51
|
Mottola C, Girerd N, Coiro S, Lamiral Z, Rossignol P, Frimat L, Girerd S. Evaluation of Subclinical Fluid Overload Using Lung Ultrasound and Estimated Plasma Volume in the Postoperative Period Following Kidney Transplantation. Transplant Proc 2018; 50:1336-1341. [PMID: 29880355 DOI: 10.1016/j.transproceed.2018.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/01/2018] [Indexed: 12/11/2022]
Abstract
AIM B-lines count measured with lung ultrasound (LUS) quantifies extravascular lung water and is validated in the setting of acute cardiac failure or chronic dialysis. Patients are often kept in moderately overhydrated states during the early postoperative period following kidney transplantation (KT). We described congestion changes during the early postoperative period following KT and the feasibility of LUS in this setting. METHODS LUS (28 scanning-points method) and inferior vena cava (IVC) measurements were routinely performed in 36 patients after KT. Estimated plasma volume (ePV) was calculated from hemoglobin and hematocrit levels. RESULTS No patient had >15 B-lines during the hospital stay. B-lines slightly increased until Day 4 after KT (Day 1, 1.7 ± 1.7; Day 4, 2.5 ± 2.5) and decreased up to Day 10 (1.4 ± 2.2; P vs Day 4 <.05). More B-lines were observed in patients aged older than 60 (P = .01 at Day 4) whereas IVC diameter and ePV were similar. In patients older than 60, B-lines had weak correlation with body weight variation (r = 0.64; P < .05), IVC diameters (r = 0.59 at Day 4 and r = 0.58 at Day 10; P < .05) but a strong correlation with ePV (r = 0.93 at Day 14; P < .05). B-line changes from Day 1 to Day 10 correlated with IVC diameter changes (r = 0.62; P < .05). CONCLUSION LUS identifies subtle congestion changes during the early postoperative period following KT. The hyperhydration strategy usually followed during this period does not result in overt pulmonary congestion as assessed by LUS, even in older recipients.
Collapse
|
52
|
|
53
|
Jabbour G, Iancu H, Zouhal H, Mauriège P, Joanisse DR, Martin LJ. High-intensity interval training improves acute plasma volume responses to exercise that is age dependent. Physiol Rep 2018; 6:e13609. [PMID: 29464883 PMCID: PMC5820462 DOI: 10.14814/phy2.13609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/25/2017] [Accepted: 12/29/2017] [Indexed: 12/30/2022] Open
Abstract
Plasma volume (PV) is affected by several factors including age, physical training and, acutely, by exercise intensity. The purpose of this study was to investigate the effects of 6 weeks of high-intensity interval training (HIT) on PV and blood pressure (BP) changes among sedentary individuals. Thirty subjects aged between 18 and 71 years [body mass index=30.1(1.2) kg/m2 ] completed a 6-weeks HIT program. Anthropometric and fitness variables were obtained at pre- and post- HIT. PV variations during warm-up and after supramaximal cycling test (SCT) were calculated using two methods based on Hematocrit (Ht) and Hemoglobin (Hb) measures. After both the warm-up and SCT, PV decreased significantly among participants at pre- and at post-HIT (P < 0.01). However, PV decreases were significantly greater at pre-HIT compared with post-HIT during warm-up and after SCT (P < 0.01, respectively). In addition, at pre-HIT, a positive relationship was found between age and both PV variations at warm-up and after SCT (r2 = 0.55 and r2 = 0.46; P < 0.01 respectively). However, no relationship was found during the post-HIT period. After SCT and after both visits, only body weight predicted 22% of PV variations. In the current study, a significant relationship was found between systolic and diastolic BP improvements and PV variations in post-HIT (r2 = 0.54 and r2 =0.56, P < 0.05, respectively). Our results suggest that HIT may improve PV values and reduce the effects of age on the decrease in PV. These interventions led to improvements in systolic and diastolic BP values among participants.
Collapse
|
54
|
Schnoor J, Schreck R, Baumert JH, Grosse-Siestrup C, Rossaint R, Unger JK. Influence of Differences in Body Weight and Volume Management on Experimental Results in Porcine Models. Int J Artif Organs 2018; 27:924-34. [PMID: 15636049 DOI: 10.1177/039139880402701104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background In contrast to humans, young pigs naturally have a low COPpl (12–16 mmHg versus 22–26 mmHg in young humans). Thus, behavior occurring when volume management is performed similar to human medicine might be different. Potentially underestimated intra- to extravascular fluid and solute shifts could influence time course of variables investigated. That is why we studied whether differences in the basic protocol for infusion therapy and different levels of COP - according to age or body weight, respectively - impair reproducibility and reliability of experimental results. Methods Group A [n=6, lower body weight (LBW < 22 kg)] was treated with unrestricted infusion rates (UIR) adjusted to maintain a constant blood pressure; group B [n=6, higher body weight (HBW > 28 kg)] was treated with a restricted continuous infusion rate for fluid balance (RIR); group C (n=6) combined HBW and UIR protocol. Blood pressure, plasma solutes, diuresis, and peritoneal fluid were analysed. Statistical analysis was performed using Kruskal-Wallis test and Wilcoxon test. Results UIR-treated pigs with LBW (group A) developed ascites and demonstrated time dependent decreases of plasma solute concentrations whereas in pigs of group C mainly diuresis was increased and subcutaneous edema occurred. None of the protocols enabled constant blood pressure. Discussion In young pigs (LBW), an adaptive volume substitution using crystalloids to standardize blood pressure may induce fluid extravasation; in turn data may not show statistical significance, stable hemodynamics may not be achieved and changes in plasma solute concentrations may lead to false interpretations. RIR-strategy provided reproducible, plausible results and thus should be recommended in combination with pigs >29 kg BW for the use of porcine models.
Collapse
|
55
|
Casagrande G, Teatini U, Romei Longhena G, Miglietta F, Fumero R, Costantino ML. A New Method to Evaluate Patient Characteristic Response to Ultrafiltration during Hemodialysis. Int J Artif Organs 2018; 30:377-84. [PMID: 17551900 DOI: 10.1177/039139880703000504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Several factors are involved in the pathogenesis of dialysis discomfort interfering with optimal fluid removal and reducing the efficacy of the treatment; the most important one is a decrease in blood volume caused by an imbalance between ultrafiltration (UF) and plasma refilling (PR) rates. Objectives. This study is aimed at devising a method to tailor the dialysis therapy to each individual patient, by analyzing the relationship between PR and UF during the sessions in stable patients and widening the knowledge of fluid exchanges during the treatment. Methods. Thirty stable patients undergoing maintenance hemodialysis were enrolled. Three dialysis sessions were monitored for each patient; systemic pressure, blood composition, blood volume % variation, weight loss and conductivity were recorded repeatedly. A Plasma Refilling Index (PRI), defined and calculated by means of parameters measured throughout the dialysis, was introduced as a novel instrument to study plasma refilling phenomena. Results. The PRI provides understanding of patient response (in terms of plasma refilling) to the set UF. In the monitored sessions, the PRI trend is found to be characteristic of each patient; a PRI course that is at variance with the characteristic trend is a signal of inadequate or unusual dialysis scheduling. Moreover, statistical analysis highlights two different PRI trends during the first hour and during the rest of the treatment, suggesting the presence of different treatment phases. Conclusion. The main advantage of the PRI index is that it is non-invasive peculiar to each patient and easy to compute in a dialysis routine based on online data recorded by the monitor. A deviation from the characteristic trend may be a warning for the clinician. The analysis of the PRI trend also suggests how to modulate UF as a function of interstitial to intravascular fluid removal balance during dialysis.
Collapse
|
56
|
Vricella LK. Emerging understanding and measurement of plasma volume expansion in pregnancy. Am J Clin Nutr 2017; 106:1620S-1625S. [PMID: 29070547 PMCID: PMC5701717 DOI: 10.3945/ajcn.117.155903] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Plasma volume expansion is an important component of a successful pregnancy. The failure of maternal plasma volume expansion has been implicated in adverse obstetric outcomes such as pre-eclampsia, fetal growth restriction, and preterm birth. Altered iron homeostasis and elevated maternal hemoglobin concentrations have also been associated with adverse pregnancy outcomes; limited data have suggested that these effects may be mediated by inadequate plasma volume expansion. In addition, it has been noted that pregnant, obese women, compared with lean subjects, have decreased plasma volume expansion along with impaired iron homeostasis and increased inflammation. Current estimates of plasma volume expansion are outdated and do not necessarily reflect contemporary obstetric populations. Moreover, the validation of clinically applicable methods of plasma volume determination as well as enhanced methodologies should be a priority. Further study is needed to characterize diminished plasma volume expansion during pregnancy and to understand the potential role of impaired iron homeostasis and inflammation in adverse obstetric outcomes, especially in obese women.
Collapse
|
57
|
Kataoka H. Proposal for heart failure progression based on the 'chloride theory': worsening heart failure with increased vs. non-increased serum chloride concentration. ESC Heart Fail 2017; 4:623-631. [PMID: 29154432 PMCID: PMC5695179 DOI: 10.1002/ehf2.12191] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 04/17/2017] [Accepted: 06/02/2017] [Indexed: 01/30/2023] Open
Abstract
AIMS Chloride (Cl) is an established key electrolyte for the activation of the renin-angiotensin-aldosterone system. Recent studies have shown the serum Cl as a key electrolyte for the regulation of body fluid distribution in heart failure (HF) patients. The clinical differences of worsening HF status according to the changes in serum Cl concentration are unclear. METHODS AND RESULTS Data from 47 chronic HF patients were analysed. Upon worsening HF, each patient exhibited at least two HF-related signs. Blood tests included haemoglobin (Hb), haematocrit (Ht), mean red blood cell volume (MCV), albumin, serum solutes, and b-type natriuretic peptide. The relative change in the plasma volume (%PV) from stable to worsening HF was estimated as follows: 100 × {Hb (stable) × [1 - Ht (worse)]}/{Hb (worse) × [1 - Ht (stable)]} - 100. When patients were divided into two groups based on changes in serum Cl concentration from stable to worsening HF, the pathophysiologic features of the patients with increased Cl (range 1-23 mEq/L; n = 31) included a greater increase in serum sodium (2.94 ± 4.15 vs. -0.69 ± 3.75 mEq/L, P = 0.005), higher vascular expansion (12 ± 11.1 vs. 4.81 ± 7.94%, P = 0.026), a tendency towards a greater MCV (1.23 ± 2.36 vs. -0.06 ± 1.88 fL, P = 0.065), and preserved renal function defined by the absence of an increase of serum creatinine (-0.24 ± 0.39 vs. -0.05 ± 0.12 mg/dL, P = 0.057) compared to patients with non-increased Cl (range -9 to 0 mEq/L; n = 16). Clinically, the increased Cl group had fewer HF signs (2.65 ± 0.71 vs. 3.31 ± 0.79, P = 0.005) although the change in symptoms did not differ between groups (48% vs. 63%, P = 0.54). CONCLUSIONS The present study suggests a new clinical entity of worsening HF status, that is, HF with increased vs. non-increased serum Cl concentration from clinical stability to worsening HF.
Collapse
|
58
|
Hundeshagen G, Kramer GC, Ribeiro NM, Salter M, Koutrouvelis AK, Li H, Solanki D, Indrikovs A, Seeton R, Henkel SN, Kinsky MP. Closed-Loop- and Decision-Assist-Guided Fluid Therapy of Human Hemorrhage. Crit Care Med 2017; 45:e1068-e1074. [PMID: 28682837 PMCID: PMC5600681 DOI: 10.1097/ccm.0000000000002593] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to evaluate the efficacy, efficiency, and physiologic consequences of automated, endpoint-directed resuscitation systems and compare them to formula-based bolus resuscitation. DESIGN Experimental human hemorrhage and resuscitation. SETTING Clinical research laboratory. SUBJECTS Healthy volunteers. INTERVENTIONS Subjects (n = 7) were subjected to hemorrhage and underwent a randomized fluid resuscitation scheme on separate visits 1) formula-based bolus resuscitation; 2) semiautonomous (decision assist) fluid administration; and 3) fully autonomous (closed loop) resuscitation. Hemodynamic variables, volume shifts, fluid balance, and cardiac function were monitored during hemorrhage and resuscitation. Treatment modalities were compared based on resuscitation efficacy and efficiency. MEASUREMENTS AND MAIN RESULTS All approaches achieved target blood pressure by 60 minutes. Following hemorrhage, the total amount of infused fluid (bolus resuscitation: 30 mL/kg, decision assist: 5.6 ± 3 mL/kg, closed loop: 4.2 ± 2 mL/kg; p < 0.001), plasma volume, extravascular volume (bolus resuscitation: 17 ± 4 mL/kg, decision assist: 3 ± 1 mL/kg, closed loop: -0.3 ± 0.3 mL/kg; p < 0.001), body weight, and urinary output remained stable under decision assist and closed loop and were significantly increased under bolus resuscitation. Mean arterial pressure initially decreased further under bolus resuscitation (-10 mm Hg; p < 0.001) and was lower under bolus resuscitation than closed loop at 20 minutes (bolus resuscitation: 57 ± 2 mm Hg, closed loop: 69 ± 4 mm Hg; p = 0.036). Colloid osmotic pressure (bolus resuscitation: 19.3 ± 2 mm Hg, decision assist, closed loop: 24 ± 0.4 mm Hg; p < 0.05) and hemoglobin concentration were significantly decreased after bolus fluid administration. CONCLUSIONS We define efficacy of decision-assist and closed-loop resuscitation in human hemorrhage. In comparison with formula-based bolus resuscitation, both semiautonomous and autonomous approaches were more efficient in goal-directed resuscitation of hemorrhage. They provide favorable conditions for the avoidance of over-resuscitation and its adverse clinical sequelae. Decision-assist and closed-loop resuscitation algorithms are promising technological solutions for constrained environments and areas of limited resources.
Collapse
|
59
|
Simmons EE, Bergeron ER, Florian JP. The impact of repetitive long-duration water immersion on vascular function. PLoS One 2017; 12:e0181673. [PMID: 28750006 PMCID: PMC5531465 DOI: 10.1371/journal.pone.0181673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 07/04/2017] [Indexed: 01/11/2023] Open
Abstract
While physiological responses to water immersion (WI) are well-studied, the vascular responses after WI are less understood. Fifteen male subjects performed six-hour resting thermoneutral water immersions (WI) at 1.35 atmospheres absolute for four consecutive days, with follow-up on the fifth day. Measurements included peripheral endothelial function and augmentation index (PAT, peripheral arterial tonometry), beat-to-beat blood pressure (BP, photoplethysmography), heart rate (HR), and plasma volume (PV) calculated from changes in hemoglobin and hematocrit. The reactive hyperemia index (RHI), a marker of peripheral endothelial function, increased with repeated immersions (p = 0.008). By WI2 and WI3, RHI increased 12% and 16%, respectively, compared to WI1 values, but no significant differences were detected between WI4 and WI1 for either measure. Absolute augmentation index (AI) increased by an average of 33% (p<0.001) and AI normalized for HR (AI@75) by 11% (p = 0.12) following each WI. PV decreased significantly by 13.2% following WI and remained 6.8% lower at follow-up compared to pre-WI. Systolic blood pressure significantly decreased by an average of 2.5% following each WI (p = 0.012). Compared to pre-WI HR, average post-WI HR decreased 4.3% lower (p<0.001), but increased overall by 8.2% over the course of repeated WI (p<0.001). Total peripheral resistance increased by an average of 13.1% following WI (p = 0.003). Thus, peripheral endothelial function increases after two days of WI, and PAT-derived measures of arterial stiffness increase transiently post-WI. Additionally, BP and PAT-derived endothelial function diverge from their usual associations with arterial stiffness (i.e. augmentation index) in the context of WI.
Collapse
|
60
|
Molitoris BA. Rethinking CKD Evaluation: Should We Be Quantifying Basal or Stimulated GFR to Maximize Precision and Sensitivity? Am J Kidney Dis 2017; 69:675-683. [PMID: 28223001 PMCID: PMC5403623 DOI: 10.1053/j.ajkd.2016.11.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 11/14/2016] [Indexed: 12/20/2022]
Abstract
Chronic kidney disease (CKD) is an increasing clinical problem. Although clinical risk factors and biomarkers for the development and progression of CKD have been identified, there is no commercial surveillance technology to definitively diagnose and quantify the severity and progressive loss of glomerular filtration rate (GFR) in CKD. This has limited the study of potential therapies to late stages of CKD when FDA-registerable events are more likely. Because patient outcomes, including the rate of CKD progression, correlate with disease severity and effective therapy may require early intervention, being able to diagnose and stratify patients by their level of decreased kidney function early on is key for translational progress. In addition, renal reserve, defined as the increase in GFR following stimulation, may improve the quantification of GFR based solely on basal levels. Various groups are developing and characterizing optical measurement techniques using new minimally invasive or noninvasive approaches for quantifying basal and stimulated kidney function. This development has the potential to allow widespread individualization of therapy at an earlier disease stage. Therefore, the purposes of this review are to suggest why quantifying stimulated GFR, by activating renal reserve, may be advantageous in patients and to review fluorescent technologies to deliver patient-specific GFR.
Collapse
|
61
|
Bartoli E, Rossi L, Sola D, Castello L, Sainaghi PP, Smirne C. Use, misuse and abuse of diuretics. Eur J Intern Med 2017; 39:9-17. [PMID: 28233622 DOI: 10.1016/j.ejim.2017.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/24/2016] [Accepted: 01/17/2017] [Indexed: 12/18/2022]
Abstract
Resolution of edema requires a correct interpretation of body fluids-related renal function, to excrete the excess volume while restoring systemic hemodynamics and avoiding renal failure. In heart failure, the intensive diuresis should be matched by continuous fluids refeeding from interstitium to plasma, avoiding central volume depletion. The slowly reabsorbed ascites cannot refeed this contracted volume in cirrhosis: the ensuing activation of intrathoracic receptors, attended by increased adrenergic and Renin release, causes more avid sodium retention, producing a positive fluid and Na balance in the face of continuous treatment. High-dose-furosemide creates a defect in tubular Na causing diuresis adequate to excrete the daily water and electrolyte load in Chronic Renal Failure. Diuretic treatment requires care, caution and bedside "tricks" aimed at minimizing volume contraction by correctly assessing the homeostatic system of body fluids and related renal hemodynamics.
Collapse
|
62
|
Hudson SR, Chan D, Ng LL. Change in plasma volume and prognosis in acute decompensated heart failure: an observational cohort study. J R Soc Med 2017; 109:337-46. [PMID: 27609799 DOI: 10.1177/0141076816661316] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study aimed to develop an inexpensive, readily available prognostic indicator in acute decompensated heart failure patients to guide management and improve outcome. Prognostic biomarkers for heart failure exist but are expensive and not routinely performed. Increasing plasma volume has been associated with worse outcomes. SETTING UK University Teaching Hospital. DESIGN Observational Cohort study. PARTICIPANTS 967 patients with acute decompensated heart failure. METHODS Haemoglobin and haematocrit were measured at admission and discharge and were used to calculate the plasma volume change using the Strauss-Davis-Rosenbaum formula. MAIN OUTCOME MEASURES Endpoints were death and the composite of death and/or heart failure hospitalisation. Change in plasma volume was added to ADHERE scoring to determine predictive value. RESULTS During follow-up, 536 died and 626 died or were hospitalised with heart failure. Multivariable Cox models showed change in plasma volume was an independent predictor of mortality (hazard ratio (HR) [95% confidence interval (CI)]: 1.150 [1.031-1.283], p = 0.012) and death or heart failure hospitalisation (HR: 1.138 [1.029-1.259], p = 0.012). Kaplan-Meier analysis of change in plasma volume tertiles for outcome measures showed significant difference for the top tertile compared to the lower two. Multivariable analysis of change in plasma volume with ADHERE scoring showed change in plasma volume change remained an independent predictor of death (HR: 1.138 [1.026-1.261], p = 0.015) and death or heart failure hospitalisation (HR: 1.129 [1.025-1.243], p = 0.014). CONCLUSIONS Change in plasma volume over an admission can be used for prognostication and adds value to the ADHERE score. Change in plasma volume can be easily and inexpensively calculated from routine blood tests. Clinically, this may facilitate targeted treatment of acute decompensated heart failure patients at greatest risk.
Collapse
|
63
|
de Haas S, Ghossein-Doha C, van Kuijk SMJ, van Drongelen J, Spaanderman MEA. Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:177-187. [PMID: 28169502 DOI: 10.1002/uog.17360] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/21/2016] [Accepted: 11/07/2016] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To describe the physiological pattern of gestational plasma volume adjustments in normal singleton pregnancy and compare this with the pattern in pregnancies complicated by pregnancy-induced hypertension, pre-eclampsia or fetal growth restriction. METHODS We performed a meta-analysis of the current literature on plasma volume adjustments during physiological and complicated pregnancies. Literature was retrieved from PubMed (NCBI) and EMBASE (Ovid) databases. Included studies reported both reference plasma volume measurements (non-pregnant, prepregnancy or postpartum) and measurements obtained during predetermined gestational ages. Mean differences bet ween the reference and pregnancy plasma volume measurements were calculated for predefined intervals of gestational age using a random-effects model described by DerSimonian and Laird. RESULTS Thirty studies were included in the meta-analysis with publication dates ranging from 1934 to 2007. Plasma volume increased in the first weeks of pregnancy, with the steepest increase occurring during the second trimester. Plasma volume continued to increase in the third trimester with a pooled maximum increase of 1.13 L (95% CI, 1.07-1.19 L), an increase of 45.6% (95% CI, 43.0-48.1%) in physiological pregnancies compared with the reference value. The plasma volume expansion in gestational hypertensive and growth-restricted pregnancies was 0.80 L (95% CI, 0.59-1.02 L), an increase of 32.3% (95% CI, 23.6-41.1%) in the third trimester, a smaller increase than in physiological pregnancies (P < 0.0001). CONCLUSIONS During physiological pregnancy, plasma volume increases by, on average, more than 1 L as compared with non-pregnant conditions. In pregnancies complicated by pregnancy-induced hypertension, pre-eclampsia or fetal growth restriction, plasma volume increase in the third trimester is 13.3% lower than in normal pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Adaptación fisiológica del volumen del plasma materno durante el embarazo: una revisi\xF3n sistemática y metaanálisis RESUMEN OBJETIVO: Describir el patrón fisiológico de los cambios en el volumen del plasma gestacional en embarazos normales con feto único y compararlo con el patrón en los embarazos complicados por hipertensión gestacional, preeclampsia o restricción del crecimiento fetal. MÉTODOS: Se realizó un metaanálisis de la literatura actual sobre los cambios en el volumen de plasma durante embarazos complicados y fisiológicos. La literatura se obtuvo de las bases de datos PubMed (NCBI) y EMBASE (Ovid). Los estudios incluidos mencionaban tanto mediciones de referencia del volumen plasmático (no embarazada, antes del embarazo o después del parto) como mediciones tomadas a edades gestacionales predeterminadas. Se calcularon las medias de las diferencias entre las mediciones de referencia y las del embarazo para el volumen plasmático a intervalos predefinidos de la edad gestacional, utilizando un modelo de efectos aleatorios descrito por DerSimonian y Laird. RESULTADOS En el metaanálisis se incluyeron treinta estudios con fechas de publicación entre 1934 y 2007. El volumen plasmático aumentó en las primeras semanas de embarazo y el mayor incremento se produjo durante el segundo trimestre. El volumen de plasma continuó aumentando en el tercer trimestre con un aumento combinado máximo de 1,13L (IC 95%, 1,7-1,19 L), lo que supone un aumento del 45,6% (IC 95%, 43,0-48,1%) en embarazos fisiológicas en comparación con el valor de referencia. El aumento del volumen plasmático en los embarazos con hipertensión y con crecimiento intrauterino restringido fue de 0,80L (IC 95%, 0,59-1,02 L), lo que supone un aumento del 32,3% (IC 95%, 23,6-41,1%) en el tercer trimestre, y un incremento menor que en los embarazos fisiológicos (P <0,0001). CONCLUSIONES Durante el embarazo fisiológico el volumen de plasma aumenta, en promedio, más de 1L, en comparación con el de las no embarazadas. En los embarazos complicados por hipertensión gestacional, preeclampsia o restricción del crecimiento fetal, el aumento del volumen plasmático en el tercer trimestre es un 13,3% menor que en el embarazo normal. :meta : ,、。 : meta。PubMed(NCBI)EMBASE(Ovid)。(、)。DerSimonianLaird,。 : Meta30,19342007。,。,1.13 L(95% CI,1.07~1.19 L),,45.6%(95% CI,43.0%~48.1%)。0.80 L(95%CI,0.59~1.02 L),32.3%(95% CI,23.6%~41.1%),(P<0.0001)。 : ,,1 L。、,13.3%。.
Collapse
|
64
|
Statkevicius S, Bonnevier J, Bark BP, Larsson E, Öberg CM, Kannisto P, Tingstedt B, Bentzer P. The importance of albumin infusion rate for plasma volume expansion following major abdominal surgery - AIR: study protocol for a randomised controlled trial. Trials 2016; 17:578. [PMID: 27923389 PMCID: PMC5142270 DOI: 10.1186/s13063-016-1714-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 11/17/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Administration of fluids to restore normovolaemia is one of the most common therapeutic interventions performed peri-operatively and in the critically ill, but no study has evaluated the importance of infusion rate for the plasma volume-expanding effect of a resuscitation fluid. The present study is designed to test the hypothesis that a slow infusion of resuscitation fluid results in better plasma volume expansion than a rapid infusion. METHODS/DESIGN The study is a single-centre, assessor-blinded, parallel-group, randomised prospective study. Patients over 40 years of age admitted to the post-operative care unit after a Whipple procedure or major gynaecological surgery and presenting with signs of hypovolaemia are eligible for inclusion. Patients are randomised in a 1:1 fashion with no stratification to either rapid (30 minutes) or slow (180 minutes) infusion of 5% albumin at a dose of 10 ml/kg ideal body weight. Plasma volume is measured using 125I human serum albumin at baseline (prior to albumin infusion) as well as at 30 minutes and 180 minutes after infusion start. The primary endpoint is change in plasma volume from baseline to 180 minutes after the start of 5% albumin infusion. Secondary endpoints include the integral of plasma volume over time from baseline to 180 minutes after the start of the infusion and transcapillary escape rate of albumin (%/h) from 180 minutes to 240 minutes after the start of albumin infusion. In addition, diuresis, change in central venous oxygen saturation, lactate and blood pressure will be evaluated. A total of 70 patients will be included in the study, and the study has 80% power to detect a difference of 4 ml/kg in plasma volume expansion between the two groups. DISCUSSION The present study is the first clinical investigation of the importance of infusion rate for the plasma volume-expanding effect of a resuscitation fluid. TRIAL REGISTRATION EudraCT identifier: 2013-004446-42 . Registration date: 20 December 2013. ClinicalTrials.gov identifier: NCT02728921 . Registration date: 31 March 2016.
Collapse
|
65
|
Andreoli SP. 50 Years Ago in The Journal of Pediatrics: Hemodynamic Findings in Acute Glomerulonephritis. J Pediatr 2016; 179:110. [PMID: 27884267 DOI: 10.1016/j.jpeds.2016.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
66
|
Zhang Y, Yang L, Liu X, Piao J, Yang X. [Application of three different methods for estimating of the plasma volume in children]. WEI SHENG YAN JIU = JOURNAL OF HYGIENE RESEARCH 2016; 45:753-757. [PMID: 29903126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the difference between three methods for estimating the plasma volume in children. METHODS The blood volume of 57 children from 10 to 12 years old were estimated by weight, formula proposed by Woodhead, and by bioelectrical impedance analysis( BIA), the effect and consistency of three methods were also compared. RESULTS There was no difference between three methods in blood volume estimating( P > 0. 05). According to the results of Passing & Bablok regression regression analysis, the residual standard deviation( RSD) was 85. 88, 122. 83 and 111. 24. The regression equation were: y_(Woodhead)= 577. 356224 + 0. 800525x_(BW); y_(BIA)=1091. 590338 + 0. 653032x( BW); y( BIA)= 560. 545257 + 0. 843899x_(Woodhead), and there was no obvious departure from the linear correlation( P > 0. 05). After regrouping by the percent body fat, there were differences between three methods in weight in overweight and obese children group( P < 0. 05), the blood volume estimated by weight was thehighest, and by the BIA was the lowest. While in normal group there was no difference between three groups(P<0. 05). CONCLUSION Three methods in blood volume estimating has a good consistency, estimating by body weight and formula have the virtue of convenience. Method of BIA is extremely fit for application in children with higher body fat.
Collapse
|
67
|
Courtar DA, Spaanderman MEA, Aardenburg R, Janssen BJA, Peeters LLH. Low Plasma Volume Coincides With Sympathetic Hyperactivity and Reduced Baroreflex Sensitivity In Formerly Preeclamptic Patients. ACTA ACUST UNITED AC 2016; 13:48-52. [PMID: 16378912 DOI: 10.1016/j.jsgi.2005.11.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preeclampsia is associated with enhanced sympathetic activity as well as subnormal plasma volume. Meanwhile, in over 50% of these complicated pregnancies, the subnormal plasma volume has been found to persist for a prolonged period after pregnancy. The objective of this study is to test the hypothesis that in normotensive formerly-preeclamptic women, persistence of a subnormal plasma volume coincides with enhanced sympathetic activity and with it, an altered autonomic control of blood pressure. METHODS Forty-eight formerly-preeclamptic women participated in this study. After measurement of their plasma volume by iodine 125-albumin indicator dilution, they were subdivided into a group with a normal plasma volume (plasma volume > 48 ml/kg lean body mass) and a group with a subnormal plasma volume (< or = 48 ml/kg lean body mass). We performed spectral analysis on their beat-to-beat blood pressure and heart rate recordings and compared both groups using non-parametric tests. RESULTS Formerly-preeclamptic women with a subnormal plasma volume had a higher sympathetic activity (P = .001) and a lower baroreflex sensitivity (P = .04) than their counterparts with a normal plasma volume. CONCLUSION In normotensive formerly-preeclamptic women, a subnormal plasma volume coincides with a higher sympathetic activity in the blood pressure regulation and lower baroreflex sensitivity. Whether these alterations in the autonomic control mechanisms are a cause or effect of the subnormal plasma volume remains to be elucidated.
Collapse
|
68
|
Abstract
Glomerular filtration rate (GFR) and renal plasma flow (RPF) increase by 40-65% and 50-85%, respectively, during normal pregnancy in women. Studies using the gravid rat as a model have greatly enhanced our understanding of mechanisms underlying these remarkable changes in the renal circulation during gestation. Hyperfiltration appears to be almost completely due to the increase in RPF, the latter attributable to profound reductions in both the renal afferent and efferent arteriolar resistances. The major pregnancy hormone involved is relaxin. The mediators downstream from relaxin include endothelin (ET) and nitric oxide (NO). New evidence indicates that relaxin increases vascular gelatinase activity during pregnancy, thereby converting big ET to ET(1-32), which leads to renal vasodilation, hyperfiltration, and reduced myogenic reactivity of small renal arteries via the endothelial ET(B) receptor and NO. Whether the chronic volume expansion characteristic of pregnancy contributes to the maintenance of gestational renal changes requires further investigation. Additional studies are also needed to further delineate the molecular basis of these mechanisms and, importantly, to investigate whether they apply to women.
Collapse
|
69
|
Hafer C, Golla P, Gericke M, Eden G, Beutel G, Schmidt JJ, Schmidt BMW, De Reys S, Kielstein JT. Membrane versus centrifuge-based therapeutic plasma exchange: a randomized prospective crossover study. Int Urol Nephrol 2016; 48:133-8. [PMID: 26531062 PMCID: PMC5360823 DOI: 10.1007/s11255-015-1137-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/09/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is either performed using a highly permeable filter with standard multifunctional renal replacement equipment (mTPE) or a centrifugation device (cTPE). Although both techniques are well established in clinical practice, performance of these two modes of TPE was never compared in a prospective randomized fashion. Thus we aimed to compare two commercially available therapeutic apheresis systems: mTPE (Octonova with Plasmaflo filter) and cTPE (Spectra Optia apheresis system). METHODS Twenty-one patients (age 51.6 ± 13.5 years; 10 F/11 M; BMI 25.1 ± 5.0 kg/m(2)) were enrolled in this randomized, prospective, paired, crossover study performed in the Hannover Medical School, Germany. First treatment (either mTPE or cTPE) was chosen by an online randomization list. The primary endpoints were plasma removal efficiency with 1.2× of the total plasma volume exchanged. Secondary endpoints were total amount of plasma substances removed, such as IgG and fibrinogen. Further, the treatment effect on platelet count and complications were evaluated. RESULTS Despite a comparable volume of the processed plasma, mTPE treatment time was 10.5 % longer than cTPE treatment time (p < 0.05), resulting in a 10 % lower plasma removal rate of the mTPE treatment. Both treatments were comparable in terms of decrease in median (IQR) IgG [pre-mTPE 5.34 (3.48-8.37), post-mTPE 1.96 (1.43-2.84) g/L; pre-cTPE 5.88 (3.42-8.84), post-cTPE 1.89 (1.21-3.52) g/L]. Also the median (IQR) amount of IgG removed in mTPE [13.14 (7.42-16.10) g] was not different from the cTPE treatment [9.30 (6.26-15.69) g]. This was also true for IgM removal. Platelet loss during mTPE was nearly twice as much as with cTPE (15 ± 9 versus 7 ± 9 %, p < 0.05). CONCLUSION Although the centrifugal procedures were conducted using flow rates that could easily be obtained using peripheral access, plasma removal efficiency was significantly higher and treatment time was significantly lower in cTPE as compared to mTPE. Despite this lower treatment time, the decline in markers of procedure efficacy was comparable. Especially in centers performing many procedures per year, cTPE in contrast to mTPE can reduce treatment time without compromising treatment efficacy.
Collapse
|
70
|
Rose R, Klemcke HG. Relationship between Plasma Albumin Concentration and Plasma Volume in 5 Inbred Rat Strains. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2015; 54:459-464. [PMID: 26424242 PMCID: PMC4587612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/11/2014] [Accepted: 01/15/2015] [Indexed: 06/05/2023]
Abstract
Using the Evans Blue procedure, we previously found strain-related differences in plasma volumes in 5 inbred rat strains. Because albumin binds strongly with Evans blue, this protein is important in the Evans blue method of plasma volume determination. Therefore, we speculated that interstrain differences in plasma albumin concentration (PAC) could distort calculated plasma volumes. To address this concern, we used ELISA techniques to measure PAC in these inbred rat strains. In study A, the blood volume was measured by using Evans blue dye, and albumin was measured at the start of hemorrhage. In study B, blood volume was not measured, and albumin was measured twice, near the start and end of hemorrhage (approximately 14 min apart). Neither study revealed any interstrain differences in PAC, which decreased after hemorrhage in all 5 strains. No correlation was found between PAC and plasma volume, survival time, blood lactate, or blood base excess. Percentage changes in PAC during hemorrhage were greater in salt-sensitive compared with Lewis rats. Moreover, these percentage changes were associated with survival time in Fawn hooded hypertensive rats. Our data show that the plasma volumes we measured previously were not misrepresented due to variations in PAC.
Collapse
|
71
|
Özdemir K, Mir MS, Dinçel N, Bozabali S, Kaplan Bulut İ, Yilmaz E, Sözeri B. Bioimpedance for assessing volume status in children with nephrotic syndrome. Turk J Med Sci 2015. [PMID: 26084125 DOI: 10.3906/sag-1312-132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND/AIM The effectiveness of assessing volume load via bioimpedance in pediatric patients with nephrotic syndrome (NS) was investigated. MATERIALS AND METHODS Patients with NS (n = 34) were compared with healthy controls (n = 20). The inferior vena cava index and inferior vena cava collapsibility index (IVCCI) scores were determined for all subjects. Bioimpedance measurements were used to directly determine volume load. Clinical findings, relative fluid load, and echocardiographic measurements were determined and compared with bioimpedance in calculating volume load. RESULTS The sensitivity and specificity of bioimpedance in determining volume load were found to be 65% and 90%, respectively. IVCCI was lower in NS patients than in controls. There were also significant differences in IVCCI values between patients with localized and generalized edema. Relative fluid load was higher in NS patients with generalized edema as opposed to patients with localized edema. For calculating volume load, the sensitivity of bioimpedance, clinical findings, and echocardiographic measurements was 87%, 95%, and 83%, respectively, whereas the specificity of determining volume load by bioimpedance, clinical findings, and echocardiographic measurements was 50%, 10%, and 80%, respectively. CONCLUSION Our data suggest that bioimpedance may be superior to echocardiography in determining volume load in children with NS, because it is cost-effective, reliable, and relatively simple to perform.
Collapse
|
72
|
Walker A, Keene T, Argus C, Driller M, Guy JH, Rattray B. Immune and inflammatory responses of Australian firefighters after repeated exposures to the heat. ERGONOMICS 2015; 58:2032-2039. [PMID: 26082313 DOI: 10.1080/00140139.2015.1051596] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
When firefighters work in hot conditions, altered immune and inflammatory responses may increase the risk of a cardiac event. The present study aimed to establish the time course of such responses. Forty-two urban firefighters completed a repeat work protocol in a heat chamber (100 ± 5°C). Changes to leukocytes, platelets, TNFα, IL-6, IL-10, LPS and CRP were evaluated immediately post-work and also after 1 and 24 h of rest. Increases in core temperatures were associated with significant increases in leukocytes, platelets and TNFα directly following work. Further, platelets continued to increase at 1 h (+31.2 ± 31.3 × 10(9) l, p < 0.01) and remained elevated at 24 h (+15.9 ± 19.6 × 10(9) l, p < 0.01). Sustained increases in leukocytes and platelets may increase the risk of cardiac events in firefighters when performing repeat work tasks in the heat. This is particularly relevant during multi-day deployments following natural disasters. Practitioner Summary: Firefighters regularly re-enter fire affected buildings or are redeployed to further operational tasks. Should work in the heat lead to sustained immune and inflammatory changes following extended rest periods, incident controllers should plan appropriate work/rest cycles to minimise these changes and any subsequent risks of cardiac events.
Collapse
|
73
|
Alis R, Ibañez-Sania S, Basterra J, Sanchis-Gomar F, Romagnoli M. Effects of an acute high-intensity interval training protocol on plasma viscosity. J Sports Med Phys Fitness 2015; 55:647-653. [PMID: 24921613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM High-intensity interval training (HIT) is an exercise model that has been seen to cause similar muscle adaptations and improvements in exercise performance to other traditional exercise models. This study aimed to examine the effects of low-volume HIT exercise on plasma viscosity (PV). METHODS Ten healthy male subjects (25.80±3.39 years) randomly performed a HIT running protocol (2-min warm up at 8 km/h, 5x2-min bouts at 90% maximal heart rate, separated by 2-min at 8 km/h, finished with another 2-min period at 8 km/h) or an aerobic (AER) running exercise (60'at 55% VO2max). Blood samples were drawn before and after exercise, and after 30-minute recovery. PV, hematocrit (Hct), fibrinogen, total proteins, triglycerides, total-cholesterol and glucose levels were analyzed. Plasma volume loss during exercise was calculated. RESULTS PV rose after HIT (P<0.05) while Hct rose after both protocols. Plasma volume loss was higher after HIT (-6.35±3.47%) than after AER (-3.11±2.49%) (P=0.045). Total-proteins (P<0.001), triglycerides (P=0.013), total-cholesterol (P<0.001) and glucose (P=0.001) concentrations increased after HIT. After AER no statistically significant differences were found in plasma constituents concentrations. CONCLUSION A low-volume HIT session causes a sufficient loss in plasma volume that leads to significantly incremented plasma constituents' concentrations and, therefore, a mild transient rise in PV.
Collapse
|
74
|
Sophasan S, Jariyawat S. Effect of plasma volume expansion on glomerular function after unilateral ureteral occlusion in rats. CONTRIBUTIONS TO NEPHROLOGY 2015; 95:54-61. [PMID: 1807921 DOI: 10.1159/000420639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
75
|
Koomans HA, Dorhout Mees EJ. Role of tissue hydration in the redistribution of extracellular fluid after ultrafiltration. CONTRIBUTIONS TO NEPHROLOGY 2015; 41:441-5. [PMID: 6396040 DOI: 10.1159/000429327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|