Background:Hypovolemia is a common cause of hypotension and low cardiac index (CI) in cardiac surgery but no hemodynamic parameters reflect this status well. The accurate diagnosis of hypovolemia is important because the wrong treatment will cause ineffectiveness and bad consequences such as severe heart failure, pulmonary edema, ... Objectives: To evaluate the performance of diagnostic characteristics of the trendelenburg 300 test for hypovolemia in cardiac surgery. Subjects and method: The prospective, cross \ufffd?sectional and randomized controlled trial (RCT) study was conducted on 30 patients (18 males, 12 females and average age 47,17 \xb1 13,93) undergoing valvular repair/replacement or coronary revascularization. The Swan \ufffd?Ganz catheters were placed in 20 patients and PiCCO catheters in 10 patients. Trendelenburg 300 test is considered positive if blood pressure (BP), central venous pressure (CVP), CI and intrathoracic blood volume (ITBV) increase. Results: The hypovolemic status in cardiac surgical patients is diagnosed if BP and/or CI increase in trendelenburg 300 position (Se 87.5% and 65.63%; Sp 100% and 75%, area under ROC 0.83 and 0.81, respectively). Conclusion: The increases in BP and CI responding to trendelenburg 300 position are good indicators of hypovolemia in cardiac surgery.
Hypovolemia/ diagnosis ; Head-Down Tilt ; Thoracic Surgery ;

Rectal bleeding is a frequent finding in patients after transrectal ultrasonography (TRUS)-guided prostate biopsy but is usually mild and stops spontaneously. We report herein a case of life-threatening hypovolemic shock due to rectal bleeding after TRUS-guided prostate biopsy that was successfully treated by selective arterial embolization. The aim of this report is to share our experiences of the management of massive rectal bleeding after prostate biopsy.
Biopsy ; Embolization, Therapeutic ; Hemorrhage ; Humans ; Hypovolemia ; Prostate ; Shock

Superior gluteal artery rupture without pelvic fracture is extremely rare, but the rupture of this vessel is a well-known complication of pelvic fractures. This vessel appears to be at risk at the time of pelvic fracture because of its vulnerable anatomical position in the sacrosciatic notch. The rupture of this vessel causes profound hypotension and compartment syndrome of the gluteal or thigh region. Embolization is the most effective treatment. We report an unusual case of a superior gluteal artery rupture without pelvic fracture in blunt trauma.
Arteries* ; Compartment Syndromes ; Hypotension ; Hypovolemia* ; Rupture* ; Shock* ; Thigh

Cerebrospinal fluid (CSF) leak or shunt overdrainage is a well-known cause of orthostatic headaches and low CSF pressures. We report two cases of orthostatic headache with pneumocephalus on brain imaging. The orthostatic headache developed after drainage of spinal operation site and epidural block. Brain MRI revealed characteristic findings of CSF hypovolemia including pachymeningeal enhancement and mild subdural fluid collections. Air was also observed in the ventricular or subarachnoid space in both patients, which might enter the subarachnoid or ventricular space during a procedure via the pressure gradient or an injection.
Brain ; Drainage ; Headache ; Humans ; Hypovolemia ; Neuroimaging ; Pneumocephalus ; Subarachnoid Space

Twin-twin transfusion syndrome(TTTS) is a serious complication of monozygotic mu-ltiple pregnancy. TTTS is associated with high perinatal mortality rate. The acute form has been attributed to rapid transfer of blood through superficial artery-to-artery or vein-to- vein anastomoses during labor and delivery, resulting in a hypovolemic, anemic donor twin and a hypervolemic, plethoric recipient twin of similar birth weight. The authors present a case of acute twin-twin transfusion syndrome with a review of literature.
Birth Weight ; Humans ; Hypovolemia ; Perinatal Mortality ; Pregnancy ; Tissue Donors ; Veins

Ischemic colitis is generally considered a disease of the elderly. The causes of ischemic colitis include low-flow states due to cardiac dysfunction or hypovolemia and certain medications including estrogen. Here we report a case of ischemic colitis in a 26-year-old woman. She had no specific medical history except taking oral-contraceptives for a long time. The mechanism of estrogen-induced ischemic colitis is not clearly understood. But we recommend that oral-contraceptives should be considered as a cause of ischemic colitis in young women.
Adult ; Aged ; Colitis, Ischemic ; Contraceptives, Oral ; Estrogens ; Female ; Humans ; Hypovolemia

There are many reports on lumbar artery injuries. However, there are only a few case reports of a lumbar artery injury presenting with hypovolemic shock from either a blunt or penetrating trauma. We described a 47-year-old man with a retroperitoneal hemorrhage secondary to a lumbar artery injury presenting as hypovolemic shock after a 3 m fall.
Arteries ; Hemorrhage ; Humans ; Hypovolemia ; Middle Aged ; Shock ; Spine

BACKGROUND: Early fluid resuscitation is one of the fundamental treatments for acute pancreatitis (AP), but there is no consensus on the optimal fluid rate. This systematic review and meta-analysis aimed to compare the efficacy and safety of aggressive vs. controlled fluid resuscitation (CFR) in AP. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science databases were searched up to September 30, 2022, for randomized controlled trials (RCTs) comparing aggressive with controlled rates of early fluid resuscitation in AP patients without organ failure on admission. The following keywords were used in the search strategy: "pancreatitis," "fluid therapy,""fluid resuscitation,"and "randomized controlled trial." There was no language restriction. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the certainty of evidence. Trial sequential analysis (TSA) was used to control the risk of random errors and assess the conclusions. RESULTS: A total of five RCTs, involving 481 participants, were included in this study. For primary outcomes, there was no significant difference in the development of severe AP (relative risk [RR]: 1.87, 95% confidence interval [CI] 0.95-3.68; P = 0.07; n = 437; moderate quality of evidence) or hypovolemia (RR: 0.98, 95% CI: 0.32-2.97; P = 0.97; n = 437; moderate quality of evidence) between the aggressive and CFR groups. A significantly higher risk of fluid overload (RR: 3.25, 95% CI: 1.53-6.93; P <0.01; n = 249; low quality of evidence) was observed in the aggressive fluid resuscitation (AFR) group than the controlled group. Additionally, the risk of intensive care unit admission ( P = 0.02) and the length of hospital stay ( P <0.01) as partial secondary outcomes were higher in the AFR group. TSA suggested that more studies were required to draw precise conclusions. CONCLUSION: For AP patients without organ failure on admission, CFR may be superior to AFR with respect to both efficacy and safety outcomes. REGISTRATION PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; CRD 42022363945.
Humans ; Randomized Controlled Trials as Topic ; Fluid Therapy ; Hypovolemia ; Pancreatitis/therapy*

BACKGROUND: Various plasma substitutes are used for the correction of hypovolemia caused by blood loss. It is known that plasma substitutes themselves have some adverse effects on blood coagulation. We performed this study to show the actual effect of plasma substitutes on blood coagulation in clinical hypovolemic situation caused by blood loss. METHODS: 60 patients scheduled for radical hysterectomy were grouped by the plasma substitutes infused; group C, S, V and P correspondingly infused with Hartman's solution, Salinhes(R), Voluven(R) and Pentaspan(R). Thromboelastograms (TEG) at 15 minutes after induction of anesthesia (T(0)), after 15% blood loss of the estimated blood volume (T(1)) and just after infusion of the plasma substitutes (T(2)) were compared among the groups and changes with the time course within each group were investigated. RESULTS: Compared to group C, MA, A60, coagulation index, CL60 (parameters of TEG) were decreased and LY60 increased in group S and P while group V presented no significant changes. Hypercoagulability and reduced fibrinolysis were observed for T(1); for T(2), group C showed decrease in k-time, LY60 and increase in alpha angle, CL60. Group S presented decrease in MA, A60 compared to T0 and decrease in CL60 and increase in LY60. CONCLUSIONS: Surgery and blood loss accelerated coagulation and reduced fibrinolysis. These were aggravated after crystalloid infusion. In contrast, coagulability was reduced and fibrinolysis augmented after infusion of HES except HES 130/0.4/6.
Anesthesia ; Blood Coagulation ; Blood Volume ; Fibrinolysis ; Humans ; Hypovolemia ; Hysterectomy* ; Plasma Substitutes* ; Plasma* ; Thrombophilia

Spontaneous gastric perforation of the newborn is a rare, serious and life-threatening problem. This is surgical emergency because of high mortality. Most historical reports have described gastric perforation in the neonate as spontaneous cause. But, recent reviews report the contributing factor including prematurity and mechanical ventilation. Usually clinician identifies the pneumoperitoneum in simple abdomen X-ray. The final diagnostic method is surgical finding and the treatment of gastric perforation is immediate surgical correction. Early diagnosis, hemodynamic monitoring and fluid therapy for hypovolemia improve outcome. Pseudocyst formation after gastric perforation is very rare in newborn. We report a rare case of pseudocyst formation after spontaneous gastric perforation in full term newborn.
Abdomen ; Early Diagnosis ; Emergencies ; Fluid Therapy ; Hemodynamics ; Humans ; Hypovolemia ; Infant, Newborn ; Mortality ; Pneumoperitoneum ; Respiration, Artificial