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Association of chylothorax with early fluid overload in neonates after cardiac surgeryBrandewie, Katie 02 June 2023 (has links)
No description available.
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Excessive Fluid Overload Among Haemodialysis Patients : Prevalence, Individual Characteristics and Self-regulation of Fluid IntakeLindberg, Magnus January 2010 (has links)
This thesis is comprised of four studies and concerns haemodialysis patients’ confidence in being able to manage fluid intake between treatment sessions, and whether the fluid intake is influenced by certain modifiable characteristics of the persons in question. The overall aim was to study aspects of excessive fluid overload and haemodialysis patients’ self-regulation of fluid allotment from a bio-psychosocial and behavioural medicine perspective. The extent of non-adherence to fluid allotment was described in Study I. National registry data were used. Three out of ten Swedish haemodialysis patients had excessive fluid overload and one out of five was at risk for treatment related complications due to too rapid ultrafiltration rate. The objective in Study II was to develop and psychometrically evaluate a self-administered scale to measure situation-specific self-efficacy to low fluid intake. The measure (the Fluid Intake Appraisal Inventory) was found to be reliable and valid in haemodialysis settings. Subgroups based on individual profiles of self-efficacy, attentional style and depressive symptoms were explored in Study III using a cluster analytic approach. Three distinct subgroups were found and the subgroup structure was validated for clinical relevance. The individuals’ profile concerning self-efficacy, attentional style and depressive symptoms has to be taken into account in nursing interventions designed to reduce haemodialysis patients’ fluid intake. In Study IV, an intervention designed to reduce haemodialysis patients’ fluid intake was introduced and its acceptability, feasibility and efficacy were evaluated and discussed. Acceptability of such an intervention was confirmed. Addressing beliefs, behaviours, emotions and physical feelings is clinically feasible and may reduce haemodialysis patient’s excessive fluid overload. This thesis indicates that there is a potential for improvement in the fluid management care of haemodialysis patients. Behavioural nursing strategies that aim to assist patients to achieve fluid control should be applied more extensively. Cognitive profiles of the patients should be taken into account when targeted nursing intervention aiming to encourage and maintain the patient’s fluid control is introduced.
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Excessive Fluid Overload Among Haemodialysis Patients : Prevalence, Individual Characteristics and Self-regulation of Fluid IntakeLindberg, Magnus January 2010 (has links)
This thesis is comprised of four studies and concerns haemodialysis patients’ confidence in being able to manage fluid intake between treatment sessions, and whether the fluid intake is influenced by certain modifiable characteristics of the persons in question. The overall aim was to study aspects of excessive fluid overload and haemodialysis patients’ self-regulation of fluid allotment from a bio-psychosocial and behavioural medicine perspective. The extent of non-adherence to fluid allotment was described in Study I. National registry data were used. Three out of ten Swedish haemodialysis patients had excessive fluid overload and one out of five was at risk for treatment related complications due to too rapid ultrafiltration rate. The objective in Study II was to develop and psychometrically evaluate a self-administered scale to measure situation-specific self-efficacy to low fluid intake. The measure (the Fluid Intake Appraisal Inventory) was found to be reliable and valid in haemodialysis settings. Subgroups based on individual profiles of self-efficacy, attentional style and depressive symptoms were explored in Study III using a cluster analytic approach. Three distinct subgroups were found and the subgroup structure was validated for clinical relevance. The individuals’ profile concerning self-efficacy, attentional style and depressive symptoms has to be taken into account in nursing interventions designed to reduce haemodialysis patients’ fluid intake. In Study IV, an intervention designed to reduce haemodialysis patients’ fluid intake was introduced and its acceptability, feasibility and efficacy were evaluated and discussed. Acceptability of such an intervention was confirmed. Addressing beliefs, behaviours, emotions and physical feelings is clinically feasible and may reduce haemodialysis patient’s excessive fluid overload. This thesis indicates that there is a potential for improvement in the fluid management care of haemodialysis patients. Behavioural nursing strategies that aim to assist patients to achieve fluid control should be applied more extensively. Cognitive profiles of the patients should be taken into account when targeted nursing intervention aiming to encourage and maintain the patient’s fluid control is introduced.
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La surcharge volémique liée à la transfusion : définition et épidémiologie aux soins intensifs pédiatriquesDe Cloedt, Lise 11 1900 (has links)
Les transfusions de culots globulaires sont une pratique fréquente aux soins intensifs; elles sont associées à de nombreuses complications. Ce travail s'intéresse à l'une d'entre elles, celle qui occasionne le plus de décès, la surcharge volémique liée à la transfusion (Transfusion-Associated Circulatory Overload - TACO).
Dans une première étude, nous avons tenté de déterminer l’impact des critères diagnostiques pris en compte dans la définition adulte du TACO dans une population de soins intensifs pédiatriques. Cette définition a été appliquée à 136 patients de soins intensifs pédiatriques durant leur séjour. Nous avons obtenu des taux d’incidence du TACO très variables (entre 1,5 et 76%) selon la manière d’interpréter les critères diagnostiques proposés.
Notre seconde étude a consisté en une revue exploratoire de la littérature concernant le TACO aux soins intensifs adultes et pédiatriques, peu importe le type de produit sanguin labile transfusé. Neuf études ont rencontré nos critères d’inclusion, à savoir décrire au moins un des critères suivants : l’incidence, les facteurs de risque ou les conséquences du TACO. Huit études étaient observationnelles. Seules trois études étudiaient la population pédiatrique.
Les résultats montrent une incidence cumulée de TACO plus élevée aux soins intensifs (5,5%) que dans la population générale. Les principaux facteurs de risque chez l'adulte sont liés à la balance liquidienne préexistante, aux caractéristiques de la transfusion elle-même et aux comorbidités déjà présentes chez le patient. En outre, le TACO adulte est associé à une augmentation de la durée de séjour à l'hôpital.
Les études pédiatriques incluses ne rapportaient aucune donnée sur les facteurs de risque et les conséquences du TACO dans cette population.
Ce travail a permis de montrer que la définition actuelle du TACO n’est pas applicable à la population des soins intensifs pédiatriques.
Le TACO aux soins intensifs est peu présent dans la littérature scientifique malgré sa fréquence et les risques qu’il présente; d’autres études sont indispensables pour en améliorer sa compréhension. Nous évoquerons certaines voies de recherche qui permettraient une meilleure connaissance de cette complication potentiellement mortelle des transfusions. / Red blood cell transfusions are common practice in intensive care and lead to many adverse reactions. This research project is focused on the most frequent fatal complication: transfusion-associated circulatory overload (TACO).
In our first study, we tried to determine the impact of the diagnostic criteria of the adult definition of TACO in a pediatric intensive care population. The definition was applied to 136 pediatric intensive care patients during their stay. We obtained highly variable incidence rates (from 1.5 to 76%) depending on the interpretation of the diagnostic criteria.
Our second study is a scoping review of the literature about TACO in intensive care, both adult and pediatric, regardless of the type of labile blood product transfused. Nine studies met our inclusion criteria, namely, to describe at least one of the following criteria: incidence, risk factors or outcomes of TACO. Eight studies were observational. Only three studies were conducted in pediatric population.
The results showed a pooled incidence of TACO which is higher (5.5%) in intensive care than in the general population. The main risk factors in the adult population were related to the positive pre-existing fluid balance, the characteristics of the transfusion itself and the patients’ preexisting comorbidities. Furthermore, the results showed an association between TACO in adult intensive care and an increased length of stay.
None of the included pediatric study reported data on risk factors or outcomes.
This research demonstrates that the current TACO definition is not applicable for the pediatric intensive care population.
There is limited literature about TACO in intensive care despite its occurrence rate and the associated risks; other studies are therefore necessary to enhance its comprehension. We will touch on potential research pathways that would lead to a better understanding of this deadly transfusion complication.
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Le délirium postopératoire en chirurgie cardiaque chez l’adulte en lien avec la pulsatilité des vélocités Doppler de la veine fémoraleHammoud, Ali 01 1900 (has links)
Les troubles cognitifs postopératoires sont fréquents après une chirurgie cardiaque, variant entre 26 % à 70 %. Bien que diverses hypothèses expliquent leur pathogenèse, la congestion veineuse représente une hypothèse prometteuse. Des études ont associé le délirium à des signes échographiques de congestion veineuse tels que la pulsatilité du Doppler de la veine porte et rénale. Détecter la congestion veineuse pourrait potentiellement prédire le trouble cognitif, facilitant ainsi sa gestion. Une technique prometteuse, mais peu explorée, est l’évaluation de la congestion veineuse par le Doppler de la veine fémorale.
Les objectifs de ce mémoire sont : (1) synthétiser les évidences sur la relation entre le Doppler de la veine fémorale et la congestion veineuse chez les adultes ; et (2) caractériser l’existence d’une association entre les trouble cognitifs et le Doppler pulsatile de la veine fémorale après une chirurgie cardiaque. Afin d’atteindre ces objectifs, nous avons effectué une revue rapide de littérature portant sur la corrélation entre le Doppler de la veine fémorale et la congestion veineuse. De plus, nous avons complété une étude (NCT05038267) dont l’objectif secondaire était de déterminer la corrélation entre un Doppler anormal de la veine fémorale et le délirium.
Les résultats ont montré une association entre la congestion veineuse et Doppler pulsatile de la veine fémorale, ainsi qu’entre les troubles cognitifs et le Doppler anormal de la veine fémorale. Toutefois, des études approfondies sont nécessaires.
En conclusion, un lien entre le Doppler de la veine fémorale, la congestion veineuse, et les troubles cognitifs après une chirurgie cardiaque a été démontré. Ces observations ouvrent la voie à des recherches approfondies sur ce lien et à de potentielles applications cliniques et thérapeutiques. / Postoperative cognitive disorders are common after cardiac surgery, ranging from 26% to 70%. While various hypotheses explain their pathogenesis, venous congestion emerges as a promising hypothesis. Studies have linked delirium to ultrasound signs of venous congestion, such as pulsatility in the Doppler of the portal and renal veins. Detecting venous congestion could potentially predict cognitive disorders, thus facilitating their management. A promising yet underexplored technique is the assessment of venous congestion using the Doppler of the femoral vein.
The objectives of this thesis are: (1) to synthesize evidence on the relationship between FV Doppler characteristics and venous congestion in adults; and (2) to characterize the existence of an association between cognitive disorders and pulsatility in femoral vein Doppler after cardiac surgery. To achieve these objectives, we conducted a rapid literature review focusing on the correlation between femoral vein Doppler and venous congestion. Additionally, we completed a study (NCT05038267) with the secondary objective of determining the correlation between abnormal femoral vein Doppler and delirium.
The results showed an association between venous congestion and pulsatility in the FV Doppler, as well as between cognitive disorders and abnormal FV Doppler. However, in-depth studies are needed.
In conclusion a connection has been demonstrated between femoral vein Doppler, venous congestion, and cognitive disorders after cardiac surgery. These findings open the way for in-depth research on this link and potential clinical and therapeutic applications.
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Facteurs de risque de mortalité des enfants à l’initiation de la thérapie de remplacement rénal aux soins intensifsMorissette, Geneviève 08 1900 (has links)
Introduction : La mortalité associée à l’insuffisance rénale aiguë (acute kidney injury ‘’AKI’’) aux soins intensifs pédiatriques (SIP) dépasse les 50%. Des études antérieures sur la thérapie de remplacement rénal (TRR) ont fait ressortir plusieurs facteurs de risque de mortalité dont le syndrome de défaillance multiviscérale (SDMV) et la surcharge liquidienne ≥ 10 à 20% avant l’initiation de la TRR. L’objectif de cette étude était d’identifier les principaux facteurs de risque de mortalité à 28 jours après l’initiation de la TRR chez les patients atteints d’AKI aux SIP.
Méthode : Il s’agit d’une étude de cohorte rétrospective aux SIP d’un centre tertiaire. Tous les enfants ayant reçus de la TRR continue ou de l’hémodialyse intermittente pour AKI, entre janvier 1998 et décembre 2014, ont été inclus. Les facteurs de risque de mortalité ont été préalablement identifiés par quatre intensivistes et deux néphrologues pédiatres et analysés à l’aide d’une régression logistique multivariée.
Résultats : Quatre-vingt-dix patients ont été inclus. L’âge médian était de 9 [2-14] ans. La principale indication d’initiation de la TRR était la surcharge liquidienne (64,2%). La durée médiane d’hospitalisation aux SIP était de 18,5 [8,0-31,0] jours. Quarante patients (44,4%) sont décédés dans les 28 jours suivant l’initiation de la TRR et quarante-cinq (50,0%) avant la sortie des SIP. Le score de PELOD ≥ 20 (OR 4,66 ; 95%CI 1,68-12,92) et la surcharge liquidienne ≥ 15% (OR 9,31; 95%CI 2,16-40,11) à l’initiation de la TRR étaient associés de façon indépendante à la mortalité.
Conclusion : Cette étude a permis de faire ressortir deux facteurs de risque de mortalité à 28 jours à l’initiation de la TRR : la surcharge liquidienne et la sévérité du SDMV mesurée par le score de PELOD. / Introduction: Mortality rate associated with acute kidney injury (AKI) in pediatric intensive care units (PICU) exceeds 50%. Prior studies on renal replacement therapy (RRT) have highlighted different mortality risk factors including the presence of a multiple organ dysfunction syndrome (MODS) and fluid overload ≥ 10 to 20% before starting RRT. The aim of this study was to identify most important risk factors of 28-day mortality in patients with AKI at RRT initiation in PICU.
Methods: We conducted a retrospective cohort study in a tertiary care pediatric center. All critically ill children who underwent acute continuous RRT or intermittent hemodialysis for AKI between January 1998 and December 2014 were included. A case report form was developed and specific risk factors were identified by a panel of four pediatric intensivists and two nephrologists. Risk factors analysis was made using logistic regression in SPSS and SAS software.
Results: Ninety patients were included. The median age was 9 [2-14] years. The most common indication for RRT initiation was fluid overload (FO) (64.2%). The median PICU length of stay was 18.5 [8.0-31.0] days. Forty of the 90 patients (44.4%) died within 28 days after RRT initiation and forty-five (50.0%) died before PICU discharge. In a multivariate logistic regression analysis, a PELOD score ≥ 20 (OR 4.66; 95%CI 1.68-12.92) and percentage of FO ≥ 15% (OR 9.31; 95%CI 2.16-40.11) at RRT initiation were independently associated with mortality.
Conclusion: This study suggests that fluid overload and severity of MODS measured by PELOD score are two risk factors of 28-day mortality in PICU patients on RRT.
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