Many different IV fluids with different compositions are available for use in fluid resuscitation (see Table 1). 1 When hypotension is not caused by blood loss, but instead most commonly due to hypovolemia and sepsis, significant debate remains over the optimal IV resuscitation fluid that should be given. When the cause of shock is hemorrhagic, the PROPPR (Pragmatic, Randomized Optimal Platelet and Plasma Ratios) randomized control trial confirmed that the ideal resuscitation strategy is balanced hemostatic resuscitation with the administration of packed red blood cells, fresh frozen plasma, and platelets.
However, there is still longstanding debate over the optimal composition of IV fluids that should be used in the resuscitation of acutely and critically ill patients. At home, the drainage is performed according to the physician’s instructions.The administration of intravenous (IV) fluids for resuscitation and shock management is a fundamental component of the management of almost all surgical and critically ill patients in intensive care units (ICU). After the implantation and the first drainage, the patient is able to return to his usual environment. Whenever necessary a drainage bottle can be connected to the catheter to drain the fluid. The permanent drainage catheter is implanted into the abdominal cavity (peritoneal cavity) in a minimally invasive outpatient or inpatient procedure under local anaesthesia. In a surgical procedure under full anaesthesia, a small electronic pump is implanted that monitors the quantity of fluid inside the abdominal cavity and – whenever necessary – pumps excess fluid into the bladder via a catheter, from where it is excreted with the urine. In this procedure, the ascites is punctured with a cannula under local anaesthesia and the accumulated fluid is removed with a syringe. The type of treatment that is useful or possible in each individual case always depends on the individual clinical picture and on the patient’s general health. Alternatively the lymphatic vessels can be affected and are no longer able to remove fluid from the body in sufficient quantities. In this context, organ function is frequently impaired to the extent that a greater quantity of fluid is secreted. Inflammations or injuries of the organs inside the abdominal cavity or acute protein deficiency (hypoalbuminaemia: a decreased concentration of protein in the body means that water can no longer be sufficiently retained in the vascular system and is forced out of the vessels) are also possible causes. There are two types of ascites: benign and malignant ascites.īenign ascites is generally caused by liver diseases (for example, liver cirrhosis) or heart diseases. Very large quantities of fluid can also obstruct breathing.
Smaller quantities of fluid are usually not noticeable however, larger quantities cause the abdomen to distend, creating a painful feeling of pressure or a feeling of nausea. This happens if an increased quantity of fluid leaks from the blood vessels into the abdominal cavity (for example, if the pressure in the blood vessels is increased due to organic problems, if pressure is too low due to protein deficiency or increased permeability of the cell walls) and / or if the fluid can no longer be sufficiently removed from the body by the lymphatic system. If the quantity of fluid inside the peritoneal cavity exceeds the norm, this is referred to as ascites (abdominal dropsy). At home, the drainage is performed according to the physician’s instructions. This is a therapeutic option for recurrent effusions, because it normally allows the patient to return to his usual environment after the implantation and the first drainage. A drainage bottle can be connected to the catheter if the fluid needs to be drained. In permanent drainage therapy, a catheter is implanted into the pleural cavity in a minimally invasive surgical procedure in the hospital under local anaesthesia. powder) is inserted into the pleural cavity that causes the viscera pleural and the parietal pleura to adhere to one another, which in turns prevents fluid from accumulating inside the cavity again. In chemical pleurodesis, the pleural cavity is obliterated under full anaesthesia during an inpatient procedure. During the procedure the effusion is punctured with a cannula under local anaesthesia and the accumulated fluid is removed with a syringe.
The following treatment alternatives exist:Ī pleural puncture is an outpatient procedure, which is often performed in the hospital.
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