. Additionally, this type of fluid administration may lead to less psychological trauma to a child from multiple needle sticks, while still achieving a similar outcome of effective volume replacement. Based on the results of this study, further research is needed to evaluate the effectiveness of utilizing EASFA in low resource settings.

L’association lésionnelle d’une contusion pulmonaire et d’un état de choc hémorragique est fréquente et constitue un réel chalenge thérapeutique. La prise en charge de ce choc va nécessiter une réanimation hémodynamique dans laquelle le remplissage vasculaire tient une place centrale. Mais dans ce contexte de poumon contus, il devra être raisonné car délétère sur le plan pulmonaire, notamment en terme d'oedème et d'altération de la compliance. Ce remplissage devra donc être titré, basé sur des objectifs tensionnels clairs et un monitorage hémodynamique fiable. L'utilisation de solutés à haut pouvoir d'expansion volémique (sérum salé hypertonique, colloïdes) présente un intérêt, de même que l'introduction précoce de vasopresseurs. Le monitorage hémodynamique permettra de conduire cette réanimation sur des objectifs de pression artérielle, sur des indices de précharge dépendance et sur la mesure de l'eau pulmonaire extravasculaire. Notre travail, basé sur des études expérimentales et cliniques, a pour objectif de caractériser les modalités actuelles de prise en charge d’une contusion pulmonaire, sur les plans hémodynamiques et respiratoires. / Pulmonary contusion is often associated with hemorrhagic shock, constituting a challenge in trauma care. For patients who have sustained lung contusions, fluid resuscitation should be carefully performed, because injured lungs are particularly vulnerable to massive fluid infusions with an increased risk of pulmonary edema and compliance impairment. Fluid administration should be included in an optimized and goal directed resuscitation, based on blood pressure objectives and hemodynamical monitoring. The use of fluids with high volume-expanding capacities (hypertonic saline, colloids) is probably interesting, as well as early introduction of vasopressors. Hemodynamic monitoring will allow to conduct resuscitation on blood pressure objectives, on preload parameters and on extravascular lung water measurement.Our work, based on experimental and clinical studies, objective to characterize the current modalities of ventilatory and hemodynamical aspect of pulmonary contusion care.

Author's name: Bc. Irena Malá School: Charles university, Prague 1st Faculty of Medicine Institut of Theory and Practice of Nursing Vídeňská 800, 140 59 Prague 4 - Krč Program: Health Care Administration Title: Early postoperative care of the patient with the left ventricular assist device HeartMate II Diploma thesis supervisor: PhDr. Hocková Jana, PhD. Number of pages: 170 Number of attachments: 41 Year: 2013 Key words: early postoperative care, hypotermia, blood transfusion, fluid resuscitation, perioperative cardiovascular dysfunction, pharmacologic support, ventricular assist device HeartMateII, monitoration, device, cardiac arrhythmias, ventilation management, postoperative anticoagulation, glycemic kontrol, renal insufficiency, nutrition, nursing, complications, physiotherapy, psychological aspects The occurrence of the heart failure is similar to an epidemic with high mortality. This fact, together with stagnate or even decreasing number of suitable donors, led to a need of replacing the heart pump activity with an artificial one. Mechanical cardiac support systems are sophisticated devices that are able to support a certain period of time or completely replace the function of the heart as a pump. The indications implantation of mechanical cardiac support is significant symptomatic heart...