Background-We assessed whether remote ischemic preconditioning (RIPC) improves myocardial, renal, and lung protection after on-pump coronary surgery.

Due to the risk of inducing hyperchloraemic acidosis in routine practice, when crystalloid resuscitation or replacement is indicated, balanced salt solutions, eg Ringer' s lactate/acetate or Hartmann' s solution should replace 0.9% saline, except in cases of hypochloraemia, eg from vomiting or gastric drainage. Evidence level 1b * Recommendation 2Solutions such as 4% dextrose/0.18% saline and 5% dextrose are important sources of free water for maintenance, but should be used with caution as excessive amounts may cause dangerous hyponatraemia, especially in children and the elderly. These solutions are not appropriate for resuscitation or replacement therapy except in conditions of significant free water deficit, eg diabetes insipidus. Evidence level 1b * Recommendation 3To meet maintenance requirements, adult patients should receive sodium 50-100 mmol/day, and potassium 40-80 mmol/day in 1.5-2.5 litres of water by the oral, enteral or parenteral route (or a combination of routes). Additional amounts should only be given to correct deficit or continuing losses. Careful monitoring should be undertaken using clinical examination, fluid balance charts, and regular weighing when possible. Evidence level 5 * Preoperative fluid management Recommendation 4In patients without disorders of gastric emptying undergoing elective surgery, clear non-particulate oral fluids should not be withheld for more than two hours prior to the induction of anaesthesia. Evidence level 1a * Recommendation 5In the absence of disorders of gastric emptying or diabetes, preoperative administration of carbohydrate-rich beverages 2-3 h before induction of anaesthesia may improve patient well being and facilitate recovery from surgery. It should be considered in the routine preoperative preparation for elective surgery. Evidence level 2a * Recommendation 6Routine use of preoperative mechanical bowel preparation is not beneficial and may complicate intra-and post-operative management of fluid and electrolyte balance. Its use should therefore be avoided whenever possible. Evidence level 1a* Recommendation 7Where mechanical bowel preparation is used, fluid and electrolyte derangements commonly occur and should be corrected by simultaneous intravenous fluid therapy with Hartmann' s or Ringer-lactate/acetate type solutions. Evidence level 5 * Recommendation 8Excessive losses from gastric aspiration/vomiting should be treated preoperatively with an appropriate crystalloid solution which includes an appropriate potassium supplement. Hypochloraemia is an indication for the use of 0.9% saline,

Repetitive low-grade inflammatory events in claudicants lead to elevation of serum acute-phase proteins. Exercise training is associated with symptomatic improvement and reduction inflammatory markers. The concern that exercise has adverse systemic effects therefore seems to be unjustified.

No abstract

For surgical, trauma, and burn patients, but not medical patients, microalbuminuria within 15 mins of intensive care unit admission predicted death as well as APACHE II and SAP II scores calculated after 24 hrs, and it shows promise as a predictor of outcome.

The results suggest that compared with gelatine, resuscitation with HES reduces posttrauma capillary leak.

Urine albumin changes rapidly within the first 6 hrs following ICU admission and predicts ICU mortality and inotrope requirement as well as or better than APACHE II and SOFA scores. Serial urine albumin measurement may provide a means of monitoring the microvascular effects of systemic inflammation.

Compared with gelatine, volume expansion with both types of HES during AAA surgery improved renal function and reduced renal injury.