Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fluid management with diuretics is a key factor for postoperative management following cardiovascular surgery, and it is common to administer intermittent doses of diuretics and fluids in the early postoperative stage as primary therapy. Loop diuretics are usually given as the first option, followed by an aldosterone blocker, mannitol, and human atrial natriuretic peptide (hANP) or recombinant human B-type natriuretic peptide infusion. Although the effects of tolvaptan, a new type of diuretic with an aquaretic effect to increase urine volume without increasing electrolyte excretion into urine by blocking the vasopressin V2 receptor, on congestive heart failure are well known, it has not been established whether advantages may also be recognized in the volume overload in early postoperative stage after cardiac surgery. In this review, we clarified the efficacy of tolvaptan as the advent of new fluid management after cardiovascular surgery. Tolvaptan has advantageous effects for immediate body weight reduction in patients with positive postoperative water balance following cardiac surgery. This immediate volume reduction could help recovery of respiratory dysfunction due to lung edema. Also, hypernatremia was rarely seen; therefore, it can be used safely during postoperative period. With regard to the response of tolvaptan, it seemed to have a beneficial effect in patients with decreased renal function, increased body weight, and hypoalbuminemia. Although long-term outcome is still unknown, tolvaptan treatment added to conventional diuretics treatment in patients undergoing cardiovascular surgery provides sufficient amount of fluid removal without affecting renal function and serum sodium concentrations, and reduced the incidence of worsening renal function.
 ...
PMID:Advent of New perioperative care for fluid management after cardiovascular surgery: A review of current evidence. 3198 Mar 55

Management of persistent patent ductus arteriosus (PDA) continues to be a challenging issue. The attitude toward PDA has shifted in the opposite direction during the last 20 years, from advocating an aggressive and early closure toward a call for watchful observation. While persistent PDA may cause challenges in the medical management of preterm neonates secondary to volume overload, pulmonary edema or hemorrhage, hypotension, and impaired tissue perfusion, its contribution toward long-term neonatal morbidities including bronchopulmonary dysplasia (BPD), ROP, NEC, and NDI has not been substantiated. By advocating conservative management, it is clear now that the majority of the PDA cases show spontaneous closure and do not require treatment. However, there has not been agreement regarding what constitutes a hemodynamically significant PDA and when, if any, it should be targeted for treatment. With increasing concern regarding possible associated complications with PDA ligation, a new trend for transcatheter approach to PDA closure is expanding. In this review, we summarize current understanding of the pathophysiology, diagnosis, and management of PDA in preterm infants, and we make some recommendations regarding evidence-based approach.
 ...
PMID:PDA: Does it matter? 3237 96