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Burkett MS. Daily weight monitoring for inpatients receiving chemotherapy. Nursing 2024; 54:48-51. [PMID: 38757998 DOI: 10.1097/nsg.0000000000000012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
ABSTRACT Unlike intake and output documentation, which is often inaccurate and inconsistent, daily weight measurement is a reliable method to assess fluid volume status. Daily weight assessment and monitoring are crucial for preventing volume overload in patients receiving chemotherapy in the inpatient setting.
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Affiliation(s)
- Melissa Styan Burkett
- Melissa Styan Burkett is a board-certified Family Nurse Practitioner practicing hematology/oncology at the UPMC Hillman Cancer Center
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2
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Borgers JSW, van Schijndel AW, van Thienen JV, Klobuch S, Seijkens TTP, Tobin RP, van Heerebeek L, Driessen-Waaijer A, Rohaan MW, Haanen JBAG. Clinical presentation of cardiac symptoms following treatment with tumor-infiltrating lymphocytes: diagnostic challenges and lessons learned. ESMO Open 2024; 9:102383. [PMID: 38364453 PMCID: PMC10937195 DOI: 10.1016/j.esmoop.2024.102383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/23/2023] [Accepted: 01/19/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Treatment with tumor-infiltrating lymphocytes (TILs) is rapidly evolving for patients with solid tumors. Following metastasectomy, TILs (autologous, intratumoral CD4+ and CD8+ T cells with the potential to recognize tumor-associated antigens) are isolated and non-specifically expanded ex vivo in the presence of interleukin-2 (IL-2). Subsequently, the TILs are adoptively transferred to the patients after a preconditioning non-myeloablative, lymphodepleting chemotherapy regimen, followed by administration of high-dose (HD) IL-2. Here, we provide an overview of known cardiac risks associated with TIL treatment and report on seven patients presenting with cardiac symptoms, all with different clinical course and diagnostic findings during treatment with lymphodepleting chemotherapy, TIL, and HD IL-2, and propose a set of clinical recommendations for diagnosis and management of these symptoms. PATIENTS AND METHODS This single-center, retrospective study included selected patients who experienced TIL treatment-related cardiac symptoms at the Netherlands Cancer Institute. In addition, 12 patients were included who received TIL in the clinical trial setting without experiencing cardiac symptoms, from whom complete cardiac biomarker follow-up during treatment was available [creatine kinase (CK), CK-myocardial band, troponin T and N-terminal pro-B-type natriuretic peptide]. RESULTS Within our TIL patient population, seven illustrative cases were chosen from the patients who developed symptoms suspected of severe cardiotoxicity: myocarditis, myocardial infarction, peri-myocarditis, atrial fibrillation, acute dyspnea, and two cases of heart failure. An overview of their clinical course, diagnostics carried out, and management of the symptoms is provided. CONCLUSIONS In the absence of evidence-based guidelines for the treatment of TIL therapy-associated cardiotoxicity, we provided an overview of literature, case descriptions, and recommendations for diagnosis and management to help physicians in daily practice, as the number of patients qualifying for TIL treatment is rapidly increasing.
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Affiliation(s)
- J S W Borgers
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam
| | - A W van Schijndel
- Department of Intensive Care, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Cardiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam
| | - J V van Thienen
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam
| | - S Klobuch
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam
| | - T T P Seijkens
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Medical Biochemistry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - R P Tobin
- Department of Surgery, Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - L van Heerebeek
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam
| | | | - M W Rohaan
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam
| | - J B A G Haanen
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands; Melanoma Clinic, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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3
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Suknuntha K, Wattanapoka K, Poonpattanachai P, Titipornwanich N, Sripakdee W. Compatibility and Physical Properties of Dexamethasone-Ondansetron Intravenous Admixture. Hosp Pharm 2022; 57:666-672. [PMID: 36081540 PMCID: PMC9445544 DOI: 10.1177/00185787221074563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Purpose: This work aimed at evaluating the impact of different concentrations and final volumes on the compatibility and physical properties of dexamethasone-ondansetron intravenous (IV) admixture. Methods: The IV admixture of dexamethasone-ondansetron was prepared at different concentrations using normal saline solution as solvent. The final volume of the IV admixture was prepared at 50 and 100 ml. Turbidity was measured as an indicator of physical compatibility of the IV admixture of dexamethasone-ondansetron using UV-visible spectrophotometer and the pH of the IV admixture was measured on day 0, 7,14, and, 21 as an index of chemical stability. Also, the particle size and potential molecular interactions of the admixtures were determined using particle size analyzer and Fourier Transform infrared spectrometry analysis, respectively. Additionally, the effect of preservatives on the IV admixture was also evaluated. Results: Precipitation was observed for mixtures with amounts of dexamethasone and ondansetron exceeding 8 and 16 mg, respectively, in a final volume of 50 ml. For all mixtures with final volume of 100 ml, clear solutions void of any precipitates were observed. The pH of the solution had no effect on the precipitation of the dexamethasone-ondansetron during storage up to 21 days. Analyses of the precipitate formed revealed the presence of molecular interactions between dexamethasone and ondansetron. The benzyl alcohol used as a preservative affected the compatibility of the IV admixture compatibility. Conclusion: Thus, for the preparation of clear, physically compatible normal saline solutions of dexamethasone-ondansetron IV admixture, the maximum amounts of the respective drugs should not exceed 8 and 16 mg in total volume of 50 ml or 20 and 16 mg in a final volume of 100 ml.
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Affiliation(s)
- Krit Suknuntha
- Prince of Songkla University, Hatyai, Songkhla, Thailand
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Chow BL, Poh CB, Chionh CY. Weight-Based Assessment of Fluid Overload in Patients with Acute Kidney Injury. Nephron Clin Pract 2020; 144:281-289. [PMID: 32403114 DOI: 10.1159/000506398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/07/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) with fluid overload is associated with poor outcomes. While percentage fluid overload (PFO) using intake/output charts (PFOi/o) has been validated as a marker of overload, accurate PFOi/o measurements may not be possible in a general ward. We propose an alternative weight-based PFO calculation: PFOw = [(maximum weight - baseline weight) ÷ baseline weight] × 100%. METHODS This is a prospective, observational pilot study on general ward inpatients with AKI who were referred for nephrology consult. PFOw was compared with PFOi/o, and both were evaluated for associations with dialysis requirement, AKI stage 2 or 3, and 90-day mortality. RESULTS Fifty-eight patients with a median age of 67.5 years (interquartile range 18.0) were recruited. Of which, 33 (56.9%) were males and 41 (70.7%) had preexisting CKD 3 or higher. We found no correlation between PFOi/o and PFOw (R2 = 0.015, p = 0.531). A higher PFOw was observed in AKI stage 2 or 3 (p = 0.005) and in patients requiring dialysis (p = 0.001). On multivariate analysis, each percentage increase in PFOw was associated with increased odds of AKI stage 2 or 3 (odds ratio 1.37 [95% CI 1.05-1.78], p = 0.020) and dialysis need (odds ratio 1.69 [95% CI 1.20-2.39], p = 0.003). Twenty-nine patients had complete quantitative data to calculate PFOi/o. Multivariate analysis of these 29 patients showed that PFOw correlated with AKI stage 2 or 3 and dialysis requirement, while PFOi/o had no correlation with these events. The area under the curve receiver operating characteristics of PFOw was 0.706 for AKI stage 2 or 3 and 0.819 for AKI requiring dialysis. The optimal PFOw cutoff was determined at ≥1%. Three deaths occurred within 90 days, and all had PFOw ≥ 1%, although the log-rank test did not achieve statistical significance (p = 0.050). CONCLUSION The proposed PFOw is a potential prognostic indicator for general ward patients with AKI. PFOw ≥ 1% is associated with poor renal outcomes.
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Affiliation(s)
- Bing Lun Chow
- Department of Renal Medicine, Changi General Hospital, Singapore, Singapore.,Anaesthetics and Critical Care, Borders General Hospital, Melrose, United Kingdom
| | - Cheng Boon Poh
- Department of Renal Medicine, Changi General Hospital, Singapore, Singapore
| | - Chang Yin Chionh
- Department of Renal Medicine, Changi General Hospital, Singapore, Singapore,
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Heng MS, Barbon Gauro J, Yaxley A, Thomas J. Does a neutropenic diet reduce adverse outcomes in patients undergoing chemotherapy? Eur J Cancer Care (Engl) 2019; 29:e13155. [DOI: 10.1111/ecc.13155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/30/2019] [Accepted: 08/01/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Mei Shan Heng
- Nutrition and Dietetics College of Nursing and Health Science, Flinders University Adelaide SA Australia
| | - Jessica Barbon Gauro
- Department of Nutrition and Dietetics Flinders Medical Centre Bedford Park SA Australia
| | - Alison Yaxley
- Nutrition and Dietetics College of Nursing and Health Science, Flinders University Adelaide SA Australia
| | - Jolene Thomas
- Nutrition and Dietetics College of Nursing and Health Science, Flinders University Adelaide SA Australia
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Raina R, Sethi SK, Wadhwani N, Vemuganti M, Krishnappa V, Bansal SB. Fluid Overload in Critically Ill Children. Front Pediatr 2018; 6:306. [PMID: 30420946 PMCID: PMC6215821 DOI: 10.3389/fped.2018.00306] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/28/2018] [Indexed: 12/16/2022] Open
Abstract
Background: A common practice in the management of critically ill patients is fluid resuscitation. An excessive administration of fluids can lead to an imbalance in fluid homeostasis and cause fluid overload (FO). In pediatric critical care patients, FO can lead to a multitude of adverse effects and increased risk of morbidity. Objectives: To review the literature highlighting impact of FO on a multitude of outcomes in critically-ill children, causative vs. associative relationship of FO with critical illness and current pediatric fluid management guidelines. Data Sources: A literature search was conducted using PubMed/Medline and Embase databases from the earliest available date until June 2017. Data Extraction: Two authors independently reviewed the titles and abstracts of all articles which were assessed for inclusion. The manuscripts of studies deemed relevant to the objectives of this review were then retrieved and associated reference lists hand-searched. Data Synthesis: Articles were segregated into various categories namely pathophysiology and sequelae of fluid overload, assessment techniques, epidemiology and fluid management. Each author reviewed the selected articles in categories assigned to them. All authors participated in the final review process. Conclusions: Recent evidence has purported a relationship between mortality and FO, which can be validated by prospective RCTs (randomized controlled trials). The current literature demonstrates that "clinically significant" degree of FO could be below 10%. The lack of a standardized method to assess FB (fluid balance) and a universal definition of FO are issues that need to be addressed. To date, the impact of early goal directed therapy and utility of hemodynamic parameters in predicting fluid responsiveness remains underexplored in pediatric resuscitation.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Akron Children's Hospital and Cleveland Clinic Akron General, Akron, OH, United States
- Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH, United States
| | - Sidharth Kumar Sethi
- Department of Nephrology, Kidney & Urology Institute, Medanta, The Medicity, Gurgaon, India
| | - Nikita Wadhwani
- Department of Nephrology, Kidney & Urology Institute, Medanta, The Medicity, Gurgaon, India
| | - Meghana Vemuganti
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, United States
| | - Vinod Krishnappa
- Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH, United States
- College of Graduate Studies, Northeast Ohio Medical University, Rootstown, OH, United States
| | - Shyam B. Bansal
- Department of Nephrology, Kidney & Urology Institute, Medanta, The Medicity, Gurgaon, India
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Köster M, Dennhardt S, Jüttner F, Hopf HB. Cumulative changes in weight but not fluid volume balances reflect fluid accumulation in ICU patients. Acta Anaesthesiol Scand 2017; 61:205-215. [PMID: 27900767 DOI: 10.1111/aas.12840] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 09/19/2016] [Accepted: 11/03/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The cumulative fluid balance of critically ill patients seems to be an outcome-relevant variable. However, there are no validated data for their reliability calculated for longer (> 5 days) periods of time. METHODS All ICU patients ≥ 18 years, with an ICU stay ≥ 5 days and a body weight ≤ 195 kg were evaluated from 1 January 2013 to 31 December 2013. Daily standardized weighing was performed using bed-integrated scales simultaneously with the daily 24-h fluid balance. Simultaneously, a fluid balance without and with insensible perspiration (10 ml/kg/day) was calculated for each 24 h. Primary endpoint: difference between cumulative fluid balance and body weight changes at the day of transfer to the normal ward or the day of death in the ICU, respectively, in each patient. All data are presented as medians with interquartile ranges (IQR) with 25 and 75 percentiles (IQR/25/75) unless otherwise noted. RESULTS One hundred and six critically ill patients were evaluated; 82 survivors and 24 nonsurvivors. Cumulative 24-h fluid balances rose continuously while body weight decreased over time. Correction of cumulative fluid balances for insensible perspiration (10 ml/kg/day) also did not match with body weight changes. Only survivors had a significant loss in body weight -1.8 (27.5/-6.1/1.0) kg. CONCLUSIONS Assuming that changes in body weight reflect changes in whole body water content cumulative daily fluid volume balances without or with correction for insensible water loss are not useful for estimating cumulative fluid balance of ICU patients. Survivors but not nonsurvivors had a significant loss of weight over time.
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Affiliation(s)
- M. Köster
- Department of Anaesthesia and Perioperative Medicine; Asklepios Klinik Langen; Langen Germany
| | - S. Dennhardt
- Department of Anaesthesia and Perioperative Medicine; Asklepios Klinik Langen; Langen Germany
| | - F. Jüttner
- Department of Anaesthesia and Perioperative Medicine; Asklepios Klinik Langen; Langen Germany
| | - H.-B. Hopf
- Department of Anaesthesia and Perioperative Medicine; Asklepios Klinik Langen; Langen Germany
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Review of Advances in Uroprotective Agents for Cyclophosphamide- and Ifosfamide-induced Hemorrhagic Cystitis. Urology 2016; 100:16-19. [PMID: 27566144 DOI: 10.1016/j.urology.2016.07.030] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
Cyclophosphamide and ifosfamide are widely used drugs for malignancies and rheumatologic conditions. One of the most significant adverse reactions to these drugs is hemorrhagic cystitis. Mesna is the most widely used uroprotective agent that acts to neutralize the caustic metabolite, acrolein, responsible for induction of hemorrhagic cystitis. However, mesna is not a perfect alternative, and studies since its discovery have investigated the use of alternative drugs and adjuncts to increase mesna's efficacy. This review details some of the recent work into novel uroprotective agents for drug-induced hemorrhagic cystitis.
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Ament SMC, de Groot JJA, Maessen JMC, Dirksen CD, van der Weijden T, Kleijnen J. Sustainability of professionals' adherence to clinical practice guidelines in medical care: a systematic review. BMJ Open 2015; 5:e008073. [PMID: 26715477 PMCID: PMC4710818 DOI: 10.1136/bmjopen-2015-008073] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 09/07/2015] [Accepted: 10/07/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate (1) the state of the art in sustainability research and (2) the outcomes of professionals' adherence to guideline recommendations in medical practice. DESIGN Systematic review. DATA SOURCES Searches were conducted until August 2015 in MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and the Guidelines International Network (GIN) library. A snowball strategy, in which reference sections of other reviews and of included papers were searched, was used to identify additional papers. ELIGIBILITY CRITERIA Studies needed to be focused on sustainability and on professionals' adherence to clinical practice guidelines in medical care. Studies had to include at least 2 measurements: 1 before (PRE) or immediately after implementation (EARLY POST) and 1 measurement longer than 1 year after active implementation (LATE POST). RESULTS The search retrieved 4219 items, of which 14 studies met the inclusion criteria, involving 18 sustainability evaluations. The mean timeframe between the end of active implementation and the sustainability evaluation was 2.6 years (minimum 1.5-maximum 7.0). The studies were heterogeneous with respect to their methodology. Sustainability was considered to be successful if performance in terms of professionals' adherence was fully maintained in the late postimplementation phase. Long-term sustainability of professionals' adherence was reported in 7 out of 18 evaluations, adherence was not sustained in 6 evaluations, 4 evaluations showed mixed sustainability results and in 1 evaluation it was unclear whether the professional adherence was sustained. CONCLUSIONS (2) Professionals' adherence to a clinical practice guideline in medical care decreased after more than 1 year after implementation in about half of the cases. (1) Owing to the limited number of studies, the absence of a uniform definition, the high risk of bias, and the mixed results of studies, no firm conclusion about the sustainability of professionals' adherence to guidelines in medical practice can be drawn.
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Affiliation(s)
- Stephanie M C Ament
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jeanny J A de Groot
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - José M C Maessen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands Department of Patient & Integrated Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jos Kleijnen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands Kleijnen Systematic Reviews Ltd, York, UK
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Davies H, Leslie G, Morgan D. Effectiveness of daily fluid balance charting in comparison to the measurement of body weight when used in guiding fluid therapy for critically ill adult patients: a systematic review protocol. ACTA ACUST UNITED AC 2015; 13:111-23. [DOI: 10.11124/jbisrir-2015-2010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/20/2015] [Indexed: 01/15/2023]
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Bekhof J, van Asperen Y, Brand PLP. Usefulness of the fluid balance: a randomised controlled trial in neonates. J Paediatr Child Health 2013; 49:486-92. [PMID: 23635344 DOI: 10.1111/jpc.12214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2012] [Indexed: 12/01/2022]
Abstract
AIM To assess the effects of fluid balance charts in neonates with moderate disease severity on duration of hospitalisation and medical interventions. METHODS Randomised, controlled trial in a neonatal ward in a general teaching hospital in the Netherlands between June 2009 and March 2010. One hundred seventy neonates with moderate disease severity, requiring continuous monitoring of vital parameters (mean gestational age 36(+2) weeks (standard deviation 2(+5) days), mean birthweight 2782 g (standard deviation 749 g)) participated. In the control group (n = 86), attending physicians could access all fluid balance data, whilst these data were blacked out in the intervention group (n = 84). Primary outcome was length of hospital stay. Secondary outcomes were percentage weight loss, interventions based on the fluid status, unblinding of fluid balance data and incident reporting. RESULTS Length of hospital stay did not differ significantly between the intervention and the control group (median 9 vs. 8 days, with ratio of geometric mean 1.25, 95% confidence interval 0.99 to 1.57; P = 0.06). We found no significant differences in secondary outcomes. CONCLUSIONS Routinely keeping fluid balances in neonates with moderate disease severity does not affect duration of hospitalisation or medical treatment.
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Affiliation(s)
- Jolita Bekhof
- Princess Amalia Children's Clinic, Isala Klinieken, Zwolle, The Netherlands.
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ALMEIDA JP, PALOMBA H, GALAS FRBG, FUKUSHIMA JT, DUARTE FA, NAGAOKA D, TORRES V, YU L, VINCENT JL, AULER JOC, HAJJAR LA. Positive fluid balance is associated with reduced survival in critically ill patients with cancer. Acta Anaesthesiol Scand 2012; 56:712-7. [PMID: 22621427 DOI: 10.1111/j.1399-6576.2012.02717.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are no studies that describe the impact of the cumulative fluid balance on the outcomes of cancer patients admitted to intensive care units ICUs. The aim of our study was to evaluate the relationship between fluid balance and clinical outcomes in these patients. METHOD One hundred twenty-two cancer patients were prospectively evaluated for survival during a 30-day period. Univariate (Chi-square, t-test, Mann-Whitney) and multiple logistic regression analyses were used to identify the admission parameters associated with mortality. RESULTS The mean cumulative fluid balance was significantly higher in non-survivors than in survivors [1675 ml/24 h (471-2921) vs. 887 ml/24 h (104-557), P = 0.017]. We used the area under the curve and the intersection of the sensibility and specificity curves to define a cumulative fluid balance value of 1100 ml/24 h. This value was used in the univariate model. In the multivariate model, the following variables were significantly associated with mortality in cancer patients: the Acute Physiology and Chronic Health Evaluation II score at admission [Odds ratio (OR) 1.15; 95% confidence interval (CI) (1.05-1.26), P = 0.003], the Lung Injury Score at admission [OR 2.23; 95% CI (1.29-3.87), P = 0.004] and a positive fluid balance higher than 1100 ml/24 h at ICU [OR 5.14; 95% CI (1.45-18.24), P = 0.011]. CONCLUSION A cumulative positive fluid balance higher than 1100 ml/24 h was independently associated with mortality in patients with cancer. These findings highlight the importance of improving the evaluation of these patients' volemic state and indicate that defined goals should be used to guide fluid therapy.
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Affiliation(s)
- J. P. ALMEIDA
- Cancer Institute; Department of Anesthesiology and Critical Care; Intensive Care Unit; School of Medicine; University of Sao Paulo; Sao Paulo; Brazil
| | - H. PALOMBA
- Cancer Institute; Department of Nephrology; Intensive Care Unit; School of Medicine; University of Sao Paulo; Sao Paulo; Brazil
| | - F. R. B. G. GALAS
- Cancer Institute; Department of Anesthesiology and Critical Care; Intensive Care Unit; School of Medicine; University of Sao Paulo; Sao Paulo; Brazil
| | - J. T. FUKUSHIMA
- Cancer Institute; Department of Anesthesiology and Critical Care; Intensive Care Unit; School of Medicine; University of Sao Paulo; Sao Paulo; Brazil
| | - F. A. DUARTE
- Cancer Institute; Department of Anesthesiology and Critical Care; Intensive Care Unit; School of Medicine; University of Sao Paulo; Sao Paulo; Brazil
| | - D. NAGAOKA
- Cancer Institute; Department of Anesthesiology and Critical Care; Intensive Care Unit; School of Medicine; University of Sao Paulo; Sao Paulo; Brazil
| | - V. TORRES
- Cancer Institute; Department of Nephrology; Intensive Care Unit; School of Medicine; University of Sao Paulo; Sao Paulo; Brazil
| | - L. YU
- Cancer Institute; Department of Nephrology; Intensive Care Unit; School of Medicine; University of Sao Paulo; Sao Paulo; Brazil
| | - J.-L. VINCENT
- Department of Intensive Care; Erasme Hospital, Université Libre de Bruxelles; Brussels; Belgium
| | - J. O. C. AULER
- Cancer Institute; Department of Anesthesiology and Critical Care; Intensive Care Unit; School of Medicine; University of Sao Paulo; Sao Paulo; Brazil
| | - L. A. HAJJAR
- Cancer Institute; Department of Anesthesiology and Critical Care; Intensive Care Unit; School of Medicine; University of Sao Paulo; Sao Paulo; Brazil
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Abstract
AIM To assess the reliability of fluid balance charts in neonates. METHODS An observational study in 170 nonbreastfed neonates, requiring continuous monitoring on a high-care unit, but not critically ill. The fluid balance was compared to daily body weight changes using Bland-Altman analysis. Differences more than 20% of daily fluid intake were considered clinically relevant. RESULTS The mean gestational age was 36 + 2 weeks (SD 18.7 days) and mean birth weight 2782 g (SD 749 g). The mean difference between 394 fluid balances over 24 h (in mL) and daily weight changes (in g) was -12.1 (limits of agreement -128.1 to 103.8). In 40% of comparisons, the difference with daily weight change was more than 20% of daily fluid intake. CONCLUSION Fluid balance charts both over- and underestimate body weight changes in an unpredictable pattern and are therefore unreliable as a single measure of fluid status in neonates.
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Affiliation(s)
- Yvette van Asperen
- Isala Klinieken, Princess Amalia Children's Clinic, Zwolle, The Netherlands
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14
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Selewski DT, Cornell TT, Lombel RM, Blatt NB, Han YY, Mottes T, Kommareddi M, Kershaw DB, Shanley TP, Heung M. Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med 2011; 37:1166-73. [PMID: 21533569 PMCID: PMC3315181 DOI: 10.1007/s00134-011-2231-3] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 03/08/2011] [Indexed: 01/20/2023]
Abstract
PURPOSE In pediatric intensive care unit (PICU) patients, fluid overload (FO) at initiation of continuous renal replacement therapy (CRRT) has been reported to be an independent risk factor for mortality. Previous studies have calculated FO based on daily fluid balance during ICU admission, which is labor intensive and error prone. We hypothesized that a weight-based definition of FO at CRRT initiation would correlate with the fluid balance method and prove predictive of outcome. METHODS This is a retrospective single-center review of PICU patients requiring CRRT from July 2006 through February 2010 (n = 113). We compared the degree of FO at CRRT initiation using the standard fluid balance method versus methods based on patient weight changes assessed by both univariate and multivariate analyses. RESULTS The degree of fluid overload at CRRT initiation was significantly greater in nonsurvivors, irrespective of which method was used. The univariate odds ratio for PICU mortality per 1% increase in FO was 1.056 [95% confidence interval (CI) 1.025, 1.087] by the fluid balance method, 1.044 (95% CI 1.019, 1.069) by the weight-based method using PICU admission weight, and 1.045 (95% CI 1.022, 1.07) by the weight-based method using hospital admission weight. On multivariate analyses, all three methods approached significance in predicting PICU survival. CONCLUSIONS Our findings suggest that weight-based definitions of FO are useful in defining FO at CRRT initiation and are associated with increased mortality in a broad PICU patient population. This study provides evidence for a more practical weight-based definition of FO that can be used at the bedside.
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Affiliation(s)
- David T Selewski
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
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15
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Alexander L, Allen D. Establishing an Evidence-Based Inpatient Medical Oncology Fluid Balance Measurement Policy. Clin J Oncol Nurs 2011; 15:23-5. [DOI: 10.1188/11.cjon.23-25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Knops AM, Storm-Versloot MN, Mank APM, Ubbink DT, Vermeulen H, Bossuyt PMM, Goossens A. Factors influencing long-term adherence to two previously implemented hospital guidelines. Int J Qual Health Care 2010; 22:421-9. [PMID: 20716551 DOI: 10.1093/intqhc/mzq038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE AND SETTING After successful implementation, adherence to hospital guidelines should be sustained. Long-term adherence to two hospital guidelines was audited. The overall aim was to explore factors accounting for their long-term adherence or non-adherence. DESIGN AND PARTICIPANTS A fluid balance guideline (FBG) and body temperature guideline (BTG) were developed and implemented in our hospital in 2000. Long-term adherence was determined retrospectively based on data from patient files. Focus groups were launched to explore nurses' perceptions of barriers and facilitators regarding long-term adherence. The predominant themes from the nurses' focus groups were posed to clinicians in questionnaires. RESULTS Nurses involved in the FBG (overall adherence 100%) stated that adherence has immediate advantages in terms of safety and a gain in time. Nurses and oncologists acted unanimously which was thought to enhance adherence. On the other hand, opinions differed on the BTG within the nursing teams and medical staff (overall adherence 50%). Although the guideline discourages routine postoperative body temperature measurements, temperature should be measured according to the guideline in a considerable number of cases due to changes in patient characteristics since the year 2000. Therefore, adherence was judged to be rather complex. CONCLUSIONS To secure adherence to hospital guidelines after their successful implementation, guidelines should preferably be comprehensive in terms of being applicable to the majority of the patients in that particular setting and to the most common clinical situations. All healthcare professionals involved should be aware of its immediate benefits for themselves or to their patients.
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Affiliation(s)
- A M Knops
- Department of Quality Assurance and Process Innovation, Academic Medical Center, Room A3-503, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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17
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Goossens A, Bossuyt PMM, de Haan RJ. Physicians and Nurses Focus on Different Aspects of Guidelines When Deciding Whether to Adopt Them: An Application of Conjoint Analysis. Med Decis Making 2007; 28:138-45. [DOI: 10.1177/0272989x07308749] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. The objectives of this study are to determine the relative importance of 6 guideline features for physicians' and nurses' willingness to adopt practice guidelines, to examine whether physicians and nurses focus on the same or on different aspects of guidelines, and to test whether professionals' learning preference influences their willingness to adopt guidelines. Methods. An orthogonal main effects design was used to develop 16 written guideline descriptions, which varied on 6 characteristics: 1) benefit for the professional, 2) source, 3) support by management, 4) scientific basis, 5) costs, and 6) subject. These descriptions were presented to 251 physicians and 110 nurses working at the Academic Medical Center in Amsterdam, the Netherlands. They indicated their willingness to adopt each guideline on a 7-point scale and completed Kolb's Learning Style Inventory to determine their preferred learning style. Results. The response rate was 55% for physicians and 66% for nurses. The mean age was 40 years; 55% and 25% of the respondents were male. The mean adoption score was 5.26 for physicians and 5.00 for nurses. Of the 6 characteristics, ``scientific basis'' was found to be the strongest determinant for physicians, and the factor ``interesting subject'' was the strongest for nurses. The other characteristics had a limited effect. Theoretically oriented physicians had a significantly lower average score compared with those who preferred active experimentation. No such effects were observed with nurses. Conclusions. Adherence to guidelines is influenced by internal as well as contextual attributes of guidelines. Physicians and nurses focus on different aspects, which is partly influenced by their preferred learning style. This difference in focus should be taken into account when developing an implementation strategy.
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Affiliation(s)
- Astrid Goossens
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center at the University of Amsterdam, the Netherlands,
| | - Patrick M. M. Bossuyt
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center at the University of Amsterdam, the Netherlands
| | - Rob J. de Haan
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center at the University of Amsterdam, the Netherlands
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Randolph AG, Forbes PW, Gedeit RG, Arnold JH, Wetzel RC, Luckett PM, O'Neil ME, Venkataraman ST, Meert KL, Cheifetz IM, Cox PN, Hanson JH. Cumulative fluid intake minus output is not associated with ventilator weaning duration or extubation outcomes in children. Pediatr Crit Care Med 2005; 6:642-7. [PMID: 16276328 DOI: 10.1097/01.pcc.0000185484.14423.0d] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The effect of fluid balance on respiratory outcomes for critically ill children has not been evaluated. The only indicator of fluid balance routinely recorded across our intensive care units was estimated fluid intake and output. We sought to determine whether cumulative intake minus output (I-O) at the start of weaning predicted weaning duration and whether cumulative I-O at extubation predicted extubation failure. DESIGN Prospective observational study. SETTING Ten pediatric intensive care units. PATIENTS Cumulative I-O was recorded daily for 301 mechanically ventilated children (<18 yrs of age) from November 1999 through April 2001. INTERVENTIONS Cumulative I-O was recorded during a study of weaning strategies and extubation failure in which mechanical ventilation of the majority of patients during weaning and extubation was managed according to a protocol that did not include fluid balance indicators. Outcomes were the time to successful removal of ventilatory support and the rate of initial extubation failure. MEASUREMENTS AND MAIN RESULTS Relationships between cumulative I-O and outcomes were assessed by means of proportional hazards and logistic regression. The mean cumulative I-O per kilogram of ideal body weight at the start of weaning was 101 mL (sd, 180). Cumulative I-O at the time weaning was initiated did not predict duration of mechanical ventilator weaning. The mean cumulative I-O per kilogram of ideal body weight at extubation was 136 mL (sd, 237). Cumulative I-O at extubation did not predict extubation outcome. There was an association between cumulative I-O at extubation and the duration of weaning in cases not managed by a protocol. CONCLUSION Although routinely recorded, cumulative fluid I-O does not appear to have clinical utility in cases managed according to a mechanical ventilator protocol in which tidal volume and oxygenation on minimal levels of ventilator support are systematically tested.
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