Defining the characteristics and expectations of fluid bolus therapy: a worldwide perspective

Purpose: The purpose of the study is to understand what clinicians believe defines fluid bolus therapy (FBT) and the expected response to such intervention. Methods: We asked intensive care specialists in 30 countries to participate in an electronic questionnaire of their practice, definition, and expectations of FBT. Results: We obtained 3138 responses. Despite much variation, more than 80% of respondents felt that more than 250 mL of either colloid or crystalloid fluid given over less than 30 minutes defined FBT, with crystalloids most acceptable. The most acceptable crystalloid and colloid for use as FBT were 0.9% saline and 4% albumin solution, respectively. Most respondents believed that one or more of the following physiological changes indicates a response to FBT: a mean arterial pressure increase greater than 10 mm Hg, a heart rate decrease greater than 10 beats per minute, an increase in urinary output by more than 10 mL/h, an increase in central venous oxygen saturation greater than 4%, or a lactate decrease greater than 1 mmol/L. Conclusions: Despite wide variability between individuals and countries, clear majority views emerged to describe practice, define FBT, and identify a response to it. Further investigation is now required to describe actual FBT practice and to identify the magnitude and duration of the physiological response to FBT and its relationship to patient-centered outcomes.Facultad de Ciencias Médica

Immunosenescence and CoQ10

The decline of the immune system associated to aging is becoming a global issue nowadays due to the increase of lifespan. Immunosenescence is the deteriorated adaptative capacity of the immune system leading to increase in morbidity and mortality in elderly population. Aging has been related to a progressive affectation of mitochondria such as increase of mtDNA mutation, deregulation of electron transport chain, increase in ROS production and reduction in ATP production. Immunosenescence has been associated with aging associated mitochondrial dysfunction linked to chronic inflammation that induce higher oxidative stress levels and mitochondrial damage deteriorating the already compromised immune system. CoQ10 administration could be considered a beneficial strategy in order to reduce the progression of age-related diseases. Highlighting the important role of CoQ10 on mitochondrial function it has been proposed that this unique antioxidant soluble lipid could be helpful in the management of immunosenescence. High levels of CoQ10 have been related with a delay of immunosenescence attributable to a reduction in DNA damage. Other prolongevity factors, such as caloric restriction and exercise, have been considered for their potential effect in delaying aging effect and immunosenescence mainly affecting mitochondrial physiology and biogenesis and antioxidant activity