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Sports Medicine (Auckland, N.Z.) Feb 2022Body-fluid loss during prolonged continuous exercise can impair cardiovascular function, harming performance. Delta percent plasma volume (dPV) represents the change in... (Meta-Analysis)
Meta-Analysis
The Hydrating Effects of Hypertonic, Isotonic and Hypotonic Sports Drinks and Waters on Central Hydration During Continuous Exercise: A Systematic Meta-Analysis and Perspective.
BACKGROUND
Body-fluid loss during prolonged continuous exercise can impair cardiovascular function, harming performance. Delta percent plasma volume (dPV) represents the change in central and circulatory body-water volume and therefore hydration during exercise; however, the effect of carbohydrate-electrolyte drinks and water on the dPV response is unclear.
OBJECTIVE
To determine by meta-analysis the effects of ingested hypertonic (> 300 mOsmol kg), isotonic (275-300 mOsmol kg) and hypotonic (< 275 mOsmol kg) drinks containing carbohydrate and electrolyte ([Na] < 50 mmol L), and non-carbohydrate drinks/water (< 40 mOsmol kg) on dPV during continuous exercise.
METHODS
A systematic review produced 28 qualifying studies and 68 drink treatment effects. Random-effects meta-analyses with repeated measures provided estimates of effects and probability of superiority (p) during 0-180 min of exercise, adjusted for drink osmolality, ingestion rate, metabolic rate and a weakly informative Bayesian prior.
RESULTS
Mean drink effects on dPV were: hypertonic - 7.4% [90% compatibility limits (CL) - 8.5, - 6.3], isotonic - 8.7% (90% CL - 10.1, - 7.4), hypotonic - 6.3% (90% CL - 7.4, - 5.3) and water - 7.5% (90% CL - 8.5, - 6.4). Posterior contrast estimates relative to the smallest important effect (dPV = 0.75%) were: hypertonic-isotonic 1.2% (90% CL - 0.1, 2.6; p = 0.74), hypotonic-isotonic 2.3% (90% CL 1.1, 3.5; p = 0.984), water-isotonic 1.3% (90% CL 0.0, 2.5; p = 0.76), hypotonic-hypertonic 1.1% (90% CL 0.1, 2.1; p = 0.71), hypertonic-water 0.1% (90% CL - 0.8, 1.0; p = 0.12) and hypotonic-water 1.1% (90% CL 0.1, 2.0; p = 0.72). Thus, hypotonic drinks were very likely superior to isotonic and likely superior to hypertonic and water. Metabolic rate, ingestion rate, carbohydrate characteristics and electrolyte concentration were generally substantial modifiers of dPV.
CONCLUSION
Hypotonic carbohydrate-electrolyte drinks ingested continuously during exercise provide the greatest benefit to hydration.
Topics: Bayes Theorem; Dehydration; Exercise; Humans; Osmolar Concentration; Sodium; Water-Electrolyte Balance
PubMed: 34716905
DOI: 10.1007/s40279-021-01558-y -
International Journal of Sport... Sep 2021Beer is used to socialize postexercise, celebrate sport victory, and commiserate postdefeat. Rich in polyphenols, beer has antioxidant effects when consumed in...
Beer is used to socialize postexercise, celebrate sport victory, and commiserate postdefeat. Rich in polyphenols, beer has antioxidant effects when consumed in moderation, but its alcohol content may confer some negative effects. Despite beer's popularity, no review has explored its effects on exercise performance, recovery, and adaptation. Thus, a systematic literature search of three databases (PubMed, SPORTDiscus, and Web of Science) was conducted by two reviewers. The search resulted in 16 studies that were appraised and reviewed. The mean PEDro score was 5.1. When individuals are looking to rehydrate postexercise, a low-alcohol beer (<4%) may be more effective. If choosing a beer higher in alcoholic content (>4%), it is advised to pair this with a nonalcoholic option to limit diuresis, particularly when relatively large volumes of fluid (>700 ml) are consumed. Adding Na+ to alcoholic beer may improve rehydration by decreasing fluid losses, but palatability may decrease. These conclusions are largely based on studies that standardized beverage volume, and the results may not apply equally to situations where people ingest fluids and food ad libitum. Ingesting nonalcoholic, polyphenol-rich beer could be an effective strategy for preventing respiratory infections during heavy training. If consumed in moderation, body composition and strength qualities seem largely unaffected by beer. Mixed results that limit sweeping conclusions are owed to variations in study design (i.e., hydration and exercise protocols). Future research should incorporate exercise protocols with higher ecological validity, recruit more women, prioritize chronic study designs, and use ad libitum fluid replacement protocols for more robust conclusions.
Topics: Alcohol Drinking; Beer; Dehydration; Exercise; Female; Fluid Therapy; Humans; Water-Electrolyte Balance
PubMed: 34284350
DOI: 10.1123/ijsnem.2021-0064 -
Nutrients Oct 2021Dehydration is common in the elderly, especially when hospitalised. This study investigated the impact of interventions to improve hydration in acutely unwell or... (Meta-Analysis)
Meta-Analysis
Dehydration is common in the elderly, especially when hospitalised. This study investigated the impact of interventions to improve hydration in acutely unwell or institutionalised older adults for hydration and hydration linked events (constipation, falls, urinary tract infections) as well as patient satisfaction. Four databases were searched from inception to 13 May 2020 for studies of interventions to improve hydration. Nineteen studies (978 participants) were included and two studies (165 participants) were meta-analysed. Behavioural interventions were associated with a significant improvement in hydration. Environmental, multifaceted and nutritional interventions had mixed success. Meta-analysis indicated that groups receiving interventions to improve hydration consumed 300.93 mL more fluid per day than those in the usual care groups (95% CI: 289.27 mL, 312.59 mL; I = 0%, < 0.00001). Overall, there is limited evidence describing interventions to improve hydration in acutely unwell or institutionalised older adults. Behavioural interventions appear promising. High-quality studies using validated rather than subjective methods of assessing hydration are needed to determine effective interventions.
Topics: Aged; Aged, 80 and over; Behavior; Environment; Female; Humans; Male; Middle Aged; Nutritional Physiological Phenomena; Patient Satisfaction; Publication Bias; Risk; Water-Electrolyte Balance
PubMed: 34684642
DOI: 10.3390/nu13103640 -
Pediatrics Nov 2021In this state-of-the-art review, we highlight the major advances over the last 5 years in neonatal acute kidney injury (AKI). Large multicenter studies reveal that... (Review)
Review
In this state-of-the-art review, we highlight the major advances over the last 5 years in neonatal acute kidney injury (AKI). Large multicenter studies reveal that neonatal AKI is common and independently associated with increased morbidity and mortality. The natural course of neonatal AKI, along with the risk factors, mitigation strategies, and the role of AKI on short- and long-term outcomes, is becoming clearer. Specific progress has been made in identifying potential preventive strategies for AKI, such as the use of caffeine in premature neonates, theophylline in neonates with hypoxic-ischemic encephalopathy, and nephrotoxic medication monitoring programs. New evidence highlights the importance of the kidney in "crosstalk" between other organs and how AKI likely plays a critical role in other organ development and injury, such as intraventricular hemorrhage and lung disease. New technology has resulted in advancement in prevention and improvements in the current management in neonates with severe AKI. With specific continuous renal replacement therapy machines designed for neonates, this therapy is now available and is being used with increasing frequency in NICUs. Moving forward, biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, and other new technologies, such as monitoring of renal tissue oxygenation and nephron counting, will likely play an increased role in identification of AKI and those most vulnerable for chronic kidney disease. Future research needs to be focused on determining the optimal follow-up strategy for neonates with a history of AKI to detect chronic kidney disease.
Topics: Acute Kidney Injury; Biomarkers; Caffeine; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Infant, Premature; Kidney; Lipocalin-2; Multicenter Studies as Topic; Oxygen Consumption; Renal Replacement Therapy; Research; Risk Factors; Theophylline; Water-Electrolyte Balance
PubMed: 34599008
DOI: 10.1542/peds.2021-051220 -
Worldviews on Evidence-based Nursing Dec 2019The charting of daily fluid balances and measurement of body weight changes are two noninvasive methods commonly used in the intensive care unit for estimating body...
BACKGROUND
The charting of daily fluid balances and measurement of body weight changes are two noninvasive methods commonly used in the intensive care unit for estimating body fluid status. The determination of body fluid status plays an important role in the management of critically ill patients where aggressive fluid resuscitation is often required. This can adversely affect patient outcomes if changes in fluid distribution are not detected early in patients who are susceptible to fluid overload.
AIM
To synthesize the best available evidence on the accuracy of daily fluid balance charting compared with the measurement of body weight for the estimation of body fluid status in critically ill adult patients.
METHODS
The review considered studies that investigated the accuracy of charting daily fluid balances or changes in body weight measurements or used both noninvasive methods in the estimation of body fluid status. The search sought to identify published, English language studies from 1980 until February 2018. Databases searched included MEDLINE, CINAHL, EMBASE, TRIP, Scopus, TROVE, ProQuest Dissertations, Australian and New Zealand Trials Registry, and Cochrane Central Register of Clinical Trials. Three reviewers independently assessed retrieved studies that matched inclusion criteria using standardized critical appraisal instruments.
RESULTS
The review included 13 cohort studies. Effectiveness of daily fluid balance charting was affected by inaccuracies observed in seven studies. Inability to obtain consecutive daily body weight measurements reduced the accuracy of monitoring changes in five studies. Seven studies found measurement of daily fluid balance inconsistent with changes in body weight.
LINKING EVIDENCE TO ACTION
The accuracy of charting fluid balance is suspect. Measurement of body weight is hard to accomplish. A combination of the two commonly used methods is more likely to be effective in estimating body fluid status than reliance on one single approach.
Topics: Adult; Body Weight; Critical Illness; Humans; Intensive Care Units; Statistics as Topic; Water-Electrolyte Balance
PubMed: 31811748
DOI: 10.1111/wvn.12394 -
Association between fluid overload and mortality in newborns: a systematic review and meta-analysis.Pediatric Nephrology (Berlin, Germany) May 2022Fluid overload (FO) is associated with higher rates of mortality and morbidity in pediatric and adult populations. The aim of this systematic review and meta-analysis... (Meta-Analysis)
Meta-Analysis Review
Fluid overload (FO) is associated with higher rates of mortality and morbidity in pediatric and adult populations. The aim of this systematic review and meta-analysis was to investigate the association between FO and mortality in critically ill neonates. Systematic search of Ovid MEDLINE, EMBASE, Cochrane Library, trial registries, and gray literature from inception to January 2021. We included all studies that examined neonates admitted to neonatal intensive care units and described FO and outcomes of interest. We identified 17 observational studies with a total of 4772 critically ill neonates who met the inclusion criteria. FO was associated with higher mortality (OR, 4.95 [95% CI, 2.26-10.87]), and survivors had a lower percentage of FO compared with nonsurvivors (WMD, - 4.33 [95% CI, - 8.34 to - 0.32]). Neonates who did not develop acute kidney injury (AKI) had lower FO compared with AKI patients (WMD, - 2.29 [95% CI, - 4.47 to - 0.10]). Neonates who did not require mechanical ventilation on postnatal day 7 had lower fluid balance (WMD, - 1.54 [95% CI, - 2.21 to - 0.88]). FO is associated with higher mortality, AKI, and need for mechanical ventilation in critically ill neonates in the intensive care unit. Strict control of fluid balance to prevent FO is essential. A higher resolution version of the Graphical abstract is available as Supplementary information.
Topics: Acute Kidney Injury; Adult; Child; Critical Illness; Female; Heart Failure; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Male; Water-Electrolyte Balance; Water-Electrolyte Imbalance
PubMed: 34727245
DOI: 10.1007/s00467-021-05281-8 -
Clinical Nephrology Oct 2016Wide ranges of sodium concentrations for different body fluid losses have been noted with minimal substantiating data and variability among sources, leading to use of... (Review)
Review
BACKGROUND
Wide ranges of sodium concentrations for different body fluid losses have been noted with minimal substantiating data and variability among sources, leading to use of "cumulative fluid balance" regardless of composition in hospitalized patients.
AIMS
To define the sodium concentrations of fluid losses from the body.
METHOD
We performed a systematic search and literature review in adult humans using PubMed database.
RESULTS
Inclusion criteria were met for 107 full-text articles. Mean sodium concentrations were significantly lower for acidic (mean ± SD: 44 ± 12 mEq/L) than for alkaline (55 ± 13 mEq/L) gastric fluid, higher for bile (185 ± 24 mEq/L) or pancreatic fluid (156 ± 3 mEq/L) than for all other body fluids, and similar for intact small bowel (119 ± 14 mEq/L) and ileostomy outputs (116 ± 25 mEq/L). Sodium concentrations were significantly greater for cholera-induced diarrhea (128 ± 18 mEq/L) and lower for osmotic-induced diarrhea (28 ± 16 mEq/L) than all other causes of diarrhea. For osmotic diarrheas, sorbitol-induced diarrhea sodium concentration was higher (63 ± 17 mEq/L) than for carbohydrate malabsorption (43 ± 20 mEq/L), lactulose (26 ± 19 mEq/L), Idolax (16 ± 13 mEq/L), or polyethylene glycol (13 ± 7 mEq/L). For secretory diarrheas, sodium concentration for idiopathic causes (53 ± 22 mEq/L) was lower than for neuroendocrine and villous tumors (75 ± 13 mEq/L) or nonosmotic laxatives (88 ± 33 mEq/L). For pleural, peritoneal, and edema fluid, sodium concentrations (137 ± 13 mEq/L) were similar to plasma. No data were found for wound fluid. Sodium concentration for sweat was 44 ± 17 mEq/L.
CONCLUSIONS
This is the first in-depth review of verifiable sodium concentrations of body fluids most commonly lost in hospitalized patients. Sodium concentrations are fluid-specific and consistent. Sodium concentrations for diarrhea are associated with specific mechanisms/causes. These data should be useful to more accurately replace sodium and water content for specific body fluid losses. .
Topics: Adult; Body Fluids; Dehydration; Female; Humans; Male; Sodium; Water-Electrolyte Balance
PubMed: 27616761
DOI: 10.5414/CN108721 -
Journal of Psychosomatic Research Sep 2009The current review aims to synthesize existing knowledge about the relationship between psychological stress and wound healing. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The current review aims to synthesize existing knowledge about the relationship between psychological stress and wound healing.
METHODS
A systematic search strategy was conducted using electronic databases to search for published articles up to the end of October 2007. The reference lists of retrieved articles were inspected for further studies and citation searches were conducted. In addition, a meta-analysis of a subset of studies was conducted to provide a quantitative estimation of the influence of stress on wound healing.
RESULTS
Twenty-two papers met the inclusion criteria of the systematic review and a subsample of 11 was included in a meta-analysis. The studies assessed the impact of stress on the healing of a variety of wound types in different contexts, including acute and chronic clinical wounds, experimentally created punch biopsy and blister wounds, and minor damage to the skin caused by tape stripping. Seventeen studies in the systematic review reported that stress was associated with impaired healing or dysregulation of a biomarker related to wound healing. The relationship between stress and wound healing estimated by the meta-analysis was r=-0.42 (95% CI=-0.51 to -0.32) (P<.01).
CONCLUSION
Attention now needs to be directed towards investigating potential moderators of the relationship, mediating mechanisms underpinning the association, as well as the demonstration of a causal link by the development of experimental interventions in healthy populations.
Topics: Arousal; Humans; Psychoneuroimmunology; Stress, Psychological; Water Loss, Insensible; Wound Healing
PubMed: 19686881
DOI: 10.1016/j.jpsychores.2009.04.002 -
Journal of Advanced Nursing Jul 2018To identify effective treatments and risk factors associated with death rattle in adults at the end of life. (Review)
Review
AIM
To identify effective treatments and risk factors associated with death rattle in adults at the end of life.
BACKGROUND
The presence of noisy, pooled respiratory tract secretions is among the most common symptoms in dying patients around the world. It is unknown if "death rattle" distresses patients, but it can distress relatives and clinicians. Treatments appear unsatisfactory, so prophylaxis would be ideal if possible.
DESIGN
Quantitative systematic review and narrative summary following Cochrane Collaboration guidelines.
DATA SOURCES
CINAHL, MEDLINE, Health Source Nursing and Web of Science were searched for international literature in any language published from 1993 - 2016 using MeSH headings and iterative interchangeable terms for "death rattle".
REVIEW METHODS
Randomized controlled trials were appraised using the Cochrane Collaboration's tool for assessing risk of bias. Non-randomized studies were assessed using ROBINS-I tool for assessing risk of bias in non-randomized studies of interventions. Instances of treatment and risk were extracted and relevant key findings extracted in line with Cochrane methods.
RESULTS
Five randomized trials and 23 non-randomized studies were analysed. No pharmacological or non-pharmacological treatment was found superior to placebo. There was a weak association between lung or brain metastases and presence of death rattle, but otherwise inconsistent empirical support for a range of potential risk factors.
CONCLUSIONS
Clinicians have no clear evidence to follow in either treating death rattle or preventing it occurring. However, several risk factors look promising candidates for prospective analysis, so this review concludes with clear recommendations for further research.
Topics: Adult; Age Factors; Cholinergic Antagonists; Consciousness; Cough; Deglutition Disorders; Female; Humans; Length of Stay; Male; Patient Positioning; Prospective Studies; Randomized Controlled Trials as Topic; Respiratory Sounds; Respiratory System; Respiratory System Agents; Respiratory Tract Infections; Risk Factors; Sex Factors; Terminal Care; Terminally Ill; Water-Electrolyte Balance
PubMed: 29495089
DOI: 10.1111/jan.13557 -
Archives of Dermatological Research May 2013Transepidermal water loss (TEWL) is regarded as one of the most important parameters for characterizing skin barrier function but an agreed upon definition of what a... (Comparative Study)
Comparative Study Meta-Analysis Review
Transepidermal water loss (TEWL) is regarded as one of the most important parameters for characterizing skin barrier function but an agreed upon definition of what a "normal" TEWL is does not exist. In order to determine generalizable TEWL values for healthy adults, a systematic review and meta-analysis was conducted. The databases MEDLINE and EMBASE and publication lists were screened. After full-text appraisal of 398 studies, 231 studies were excluded due to unclear or insufficient reporting. 167 studies providing data about 50 skin areas were included in the final data synthesis. Pooled sample sizes ranged from n = 5 for the left cheek and the left lower back to a maximum of n = 2,838 for the right midvolar forearm area. The lowest TEWL of 2.3 (95 % CI 1.9-2.7) g/m(2)/h was calculated for the breast skin, the highest TEWL of 44.0 (39.8-48.2) g/m(2)/h for the axilla. TEWL in individuals being 65 years and above was consistently lower compared to the group of 18- to 64-year-old individuals. The quality of reporting TEWL in humans should be increased in future studies.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aging; Epidermis; Female; Humans; Male; Middle Aged; Skin Physiological Phenomena; Water Loss, Insensible; Young Adult
PubMed: 23341028
DOI: 10.1007/s00403-012-1313-6