Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment

The effect of restrictive fluid management on outcomes among geriatric hip fractures: a retrospective cohort study at five level I trauma centers

Restrictive fluid management (RFM) for hemodynamically unstable trauma patients has reduced mortality rates. The objective was to determine whether RFM benefits geriatric hip fracture patients, who are usually hemodynamically stable.

Design

Retrospective propensity-matched study.

Setting

Five Level I trauma centers (January 1, 2018-December 12, 2018).

Patients

Geriatric patients (65 years or older) with hip fractures were included in this study. Patients with multiple injuries, nonoperative management, and preoperative blood products were excluded.

Intervention

Patients were grouped by fluid volume (normal saline, lactated Ringer, dextrose, electrolytes, and medications) received preoperatively or ≤24 hours of arrival; patients with standard fluid management (SFM) received ≥150 mL and RFM <150 mL of fluids.

Main Outcome Measurements

The primary outcomes were length of stay (LOS), delayed ambulation (>2 days postoperatively), and mortality. Paired Student t-tests, Wilcoxon paired rank sum tests, and McNemar tests were used; an α value of < 0.05 was considered statistically significant.

Results

There were 523 patients (40% RFM, 60% SFM); after matching, there were 95 patients per arm. The matched patients were well-balanced, including no difference in time from arrival to surgery. RFM and SFM patients received a median of 80 mL and 1250 mL of preoperative fluids, respectively (P < 0.001). Postoperative fluid volumes were 1550 versus 2000 mL, respectively, (P = 0.73), and LOSs were similar between the two groups (5 versus 5 days, P = 0.83). Mortality and complications, including acute kidney injuries, were similar. Delayed ambulation rates were similar overall. When stratified by preinjury ambulation status, SFM was associated with delayed ambulation for patients not walking independently before injury (P = 0.01), but RFM was not (P = 0.09).

Conclusions

RFM seems to be safe in terms of laboratory results, complications, and disposition. SFM may lead to delayed ambulation for patients who are not walking independently before injury.

Hyperspectral Imaging for the Evaluation of Microcirculatory Tissue Oxygenation and Perfusion Quality in Haemorrhagic Shock: A Porcine Study

BACKGROUND

The ultimate goal of haemodynamic therapy is to improve microcirculatory tissue and organ perfusion. Hyperspectral imaging (HSI) has the potential to enable noninvasive microcirculatory monitoring at bedside.

METHODS

HSI (Tivita® Tissue System) measurements of tissue oxygenation, haemoglobin, and water content in the skin (ear) and kidney were evaluated in a double-hit porcine model of major abdominal surgery and haemorrhagic shock. Animals of the control group (n = 7) did not receive any resuscitation regime. The interventional groups were treated exclusively with either crystalloid (n = 8) or continuous norepinephrine infusion (n = 7).

RESULTS

Haemorrhagic shock led to a drop in tissue oxygenation parameters in all groups. These correlated with established indirect markers of tissue oxygenation. Fluid therapy restored tissue oxygenation parameters. Skin and kidney measurements correlated well. High dose norepinephrine therapy deteriorated tissue oxygenation. Tissue water content increased both in the skin and the kidney in response to fluid therapy.

CONCLUSIONS

HSI detected dynamic changes in tissue oxygenation and perfusion quality during shock and was able to indicate resuscitation effectivity. The observed correlation between HSI skin and kidney measurements may offer an estimation of organ oxygenation impairment from skin monitoring. HSI microcirculatory monitoring could open up new opportunities for the guidance of haemodynamic management.

Effect of cryoprecipitate transfusion therapy in patients with postpartum hemorrhage: a retrospective cohort study

To evaluate the effect of cryoprecipitate (CRYO) transfusion in women referred for postpartum hemorrhage (PPH). This retrospective cohort study included patients with primary PPH referred to Gifu University Hospital between April 2013 and March 2020. We analyzed the effect of CRYO transfusion on fluid balance 24 h after the initial examination using a multivariable linear regression model adjusted for several confounding variables. To evaluate whether outcomes were modified by active bleeding, an interaction term of CRYO*active bleeding was incorporated into the multivariable model. We identified 157 women: 38 in the CRYO group (cases) and 119 in the control group. Fluid balance in the aforementioned period tended to decrease in the CRYO group compared with that in the control group (coefficient - 398.91; 95% CI - 1298.08 to + 500.26; p = 0.382). Active bleeding on contrast-enhanced computed tomography affected the relationship between CRYO transfusion and fluid balance (p = 0.016). Other outcomes, except for the overall transfusion requirement, were not significantly different; however, the interaction effect of active bleeding was significant (p = 0.016). CRYO transfusion may decrease the fluid balance in the first 24 h in PPH patients, especially in those without active bleeding.

Noninvasive real-time detection of cerebral blood perfusion in hemorrhagic shock rabbits based on whole-brain magnetic induction phase shift: an experimental study

OBJECTIVE

This study aimed to perform experiments to investigate the change trend in brain magnetic induction phase shift (MIPS) during hemorrhagic shock of different degrees of severity and to find the correlation between brain MIPS value and commonly used physiological indicators for detecting shock so as to explore a noninvasive method suitable for prehospital real-time detection of cerebral blood perfusion in hemorrhagic shock.

APPROACH

The self-developed MIPS detection system was used to monitor the brain MIPS value in the whole process of hemorrhagic shock models of rabbits with different degrees of severity (control, mild, moderate, and severe) of shock in real time. Meanwhile, common physiological parameters, including arterial blood lactate (ABL), mean arterial pressure (MAP), heart rate (HR),core body temperature (CBT), regional cerebral blood flow (rCBF), and electroencephalogram (EEG), were also evaluated.

MAIN RESULTS

The findings suggested that the brain MIPS value showed a downward trend in the shock process, and the decline degree of the MIPS value positively correlated with the severity of shock. Moreover, it showed a good detection and resolution ability in time/process and severity (P < 0.05). The MIPS values significantly correlated with ABL (P < 0.01), CBT (P < 0.01), and EEG (P < 0.05) at all four shock levels; with MAP (P < 0.05) and rCBF (P < 0.05) in the control, moderate, and severe groups; and with HR (P < 0.01) only in the severe group.

SIGNIFICANCE

The results demonstrated that the brain MIPS value has the capability of detecting hemorrhagic shock. The MIPS technique is a noninvasive method suitable for prehospital real-time detection of cerebral blood perfusion in hemorrhagic shock.