Page 153 - HA Convention 2015

Masterclasses

MC8.1 Recent Advances in Treatment of Acute Respiratory Diseases 10:45 Theatre 1

Fluid Balance in Critical Care
Shum HP
Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong

Fluid therapy is a critical aspect of initial resuscitation in critically ill patients. Following the acute resuscitative phase,
excessive fluid accumulation has been associated with worse clinical outcome particularly in those with acute kidney injury
(AKI). Increasing severity of fluid accumulation among both paediatric and adult patients with AKI at the time of initiation
of renal replacement therapy has been associated with increased mortality and reduced likelihood of renal recovery.
These observations highlight the importance of monitoring fluid balance in critically ill patients, in particular after the
initial phase of resuscitation. A key concept for dosing fluid therapy in critically ill patients is to actively address ongoing
losses and constantly reassessment of need for further haemodynamic support. Functional haemodynamic measures
such as stroke volume variation, pulse pressure variation and bedside ultrasonic interrogation of cardiac output can better
predict the haemodynamic response to fluid loading than static tools like central venous pressure (CVP) or blood pressure
monitoring. Recognising three phases of fluid balance, namely resuscitation, maintenance and recovery phases, will improve
understanding of overall fluid management in critically ill patients. Appropriate use of colloid and balanced solution may
further improve patient outcome.

Tuesday, 19 May

MC8.2 Recent Advances in Treatment of Acute Respiratory Diseases 10:45 Theatre 1

Prone Ventilation HOSPITAL AUTHORITY CONVENTION 2015
So DHK
Intensive Care Unit, Princess Margaret Hospital/Yan Chai Hospital, Hong Kong

In recent years, we are seeing an increasing number of viral pneumonia cases, many of which develop severe Acute
Respiratory Distress Syndrome (ARDS) resulting in severe hypoxemia despite high conventional mechanical ventilatory
support. Prone positioning for the treatment of ARDS was first described in 1977. While prone ventilation has been shown to
improve oxygenation, earlier trials have failed to show an improvement in terms of mortality. However, more recent evidence
using prone ventilation much earlier and for more prolonged periods have demonstrated significant survival benefit when it
is used as lung protection rather than salvage therapy. In this talk, the theoretical background and latest evidence for prone
ventilation for the management of severe ARDS, as well as the Unit’s current practice in the management of these severely
hypoxemic patients will be presented.

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