无创血流动力学监测系统在ICU的综合应用分析

目的 探讨无创血流动力学监测系统在ICU的综合应用价值。方法 选取我院2003年7月初～2003年11月底收治于综合ICU的急危重病人、术后复苏病人、应用呼吸机通气病人共215例,总结分析Bioz.com无创血流动力学监测系统应用情况,研究选择有代表性的CO(心排血量)、TFC(胸液成分)、ACI(心肌加速度指数)、SVR(外周血管阻力)做统计学分析。结果 1. 全麻后复苏组各参数值均接近正常参考值(p>0.05)。2. 不同的PSV对各参数的影响不显著(p>0.05),但不同PEEP值对ACI、SVR参数的影响显著(p<0.01)。3. GCS评分<8组各参数三日中有显著变动(p<0.05),8分及以上组各参数波动不显著(p>0.05)。4. 心衰病人组用药前后各参数有显著差异(p<0.001)。结论 Bioz.com系统有无创、连续、操作简便、高精确性、性价比高、极强的抗干扰能力的特点,可在大多数情况下替代有创血流动力学监测方法,在综合ICU中广泛应用,但要注意电阻抗弱的时候,结果有可能不可靠。

脉波指示持续心排血量血流动力学和动脉血乳酸监测在感染性休克血液灌流治疗中的应用价值

目的分析感染性休克患者病原学特点及脉波指示持续心排血量(PiCCO)血流动力学、动脉血乳酸在血液灌流治疗中的监测价值。方法选取2019年7月-2021年7月医院收治的91例感染性休克患者为研究对象,收集所有研究对象的临床资料,随访患者入住急诊重症监护室(EICU)后28 d预后情况,并根据患者预后情况将其分为存活组(52例)和死亡组(39例)。监测入住EICU后0、6、24 h时的PiCCO血流动力学及动脉血乳酸指标水平。采用受试者工作特征(ROC)曲线分析PiCCO血流动力学指标及血乳酸水平对感染性休克患者预后的预测价值,曲线下面积(AUC)表示预测的准确度;采用多因素Logistic回归分析法分析预后影响因素。结果对患者进行病原学检测,共检出病原菌91株,其中革兰阴性菌67株(73.63%)、革兰阳性菌22株(24.18%)、真菌2株(2.20%)。存活组在24 h时的CO指标高于死亡组,而SVRI、EVLWI及PVPI指标低于死亡组(P<0.05)。存活组在6、24 h时的血乳酸指标水平低于死亡组(P<0.05)。24 h CO、24 h SVRI、24 h EVLWI、6 h血乳酸及24 h血乳酸指标用于感染性休克患者预后预测的AUC值分别为0.876、0.846、0.877、0.797、0.836,各指标间AUC值比较差异无统计学意义。Logistic回归分析结果显示,24 h CO≤4.21 L/min、24 h SVRI>2179.2 mmHg·min/L·m^(2)、24 h EVLWI>8.05 ml/kg、6 h血乳酸>4.36 mmol/L、24 h血乳酸>2.43mmol/L是感染性休克患者血液灌流治疗预后不良的独立影响因素(P<0.05)。结论监测感染性休克患者血液灌流治疗期间的PiCCO血流动力学和乳酸指标水平对于预测患者预后可能具有积极意义。

Clinical application of hepatic CT perfusion

Complicated changes occur in hemodynamics of hepatic artery and vein, and portal vein under various kinds of pathologic status hepatic blood supply. This because of distinct double article reviews the clinical application of hepatic computed tomography perfusion in some liver diseases.

Effects of continuous intermedin infusion on blood pressure and hemodynamic function in spontaneously hypertensive rats

Objective To examine the effects of exogenously administered intermedin （IMD,adrenomedullin-2） on arterial blood pressure,cardiac function and the cardiovascular IMD receptor system in spontaneously hypertensive rats （SHRs） as well as to investigate the associated mechanisms.Methods Thirteen week-old male rats were divided in Wistar Kyoto （WKY） group （n =12）,SHR group （n =12）,IMD group （SHRs infused with IMD 1-47 500 ng/kg per hour,n =12）,and ADM group （SHRs infused with adrenomedullin 500 ng/kg per hour,n =12）.Results A two-week continuous administration of low dose IMD 1-47 via mini-osmotic pumps markedly reduced blood pressure,the maximal rates of increase and decrease of left-ventricle pressure development （LV ± dp/dtmax）,left ventricular systolic pressure and heart rate in SHRs.Furthermore,IMD also inhibited protein over-expression of cardiovascular IMD receptors,myocardial Receptor Activity-Modifying Proteins （RAMP1 and RAMP2）,aortic RAMP1,RAMP2,RAMP3,and calcitonin receptor-like receptor （CRLR）;suppressed up-regulation of aortic RAMP1,RAMP2,RAMP3 and CRLR gene expression; and markedly elevated the mRNA abundance of myocardial atrial natriuretic peptide （ANP） and myocardial brain natriuretic peptide （BNP）.Additionally,IMD 1-47 administration in SHRs increased aortic cAMP concentration and reduced myocardial cAMP concentration.Conclusion These findings support the speculation that IMD,as a cardiovascular active peptide,is involved in blood pressure reduction and cardiac function amelioration during hypertension.The mechanism underlying this effect may involve IMD binding of a receptor complex formed by RAMPs and CRLR,and consequential regulation of cAMP levels and other cardiovascular active factors,such as ANP and BNP.

Relationship between angiotensin-(1-7) and angiotensin Ⅱ correlates with hemodynamic changes in human liver cirrhosis

AIM： To measure circulating angiotensins at different stages of human cirrhosis and to further evaluate a possible relationship between renin angiotensin system （RAS） components and hemodynamic changes. METHODS： Patients were allocated into 4 groups： mild-to-moderate liver disease （MLD）, advanced liver disease （ALD）, patients undergoing liver transplantation, and healthy controls. Blood was collected to determine plasma renin activity （PRA）, angiotensin （Ang） Ⅰ, Ang Ⅱ, and Ang-（1-7） levels using radioimmunoassays. During liver transplantation, hemodynamic parameters were determined and blood was simultaneously obtained from the portal vein and radial artery in order to measure RAS components. RESULTS： PRA and angiotensins were elevated in ALD when compared to MLD and controls （P 〈 0.05）. In contrast, Ang Ⅱ was significantly reduced in MLD. Ang-（1-7）/Ang Ⅱ ratios were increased in MLD when compared to controls and ALD. During transplantation, Ang Ⅱ levels were lower and Ang-（1-7）/Ang Ⅱ ratios were higher in the splanchnic circulation than in the peripheral circulation （0.52 ± 0.08 vs 0.38 ±0.04, P 〈 0.02）, whereas the peripheral circulating Ang Ⅱ/Ang Ⅰ ratio was elevated in comparison to splanchnic levels （0.18 ±0.02 vs 0.13 ±0.02, P 〈 0.04）. Ang-（1-7）/ Ang Ⅱ ratios positively correlated with cardiac output （r = 0.66） and negatively correlated with systemic vascular resistance （r = -0.70）. CONCLUSION： Our findings suggest that the relationship between Ang-（1-7） and Ang Ⅱ may play a role in the hemodynamic changes of human cirrhosis.

Exercise intolerance in heart failure with preserved ejection fraction： more than a heart problem

Heart failure （HF） with preserved ejection fraction （HFpEF） is the most common form of HF in older adults, and is increasing in preva- lence as the population ages. Furthermore, HFpEF is increasing out of proportion to HF with reduced EF （HFrEF）, and its prognosis is worsening while that of HFrEF is improving. Despite the importance of HFpEF, our understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. A cardinal feature of HFpEF is reduced exercise tolerance, which correlates with symptoms as well as reduced quality of life. The traditional concepts of exercise limitations have focused on central dysfimction related to poor cardiac pump function. However, the mechanisms are not exclusive to the heart and lungs, and the understanding of the pathophysiology of this dis- ease has evolved. Substantial attention has focused on defining the central versus peripheral mechanisms underlying the reduced functional capacity and exercise tolerance among patients with HF. In fact, physical training can improve exercise tolerance via peripheral adaptive mechanisms even in the absence of favorable central hemodynamic function. In addition, the drug trials performed to date in HFpEF that have focused on influencing cardiovascular function have not improved exercise capacity. This suggests that peripheral limitations may play a significant role in HF limiting exercise tolerance, a hallmark feature of HFpEF.

DYNAMIC CHANGES OF SERUM VASCULAR ENDOTHELIAL GROWTH FACTOR LEVELS IN A RAT MYOCARDIAL INFARCTION MODEL

To investigate the dynamic changes of serum vascular endothelial growth factor(VEGF) levels in a rat model of acute myocardial infarction. Materials and methods.Eighty eight adult male Sprague Dawley rats weighing approximately 270 g were used in this study. Eighty rats were subjected to left coronary artery ligation, with 8 rats for each different duration of infarct. Eight sham operated animals in which the left coronary artery was surgically exposed without ligation were used as controls. Blood samples were drawn from the right atrium before (sham animals) and 1,3,6,12,24 h and 2,3,5,7,14 d after myocardial infarction. The concentrations of serum VEGF were measured by a sensitive enzyme linked immunosorbent assay with a rabbit polyclonal antibody specific for VEGF. Results. In the 8 control animals, the mean concentration of serum VEGF was 66.99±17.83 pg/ml. Six hours after myocardial infarction, the level of serum VEGF significantly increased to 125.68±28.07 pg/ml (P<0.01 vs. sham controls), and reached a peak (240.61±70.63 pg/ml. P<0.01 vs. sham animals) at 24 h after ligation and then decreased gradually over the remaining 2 weeks. However, the level remained significantly elevated for 14 d (107.64±30.13pg/ml, P<0.01 vs. sham controls). Conclusion. The present study shows that the levels of serum VEGF are markedly increased until 14 d in the rat model of acute myocardial infarction. The increased serum VEGF level may play an important role in the angiogenesis associated with myocardial infarction.

Hemodynamics in the portal vein evaluated by pulse wave Doppler ultrasonography in patients with chronic hepatitis C treated with interferon

AIM: To employ pulse wave Doppler ultrasonography to evaluate the changes in portal blood flow velocity in patients with chronic hepatitis C (CHC) receiving interferon (IFN) treatment. METHODS: The subjects in this study were 14 patients (13 men and l woman) with CHC who received IFN treatment. Portal blood flow velocity was measured in the vessels at the porta hepatis at four time points: before IFN administration (pre-IFN), 2 wk after the start of administration (wk 2), 24 wk after the start of administration (wk 24, i.e., the end of IFN administration), and 24 wk after the end of administration (wk 48). RESULTS: The patients with CHC in whom IFN treatment resulted in complete elimination or effective elimination of viruses showed a significant increase in portal blood flow velocity at the end of IFN treatment compared with that before IFN treatment. In contrast, when IFN was ineffective, no significant increase in portal blood flow velocity was observed at wk 24 or 48 compared with the pre-IFN value. In addition, the patients with CHC in whom IFN was ineffective showed significantly lower portal blood flow velocity values than control subjects at all measurement time points. CONCLUSION: Pulse wave Doppler ultrasonography is a noninvasive and easily performed method for evaluating the effects of IFN treatment in patients with CHC. This technique is useful for measuring portal blood flow velocity before and 24 wk after IFN administration in order to evaluate the changes over time, thus assessing the effectiveness of IFN treatment.

Ankaferd hemostat in the management of gastrointestinal hemorrhages

Gastrointestinal (GI) bleeding refers to any hemorrhage ascribed to the pathologies of the gastrointestinal tract,extending from the mouth to the anal canal.Despite the recent improvements in the endoscopic,hemostatic and adjuvant pharmacologic techniques,the reported mortality is still around 5%-10% for peptic ulcer bleeding and about 15%-20% for variceal hemorrhages.Although endoscopic management reduces the rates of re-bleeding,surgery,and mortality in active bleeding;early recurrence ratios still occur in around 20% of the cases even with effective initial hemostatic measures.In this quest for an alternative pro-hemostatic agent for the management of GI bleedings,Ankaferd blood stopper (ABS) offers a successful candidate,specifically for "difficult-to-manage" situations as evidenced by data presented in several studies.ABS is a standardized mixture of the plants Thymus vulgaris,Glycyrrhiza glabra,Vitis vinifera,Alpinia officinarum,and Urtica dioica.It is effective in both bleeding individuals with normal hemostatic parameters and in patients with deficient primary and/or secondary hemostasis.ABS also modulates the cellular apoptotic responses to hemorrhagic stress,as well as hemostatic hemodynamic activity.Through its effects on the endothelium,blood cells,angiogenesis,cellular proliferation,vascular dynamics,and wound healing,ABS is now becoming an effective alternative hemostatic medicine for gastrointestinal bleedings that are resistant to conventional anti-hemorrhagic measurements.The aim of this review is to outline current literature experience suggesting the place of ABS in the management of GI bleeding,and potential future controlled trials in this complicated field.

Long-term survival following heart transplantation is possible

Objective:To determine whether long-term survival(>10 years) after heart transplantation is possible and identify complications influencing long-term survival.Methods:We analyzed clinical outcomes in the group of 21 patients who had undergone heart transplantation at the Second Affiliated Hospital of Harbin Medical University since 1992 and 4 of them survived more than 10 years.Results:Nine patients are still alive with normal left ventricular function,and 4 of them have survived more than 10 years.The longest survival patient has lived more than 18 years after transplantation,whose survival is the longest in China and in Asia.We have also found that there has been a high incidence of complications,such as rejection episodes during the first 6 months,and transplant vasculopathy in the long-term survival patients.Conclusion:Long-term survivors maintain normal hemodynamic function of their allografts,and long-term survival following cardiac transplantation is possible.Aggressive preventive and therapeutic measures are essential to limit the risk factors for development of complications such as rejection episodes and transplant vasculopathy,and enable long-term survival after cardiac transplantation.

Comparison of percutaneous transhepatic portal vein embolization and unilateral portal vein ligation

AIM： To compare the effect of percutaneous transhepatic portal vein embolization （PTPE） and unilateral portal vein ligation （PVL） on hepatic hemodynamics and right hepatic lobe （RHL） atrophy.METHODS： Between March 2005 and March 2009, 13 cases were selected for PTPE （n = 9） and PVL （n = 4） in the RHL. The PTPE group included hilar bile duct carcinoma （n = 2）, intrahepatic cholangiocarcinoma （n = 2）, hepatocellular carcinoma （n = 2） and liver metastasis （n = 3）. The PVL group included hepatocellular carcinoma （n = 2） and liver metastasis （n = 2）. In addition, observation of postoperative hepatic hemodynamics obtained from computed tomography and Doppler ultrasonography was compared between the two groups.RESULTS： Mean ages in the two groups were 58.9 ± 2.9 years （PVL group） vs 69.7 ±3.2 years （PTPE group）, which was a significant difference （P = 0.0002）. Among the indicators of liver function, including serum albumin, serum bilirubin, aspartate aminotransferase, alanine aminotransferase, platelets and indocyanine green retention rate at 15 min, no significant differ- ences were observed between the two groups. Preop-erative RHL volumes in the PTPE and PVL groups were estimated to be 804.9 ±181.1 mL and 813.3 4±129.7 mL, respectively, with volume rates of 68.9% ± 2.8% and 69.2% ±4.2%, respectively. There were no significant differences in RHL volumes （P = 0.83） and RHL volume rates （P = 0.94）, respectively. At 1 mo after PTPE or PVL, postoperative RHL volumes in the PTPE and PVL groups were estimated to be 638.4±153.6 mL and 749.8 ± 121.9 mL, respectively, with no significant difference （P = 0.14）. Postoperative RHL volume rates in the PTPE and PVL groups were estimated to be 54.6% ± 4.2% and 63.7% ± 3.9%, respectively, which was a significant difference （P = 0.0056）. At 1 mo after the operation, the liver volume atrophy rate was 14.3% ± 2.3% in the PTPE group and 5.4%± 1.6% in the PVL group, which was a significant difference （P = 0.0061）.CONCLUSION： PTPE is a more effective procedure than PVL because PTPE is able to occlude completely the portal branch throughout the right peripheral vein.

TCD study of hemodynamic changes in PCA response to photic stimulation

Objectives: During visual stimulation, the elevated metabolism rate will coupl e with increase of blood flow velocity(BFV) in posterior cerebral artery(PCA). T his study with TCD was aimed to investigate whether the coupling might change ac cording to the different vasoneuronal conditions. Methods: Ninety-nine voluntee r s including 24 hypertension(HT) patients and 2 patients suffering from both HT a nd diabetes mellitus(DM) were enrolled in this trial. BFV and pulse indexes(PI) in P2 segments of PCA on both sides were monitored during visual stimulation. Re sults: In all subjects, Mean BFV increased and PI went down in response to visua l stimulation. The percentages of changes (ΔV and ΔP) of both mean BFV and PI we re larger in young group(<55 years old) than in old one(≥55 years old). There w a s significant positive correlation between ΔV and ΔP. Multivariated re gression a nalysis did not show HT and DM, but age related to ΔV(ΔP). We did not find signi ficant difference of ΔV(ΔP) between left and right sides. Conclusions: Blood flo w velocity in PCA P2 segment increased due to decreased cerebrovascular resistan ce during visual stimulation and the response weakened with aging of the patient .

EFFECT OF ACU-MOXIBUSTION ON BLOOD RHEOLOGY IN PATIENTS WITH AORTO-ARTERITIS

In the present paper, the authors compared the therapeutic effects of acu moxibustion and medication in the treatment of 80 cases of aorto arteritis and observed their effects on blood rheology of the limbs. Results showed that in acu moxibustion group (n=40) and medication group (n=40), the cure rates were 15% and 0, the markedly effective rates 62.5% and 12.5%, and the total effective rates 95% and 75% respectively. The therapeutic effect of acu moxibustion group was significantly superior to that of medication group (P<0.01). Following acu moxibustion treatment, the blood pressure and blood flow velocity of the brachial artery, the amplitude of the air volume wave of the wrist and the amplitude of the digital volume pulse wave increased remarkably compared with pre treatment (P<0.01), and after treatment with medication, only the blood velocity of brachial artery increased evidently in comparison with pre treatment (P<0.05). Comparison between two groups showed that values of the 4 indexes of acu moxibustion group were all significantly higher than those of medication group (P<0.01), displaying that the therapeutic effect of acu moxibustion is superior to that of medication. It provides experimental evidence for clinical effective treatment of aorto arteritis (branchiocephalic artery type) with acupuncture and moxibustion.

Dynamic Effect of Rolling Massage on Blood Flow

The Chinese traditional medical massage has been used as a natural therapy to eliminate some diseases. Here, the effect of the rolling massage frequency to the blood flow in the blood vessels under the rolling massage manipulation is studied by the lattice Boltzmann simulation. The simulation results show that when the frequency is smaller than or comparable to the pulsatile frequency of the blood flow, the effect on the blood flux by the rolling massage is small. 011 the contrast, if the frequency is twice or more times of the pulsatile frequency of the blood flow, the blood flux is greatly enhanced and increases linearly with respect to the frequency. Similar behavior has also been observed on the shear stress on the blood vessel walls. The result is helpful for understanding that the rolling massage has the function of promoting the blood circulation and removing the blood stasis.

新生儿全身麻醉中瑞芬太尼复合七氟醚的应用分析

目的:研究瑞芬太尼复合七氟醚用于新生儿全身麻醉中的临床效果。方法:选取2019年1月~2020年4月于我院择期开展手术治疗的62例足月新生儿,以随机抽选方式划分为对照组和观察组各31例。对照组给予麻醉维持单独采用七氟醚,观察组采用瑞芬太尼与七氟醚复合维持麻醉,对比观察两组新生儿的麻醉效果、血流动力血变化以及不良反应情况。结果:诱导后,两组患者的HR、MAP水平值均较麻醉诱导前降低(P<0.05),且观察组诱导后的HR、MAP水平值均低于对照组(P<0.05)。术后,观察组麻醉苏醒时间长于对照组(P<0.05),观察组术后不同时间的CRIES评分均低于对照组(P<0.05)。观察组不良反应发生率低于对照组(P<0.05)。结论:瑞芬太尼与七氟醚复合麻醉方案用于新生儿全身麻醉中麻醉效果更为理想,对患儿的HR、MAP等血流动学指标影响更小,且安全性更高,值得临床推广运用。

右旋美托咪定在胸腰椎骨折手术中的临床价值

分析右旋美托咪定在胸腰椎骨折手术中的临床价值。方法 在本院的病例资料中,结合研究要求,随机在2021年1月-2022年1月,选取年龄30-70岁胸腰椎骨折手术病例40例病例,结合患者在手术治疗中,其止痛镇静药物的应用特点,将其分组对比观察。其中观察组的20例患者在手术前1h接受静脉注右旋美托咪定,对照组的20例患者在手术前1h接受等量生理盐水。观察患者在手术过程中血液力学情况。观察指标为心率、血压指标。结果 血流动力学指标:两组的平均动脉压在T0、T2、T3无差异,在T1、T4差异明显(观察组数据比对照组低),心率在T0无差异,在T1、T2、T3、T4差异明显(观察组数据比对照组低),收缩压在T2、T3差异对比明显(观察组数据比对照组高),舒展压在T1、T2、T3、T4差异明显(观察组数据比对照组低);皮质醇:观察指标时间段内,其无明显的组间差异;血糖指标:观察时间段,进入T2后,两组数据对比差异显现(观察组数据比对照组低);观察组手术苏醒时间更快;两组手术时间和出血量无差异;评分对比:观察组的咳呛分数、OAA/S评分、躁动分数均更低。结论 胸腰椎骨折患者在手术治疗时,选择右旋美托咪定作为术前止痛镇静药物,可降低降低麻醉药物对患者的影响,提升提升患者术后苏醒时间效率,维持血流力学的稳定性,降低气管所致的咳呛、躁动评分。因此右旋美托咪定在胸腰椎骨折手术中的临床价值为保障患者在手术治疗过程中的身体健康,维持血糖稳定。

Salusins protect myocardium against ischemic injury by alleviating endoplasmic reticulum stress

Salusins are regulatory peptides that affect cardiovascular function. We previously reported that salusin-a and -β protected cultured cardiomyocytes from serum deprivation-induced cell death through upregulating glucose-regulated protein 78 （GRP78）, an endoplasmic reticulum （ER） resident protein whose overexpression acts as a marker and suppressor of ER stress. The present study examined whether salusin-α and -β inhibit ER stress in ischemic myocardium. In a rat model of myocardial infarction created by ligating the left anterior descending coronary artery （LAD）, salusin-α or -β was intravenously injected at 5 or 15 nmol kg-1 15 min prior to 2 h of LAD occlusion. The high dose of salusin-α and -β3 significantly improved heart function and hemodynamics in LAD-occluded rats, but had no effects in sham-operated rats. The arrhythmias caused by LAD oc- clusion were markedly attenuated by salusin-α and -β. The apoptotic rate in ischemic myocardium was reduced from 31.5%±3.7% to 19.8%±2.2% and 12.3%±2.2%, and the infarct size was reduced from 53.4%±4.0% of the risk area to 26.5%±9.7% and 23.7%±8.9% by 15 nmol kg-1 salusin-α and -β, respectively. Furthermore, salusin-α and -β prevented the ac- tivation of GRP78 and ER stress-specific apoptotic effectors caspase-12 and CHOP （C/EBP homologous protein）, and attenu- ated the reduction of an ER stress-associated antiapoptotic protein Bcl-2 in ischemic cardiac tissue. The salusins also inhibited the ER stress induced by tunicamycin in cultured rat H9c2 cardiomyocytes. These results indicate that salusins protect myo- cardium against ischemic injury by inhibiting ER stress and ER stress-associated apoptosis.

0.9% saline is neither normal nor physiological

The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic acid-base bal- ance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume （〉2 L） saline infusion in healthy adults induces hyperohloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload （80 ml/kg） in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger （NHE） and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemody- namics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising 02 delivery to the renal perenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, in- creases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastroin- testinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.