fluid replacement or fluid resuscitation is a medical practice to replace lost body fluids through sweating, bleeding, fluid shifts or other pathological processes. Fluids can be replaced by oral rehydration therapy (drinking), intravenous, rectal therapy such as with Murphy drops, or with hypodermoclysis , direct injection of fluid to subcutaneous tissue. The fluids administered by oral and hypodermic routes are absorbed more slowly than those given intravenously.
Video Fluid replacement
By mouth
Oral rehydration therapy (ORT) is a simple treatment for dehydration associated with diarrhea, especially gastroenteritis/gastroenteropathy, such as those caused by cholera or rotavirus. ORT consists of saline solution and sugar taken. For most mild to moderate dehydration in children, better care in the emergency department is ORT during intravenous fluid replacement.
It is used worldwide, but the most important in developing countries, where it saves millions of children a year from dying from diarrhea - the second leading cause of death in toddlers.
Maps Fluid replacement
Intravenous
In severe dehydration, intravenous fluid replacement is preferred, and can save lives. This is particularly useful where there is fluid depletion both in intracellular space and vascular space.
Fluid replacement is also indicated in fluid depletion due to bleeding, extensive burns and excessive sweating (such as from prolonged fever), and prolonged diarrhea (cholera).
During the surgical procedure, the fluid requirement increases with increased evaporation, fluid transfer and/or excessive urine production among other possible causes. Even small operations can cause loss around. 4 ml/kg/hr, and a large operation of about 8 ml/kg/hr, in addition to the basal fluid requirement.
The table on the right shows the daily requirement for some major fluid components. If these can not be administered enterally, they may need to be given fully intravenously. If long-term continuation (more than 2 days), a fuller total parenteral nutrition regimen may be required.
The types of liquids used
The types of intravenous fluids used in fluid replacement are generally in the volume expander class. Physiological saline solution, or 0.9% sodium chloride solution, is often used because it is isotonic, and therefore will not cause potentially harmful fluid shifts. Also, if anticipated that blood will be given, normal saline is used because it is the only fluid that is compatible with blood administration.
Blood transfusion is the only approved fluid replacement capable of carrying oxygen; several substitutes of oxygen-carrying blood are under development.
The Ringer Lactate solution is another isotonic crystalloid solution and is designed to match the closest blood plasma. If administered intravenously, isotonic crystalloid fluid will be distributed to the intravascular and interstitial space.
Plasmalyte is another isotonic crystalloid.
Blood products, non-blood products and combinations are used in fluid replacement, including colloidal and crystalloid solutions. Colloid is increasingly used but the price is more expensive than crystalloid. A systematic review found no evidence that colloidal resuscitation, rather than crystalloids, reduced the risk of death in patients with trauma, burns or after surgery.
Maintenance
Treatment fluids are used in those who are currently normally hydrated but can not drink enough to maintain this hydration. In children, isotonic fluids are recommended to maintain hydration.
Procedures
It is important to achieve good enough fluid status to avoid low urine production. Low urine output has various limits, but the output of 0.5Ã, mL/kg/h in adults is usually considered adequate and indicates adequate organ perfusion. The garden formula is not perfect and fluid therapy needs to be titrated to hemodynamic value and urine output.
The speed of fluid replacement may vary between procedures. Planning of fluid replacement for burn patients is based on the Parkland formula (4mL Lactated Ringers Xwt.in kg XÃ,% TBSA burned = Total fluid (in ml) to give over 24 hours). The Parkland formula provides the minimum amount to be given in 24 hours. Half of the volume is given during the first eight hours after the combustion time (not from entry time to ED) and the other half for the next 16 hours. In dehydration, 2/3 deficits can be given in 4 hours, and the rest for roughly. 20 hours.
Clinical use
Septic shock
The fluid replacement in patients with septic shock can be divided into four stages as shown below:
- Resuscitation stage - The purpose of this phase is to correct hypotension. Intravenous crystalloid is the first treatment option. The Defensive Sepsis Camp recommends fluid resuscitation of 30 ml/kg in this phase. Early fluid resuscitation is associated with increased survival. Average arterial pressure should be targeted at more than 65 mmHg. In the meantime, for initial-purpose therapy (EGDT), fluids should be given in the first six hours of septic shock until the central venous pressure (CVP) reaches between 8 and 12 mmHg, with elevated blood lactate levels, central venous oxygen saturation & gt; 70%, and urine output> = 0.5 ml/kg/hr. Higher mean arterial stress can be used in patients with chronic hypertension to reduce the use of renal replacement therapy. However, if fluid replacement is inadequate in increasing blood pressure, then a vasopressor should be used. However, there is no definite time to start the vasopressor. Vasopressor initiation within the first hour of sepsis can lead to poor organ perfusion and poor organ function. The final initiation of the vasopressor can cause organ damage and increase the risk of death. Frequent monitoring of patient fluid status is necessary to prevent excess fluid.
- Optimization phase - In this phase, the goal is to increase oxygen delivery to the network to meet the oxygen requirements of the network. Oxygen delivery can be increased by increasing the volume of heart stroke (via fluid challenge), hemoglobin concentration (through blood transfusions), and arterial oxygen saturation (via oxygen therapy). The fluid challenge is the procedure of administering large amounts of fluid in a short time. However, 50% of them do not respond to fluid challenges. Additional fluid challenges only cause excess fluid. However, there is no gold standard in determining the fluid response. Among other ways to determine fluid response and fluid resuscitation endpoints are: Central venous oxygen saturation (ScvO2), passive leg enhancement test, ultrasound measurement of pulse pressure variation, stroke volume variation, and respiratory variation in superior, inferior cava vena vena cava and internal jugular vein.
- Stabilization phase - At this stage, tissue perfusion begins to stabilize and the need for fluid or vasopressor begins to decrease. Additional fluid challenges can be given only to those who are responsive. Treatment fluids may be discontinued if adequate perfusion status.
- Evacuation phase - In this phase, the goal is to remove excess fluid from those who achieve adequate tissue perfusion. A negative fluid balance is associated with a reduced risk of death. However, there is no consensus regarding the optimal time to remove fluid and reduced perfusion risk after fluid removal is also unconvincing. A sensible approach is to start fluid restriction when tissue perfusion is adequate, and consider diuretic treatment for those who have clinical evidence of fluid overload and positive fluid balance. According to Fluid and Catheter Treatment (FACTT Trial) trials, those with an average arterial pressure of more than 60 mmHg, vasopressor-free for more than 12 hours, with adequate urine output may be given furosemide to target central venous pressure of less than 4 mmHg and pulmonary artery occlusion pressure (PAOP) is less than 8 mmHg. The level of brain's natriuretic peptide can also be used to guide fluid removal.
Acute kidney injury
Sepsis accounts for 50% of patients with acute renal injury in (intensive care unit) (ICU). Intravenous crystalloid is recommended as first-line therapy to prevent or treat acute kidney injury (AKI) when compared with colloids as colloids increase the risk of AKI. 4% human albumin can be used in cirrhotic patients with spontaneous bacterial peritonitis because it can reduce the rate of renal failure and improve survival. However, excess fluid can cause acute kidney injury. The use of diuretics does not prevent or treat AKI even with the help of renal replacement therapy. The 2012 KDIGO Guideline (Kidney Disease: Improving Global Outcome) states that diuretics should not be used to treat AKI, except for excessive volume management. In adult respiratory distress syndrome (ARDS), conservative fluid management is associated with better oxygenation and lung function with fewer dialysis prevalence within the first 60 days of hospitalization when compared with liberal fluid management.
Excess fluid
Excess fluid is defined as weight gain of more than 10%. Aggressive fluid resuscitation can lead to excess fluid that can cause damage to several organs such as cerebral odema leading to delirium, pulmonary edema, and pleural effusions that cause respiratory distress, myocardial edema and pericardial effusion leading to impaired cardiac contractility. , gastrointestinal edema leading to malabsorption, liver congestion leading to cholestasis, acute renal injury, and tissue odema lead to poor wound healing. All of these effects can cause disability and death, and an increase in hospitalization costs.
Excess fluid causes heart dilatation, which causes increased ventricular wall stress, mitral insufficiency and lead to cardiac dysfunction. Pulmonary hypertension may lead to tricuspid insufficiency. Excess fluid administration leads to extracellular fluid accumulation, leading to pulmonary edema and lack of oxygen delivery to the tissues. Use of mechanical ventilation in such cases can cause barotrauma, infection, and oxygen toxicity, leading to acute respiratory distress syndrome. Excess fluid also extends the arterial endothelium, which causes glycocalyx damage, leading to capillary leakage and worsening acute renal injury.
Other treatments
Proctoclysis, an enema, is the administration of fluid into the rectum as a hydration therapy. Sometimes it is used for people who are sick with cancer. Murphy drops are a tool that allows this treatment to be performed.
See also
- Hipodermoclysis
- Intravenous therapy
- Hypovolaemia
- Third assignment
- Pentastarch
- Passive foot lift test
References
Source of the article : Wikipedia
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