Boclet Final_500

Fresenius Kabi
Middle East
Scientific Summit
Sharm El Sheikh-Egypt 2017

Introduction
Fresenius Kabi Middle East Scientific Summit
is a clinically oriented advanced conference
in clinical nutrition therapy & Perioperative
fluid management.
This meeting took place in Sharm El-Sheikh,
Egypt during the period May 19-20, 2017.
Fresenius Kabi
Middle East
Scientific
Summit
On the first day, under the title of “Mind the
Gap” the focus of the meeting was clinical nutrition
therapy in adults.
Clinical nutrition plays a major role in patient
progress, different special nutrients substrates
have shown positive impact in patients receiving
clinical nutrition, like Omega 3 FA, Glutamine and
Taurine. Cancer-associated malnutrition,
cachexia, and sarcopenia are common in cancer
patients and have meaningful adverse clinical
consequences. Moreover, enteral nutrition as a
fundamental part of clinical nutrition have been
discussed along with role of supplemental
parenteral nutrition.
Clinical nutrition day “Mind the Gap” offered a platform for 100 delegates including
oncologists, dietitians, Intensivists and clinical pharmacists from the middle east
countries to share the newest insights from research, exchange best practices and
discuss patient cases in the field of Clinical Nutrition. The meeting was chaired by
Prof. George Abi Saad and Prof. Mohamed Abd El Khalik, two leading regional experts
in the field of clinical nutrition therapy.
On the second day, under the title of “Time Always Matters” the focus of the meeting
was addressing the impact of the perioperative fluid administration on the clinical outcomes.
Perioperative fluid therapy is a highly debated topic. Its aim is to sustain or restore
effective circulating blood volume during the perioperative period. Enhanced Recovery
After Surgery (ERAS) included optimal perioperative fluid management as an important
component of its pathways.

Introduction
Introduction
Fresenius Kabi
Middle East
Fresenius Kabi Middle East
Scientific Summit (FrKMESS),
is a clinically oriented advanced
Scientific
conference in clinical nutrition therapy
& Perioperative fluid management. This Summit
meeting took place in Sharm El-Sheikh,
Egypt during the period May 19-20, 2017.
On the first day, under the title of “Mind the Gap”
the focus of the meeting was clinical nutrition
therapy in adults.
Clinical nutrition plays a major role in patient progress,
different special nutrients substrates have shown positive
impact in patients receiving clinical nutrition, like Omega
3 FA, Glutamine and Taurine. Cancer-associated malnutritio
cachexia, and sarcopenia are common in cancer patients a
meaningful adverse clinical consequences. Moreover, ente
as a fundamental part of clinical nutrition have been discus
role of supplemental parenteral nutrition.
Clinical nutrition day “Mind the Gap” offered a platform fo
including oncologists, dietitians, Intensivists and clinical pha
middle east countries to share the newest insights from res
practices and discuss patient cases in the field of Clinical N
chaired by Prof. George Abi Saad and Prof. Mohamed Abd
experts in the field of clinical nutrition therapy.
On the second day, under the title of “Time Always Ma
was addressing the impact of the perioperative fluid admini
Perioperative fluid therapy is a highly debated topic. Its aim
circulating blood volume during the perioperative period. En
(ERAS) included optimal perioperative fluid management a
pathways. Goal-directed fluid therapy (GDFT) attempts to a
by optimizing perfusion and oxygen delivery through hemod
avoiding the risks associated with either organ hypo- or hyp
It is reasonable to conclude that if colloids are going to be u
offers benefits.
Goal-directed fluid therapy (GDFT) attempts to add precision to fluid
resuscitation by optimizing perfusion and oxygen delivery through
hemodynamics monitoring, while avoiding the risks associated with either
organ hypo- or hyperperfusion.
It is reasonable to conclude that if colloids are going to be used, then a GDFT approach
offers benefits.
Compared to older generations, modern Hydroxyethyl Starches (HES) of low Molecular
Weight (MW) & low Molar Substitution (MS) show significant improvement in the safety
profile.
Perioperative fluid management day “Time Always Matters” offered a platform for
80 delegates including anesthesiologists and Emergency Medicine physicians from
the middle east countries to share the newest insights from research, exchange
best practices, and discuss patient cases in the field of perioperative fluid management
in surgical and trauma patients. The meeting was chaired by Prof. Abdelazeem
Eldawlatly and Prof. Magdy Khalil, two leading regional experts in the field of
Anesthesia and critical care.

Mind The Gap
Session one:
therapy in adults.
Role Of Special
Substrates In Clinical Nutrition
have
utrition Dr. Khalid Sewify
along with
Consultant Intensivist
Head of Adult Critical Care Unit and
Chairman of CPR Committee
King Fahd Medical Military complex
Dhahran, Saudi Arabia.
00 delegates
acists from the
ch, exchange best
tion. The meeting was
Khalik, two leading regional
rs” Prof. the focus George of the meeting Abi Saad
tion on the clinical outcomes.
to sustain or restore effective
nced Recovery After Surgery
important component of its
precision to fluid resuscitation
amics monitoring, while
erfusion.
, then a GDFT approach
Prof. Amr Yassin
Professor of Clinical Surgery
Head of Trauma Services and Surgical
Critical Care American University
of Beirut Medical Center
Beirut, Lebanon.
Introduction
Professor on Anesthesia & Intensive Care
Director of Anesthesia and Intensive Care Services
Liver Transplantation Program
Mansoura University, Egypt.
Fresenius Kabi Middle East
Scientific Summit (FrKMESS),
is a clinically oriented advanced
conference in clinical nutrition therapy
& Perioperative fluid management. This
meeting took place in Sharm El-Sheikh,
Egypt during the period May 19-20, 2017.
On the first day, under the title of “Mind the Gap”
the focus of the meeting was clinical nutrition
Friday 19 th May
Clinical nutrition plays a major role in patient progress,
different special nutrients substrates have shown positive
impact in patients receiving clinical nutrition, like Omega
3 FA, Glutamine and Taurine. Cancer-associated malnutritio
cachexia, and sarcopenia are common in cancer patients a
meaningful adverse clinical consequences. Moreover, ente
as a fundamental part of clinical nutrition have been discus
role of supplemental parenteral nutrition.
Clinical nutrition day “Mind the Gap” offered a platform fo
including oncologists, dietitians, Intensivists and clinical pha
middle east countries to share the newest insights from res
practices and discuss patient cases in the field of Clinical N
chaired by Prof. George Abi Saad and Prof. Mohamed Abd
experts in the field of clinical nutrition therapy.
On the second day, under the title of “Time Always Ma
was addressing the impact of the perioperative fluid admini
Perioperative fluid therapy is a highly debated topic. Its aim
circulating blood volume during the perioperative period. En
(ERAS) included optimal perioperative fluid management a
pathways. Goal-directed fluid therapy (GDFT) attempts to a
by optimizing perfusion and oxygen delivery through hemod
avoiding the risks associated with either organ hypo- or hyp
It is reasonable to conclude that if colloids are going to be u
offers benefits.

Lecture 1
“Omega-3 FA”
Dr. Khalid Sewify
have
utrition Consultant Intensivist
along with
Head of Adult Critical Care Unit and
Chairman of CPR Committee
King Fahd Medical Military complex
00 delegates
acists
Dhahran,
from the
Saudi Arabia.
ch, exchange best
tion. The meeting was
Khalik, two leading regional
Main focus of this interesting lecture was focusing on importance of fish oil supplemented parenteral
nutrition with deep insights on recent published studies and recommendations addressing
role of fish oil -Omega 3 Fatty acids- as an indispensable part in parenteral nutrition.
Main messages:
rs” the focus of the meeting
tion on the clinical outcomes.
to sustain or restore effective
nced Recovery After Surgery
important component of its
precision to fluid resuscitation
amics monitoring, while
to play a role.
erfusion.
, then a GDFT approach
• Patients on long-term PN are at risk of complications, such as catheter- related sepsis, metabolic
disorders, metabolic bone disease and liver disorder. Intestinal failure associated liver disease
(IFALD) represents a major limitation for long-term parenteral nutrition management, and may
result in cirrhosis and the need for liver transplantation. Amongst a variety of factors, long-term
use of intravenous lipid emulsions rich in n-6 FAs especially
provided at a dose of >1 g fat/kg BW/d has been considered
• In this context, replacing a pure soybean oil emulsion by
a lipid emulsion containing soybean oil, MCT, olive oil and fish
oil, resulting in a lower n-6/n-3 fatty acid ratio (approx. 2.5:1)
in accordance with accepted recommendations appears to be
a promising approach.
• SMOFlipid is safe & FDA approved
• Lipids free parenteral nutrition does not exist
• FO may Prevent and Reverse PNALD
• FO has anti-inflammatory & Immun-modulatory Effect
“REPLACING A PURE SOYBEAN OIL
EMULSION BY A LIPID EMULSION
CONTAINING SOYBEAN OIL, MCT,
OLIVE OIL AND FISH OIL, RESULT-
ING IN A LOWER N 6/N 3 FATTY
ACID RATIO (APPROX. 2.5:1) IN
ACCORDANCE WITH ACCEPTED
RECOMMENDATIONS APPEARS TO BE
A PROMISING APPROACH.” (Dr.
Sewify)

Lecture 2
“Glutamine role
in critically
ill patients”
Prof. George Abi Saad
Professor of Clinical Surgery
Head of Trauma Services and Surgical Critical Care
American University of Beirut Medical Center
Beirut, Lebanon.
Main messages:
Lecture was focusing on importance of IV Glutamine in critically ill
patients when administered in in right patient with right dose.
Also Prof. George showed that IV glutamine still have a big role
even after recent ASPEN and Canadian guidelines if clinicians make
sure avoiding contraindicated patients.
“Low plasma glutamine at
ICU admission is associated
with increased mortality.”
(Prof. Abi Saad)
Take home massages:
• Low plasma glutamine at ICU admission is associated with increased
mortality.
• Plasma glutamine levels may be restored.
• Clinical effects of glutamine supplementation are related to length of
treatment.
• Clinical evidence for glutamine supplementation is high.
• Patient needs ENOUGH glutamine (0.3-0.5 g/Kg BW/day).
• Patient needs glutamine EARLY enough (as soon as possible).
• Patient needs glutamine LONG enough (> 5- 9 days).
“Clinical effects of
glutamine supplementation
are related to length
of treatment.”
(Prof. Abi Saad)

Lecture 3
“Importance
of Taurine”
Prof. Amr Yassin
Professor on Anesthesia & Intensive Care
Director of Anesthesia and Intensive Care Services
Liver Transplantation Program
Mansoura University, Egypt.
Main messages:
Prof. Amr has emphasized on role of taurine as a conditionally
essential ِAmino Acid, showing benefits according available
published studies.
Take home messages:
“Taurine may be essential
for patients and should
be added to solutions
used for long-term
parenteral nutrition to
avoid cholestasis.” (Prof.
Yassin)
• In critically ill patients the human synthetic capacity is limited and dietary intake is essential.
• It is will established that it may be deficient in stress conditions.
• There is a growing evidence of the benefit of taurine supplementation.
• High safety index even with larger than clinically recommended doses.
• Taurine may be essential for patients and should be added to solutions used for long-term
parenteral nutrition to avoid cholestasis.
• Taurine-supplemented patients reported significant improvement in chemotherapy-induced
nausea and/or vomiting.

Mind The Gap
Session two:
Nutrition in
Oncology patients
(Discover the potential)
Dr. Abdulrahman El Kinj, MD, FACP
Specialist in Hematology/Oncology
Specialized Medical Center Hospital
Riyadh, Saudi Arabia

Lecture 1
“New advances
in oncology
clinical”
Dr.Abdulrahman El Kinj, MD, FACP
Specialist in Hematology/Oncology
Specialized Medical Center Hospital
Riyadh, Saudi Arabia
Main messages:
Lecture addressed Definitions (Malnutrition, Cachexia, Sarcopenia),
Measurement of Sarcopenia, Sarcopenia and Cancer Prognosis,
Sarcopenia and Chemotherapy Toxicity and Nutritional Intervention
Pathway.
“Early intervention in
Improving the nutritional
status of cancer
patients is a must as it
will improve their quality
of life andprobably
their survival.” (Dr. El
Take home messages:
Kinj)
• Malnutrition/ Cachexia/ Sarcopenia is very prevalent among our
Cancer patients and commonly overlooked by Oncologists.
• It is a strong bad prognostic factor as well as therapeutic dose limiting factor.
• Early intervention in Improving the nutritional status of cancer patients is a must as it will
improve their quality of life and probably their survival.

Mind The Gap
Session three:
Different options
One objective
Prof. ENAS MOGAWER
Professor of Internal
Medicine – Endocrinology & Diabetes
Head of Clinical Nutrition Department
Air Force Specialized Hospital
Cairo, Egypt
Dr. Medhat Shalby
Consultant Anesthesiologist
Head of Anesthesia & Critical Care Department
Al Zahra Hospital
Dubai, UAE
Prof. Bassem Bolus
Professor of Anesthesia & Intensive are
Ain Shams University
Cairo, Egypt

Lecture 1
“Clinical rational
and practical
application
of EN”
Prof. Enas Mogawe
Professor of Internal Medicine
Endocrinology & Diabetes
Head of Clinical Nutrition Department
Air Force Specialized Hospital
Cairo, Egypt
Main messages:
Lecture was focusing on role of EN a fundamental part of clinical
nutrition and what are the parameters regarding screening,
assessment, application, monitoring and assessment.
“Regardless of the tolerance
to EN, one should not plan
to meet all nutritional
requirements via the GI
tract.”
(Prof. Mogawer)
Take home messages:
• Regardless of the tolerance to EN, one should not plan to meet all nutritional requirements
via the GI tract.
• A prerequisite for initiating EN in critically ill patients is adequate cardiopulmonary stability.
• Enteral nutrition is contraindicated if the patient has failure of more than two organ systems,
with continuing sepsis unresponsive to therapy, and cardiopulmonary instability.

Lecture 2
“ERAS updates
on EN”
Dr. Medhat Shalby
Consultant Anesthesiologist
Head of Anesthesia & Critical Care Department
Al Zahra Hospital
Dubai, UAE
Main messages:
It was a very informative presentation about how Clinical Nutrition
contribute with a major part in Enhanced Recovery After Surgery
(ERAS) Protocols which are combinations of Evidence Based,
perioperative Strategies which work Synergistically to markedly
Speed recovery after surgery.
Regardless of the tolerance
“Increased calorie and
to EN, one should not plan to
protein intake post operatively
enhance recovery
after surgery.”
meet all nutritional requirements
via the GI tract. (Prof.
(Dr. Shalby)
Mogawer)
Take home messages:
• Preoperative:
o Preoperative Nutrition Assessment: Optimize calorie and protein intake Optimize
micronutrient intake Immun-nutrition
o Reduced preoperative fasting time
o CHO Loading
• Postoperative:
o Early feeding and rapid diet advancement
o Increased calorie and protein intake post operatively

Lecture 3
“Supplemental
parenteral
nutrition”
Prof. Bassem Bolus
Professor of Anesthesia & Intensive are
Ain Shams University
Cairo, Egypt
Main messages:
Prof. Bassem tried to highlight on role of SPN in clinical nutrition and
how it may improve outcomes in patients suffering from inadequate
EN feeding along with controversies about the concept.
“Early PN is very important
if EN alone is not
achieving the nutritional
target.”
(Prof. Bolus)
Take home messages:
• Enhancing early EN and optimizing enteral energy and protein targets is probably the best
strategy.
• SPN Important for optimization of caloric and protein Provision.
• Early PN is very important if EN alone is not achieving the nutritional target.
• Early PN and Late PN Studies and Trials- no clear difference.

Mind The Gap
Session four:
Together
we achieve more
Prof. Wafaa Taha
Professor of Anesthesia, ICU
and Pain Relief National Cancer
Institute (NCI), Cairo University
Cairo, Egypt
Dr. Faisal El Sehli
Pharm.D, MHSQM
Doctor of Pharmacy, specialized in Pediatric/Neonatal
Ass. Professor in clinical pharmacy
King Saud Bin Abdul-Aziz for Health Science University
Riyadh, Saudi Arabia
Ms. Murielle Abu-Samra
MS. Nutrition and Dietetics
Head of Dietary Department, Middle East
institute of Health – Lebanon
Clinical Dietitian at the Obesity & Weight
Control Center, Beirut, Lebanon

Lecture 1
“Role of
nutrition
support
team”
Prof. Wafaa Taha
Professor of Anesthesia, ICU and Pain Relief
National Cancer Institute (NCI), Cairo University
Cairo, Egypt
Main messages:
Prof. Wafaa tried to emphasize on role of nutrition support team and
Clinical Nutrition became a collaboration between all related medical
team in the hospital starting from Doctors, nursing, Clinical pharmacists
& Dietitians.
Take home messages:
• NST Maintains itself as the principal source of evidence-based
information about nutritional assessment and support.
• It is a focus for a multi-professional approach to artificial nutrition
“Nutrition support team
develop nutrition care
plans in a timely fashion
and implement comprehensive
nutrition interventions.”
(Prof. Taha)
and provides coordinated medical, pharmaceutical, nursing and dietetic advice on request
• Develop Systems to Quickly Diagnose All Malnourished Patients and Those at Risk.
• If malnutrition is present, it should be included as one of the patient’s coded diagnoses.
• Develop Nutrition Care Plans in a Timely Fashion and Implement Comprehensive Nutrition
interventions.
• Links to expert capabilities for intravenous catheter and Gastrostomy insertion and assists
in developing standards for such procedures.
• Develops and audits practical standards of care and organises approaches to nutritional
screening, assessment, and monitoring.
• Fosters and provides education & training in nutritional screening, assessment, monitoring
and nutritional support, for nurses, medical students, doctors, dietitians, pharmacists and
managers.
• Researches in all aspects of artificial nutrition support.

Lecture 2
“Case
scenario 1”
Dr. Faisal El Sehli
Pharm.D, MHSQM
Doctor of Pharmacy, specialized in Pediatric/Neonatal
Ass. Professor in clinical pharmacy
King Saud Bin Abdul-Aziz for Health Science University
Riyadh, Saudi Arabia
Main messages:
Objective of the lecture was to make a practical guidance on how PN can be prepared and what
are the precautions which have to be monitored during administration.
Dr. Faisal also has shown a practical example of a cancer patient receiving PN and emphasize on
role readymade PN (3 Chamber bags) as a practical solution for standard requirement of PN.

Lecture 3
“Case
scenario 2”
Ms. Murielle Abu-Samra
MS. Nutrition and Dietetics
Head of Dietary Department, Middle East institute
of Health – Lebanon
Clinical Dietitian at the Obesity & Weight Control Center
Beirut, Lebanon
Main messages:
Main objective of the presentation was how to give a practical model of how to manage EN for
cancer patients was more focus on special substrates which may improve outcomes in these
patient group.

“Time Always Matters”
Saturday, 20 th May
Prof. Magdy Khalil
Professor of Anesthesia & Intensive
Care Menofia University,
Egypt
Prof. Abdel Azeem Eldawlatly
Professor of Anesthesia
College of Medicine, King Saud University
Riyadh, Saudi Arabia
Prof. Patricia Yazback
Head of the Department of Anesthisia & Critical Care
Hotel-Dieu De Francr University Hospital
Beirut School of Medicine at The Saint Joseph University
Beirut, Lebanon(Lebanon)

“Time Always Matters”
Saturday, 20 th May
Prof. Assem Abel Razek
Professor of Anesthesia and Surgical Intensive Care
Faculty of Medicine, Alexandria University
Alexandria, Egypt
Prof. Waleed Hamimy
Professor of Anesthesia
Cairo University
Cairo, Egypt
Dr. Jawad Khaled
Consultant of Emergency Medicine
Armed Force Hospital, Southern Region
Khamis Mushait, Saudi Arabia

Lecture 1
“Colloids on
The Right
Track”
Prof. Magdy Khalil
Professor of Anesthesia & Intensive Care
Menofia University, Egypt
Main messages:
Differentiate between HES products’ generation and how the MW & MS
reflect on the pharmacodynamics of the products.
EMA & FDA warning based on Studies in ICU patients. ICU patients are
different from surgical patients.
It’s not right to extrapolate data from one to another clinical situation.
Many recent studies and publication confirm safety of Voluven in surgical
settings in term of blood loss, renal function and mortality.
“It’s not right to extrapolate
data from one to
another clinical situation.”
(Prof. Khalil)
Conclusion:
• Fluid therapy is a drug therapy.
• Colloids are not the same.
• Colloids as any drug have advantages and side-effects.
• Any side-effects should be weighed against benefits.
Take home messages:
• That 6% HES 130/0.4 when given perioperatively to compensate for an acute blood loss can
be given without a clinically relevant risk of:
• Increased bleeding
• Complications
• Renal impairment
• Mortality

Lecture 2
“ERAA/ERAS
&
GDFT”
Prof. Abdel Azeem Eldawlatly
Professor of Anesthesia
College of Medicine, King Saud University
Riyadh, Saudi Arabia
Main messages:
Anesthesia play an important role in ERAS protocols.
GDFT is a corner stone to optimize organ perfusion and improving surgical
outcome.
GDFT is done through hemodynamic monitoring Glycocalyx degradation
causes microvascular perfusion failure.
HES130/0.4 is associated with better impact on small intestinal mucosa
integrity compared to RL. HES 130/0.4 is associated with lower fluid balance
compared to crystalloids.
HES 130/0.4 does not result in significant differences in microvascular
reactivity or endothelial glycocalyx degradation unlike crystalloids.
Among ICU patients with hypovolemia, 90-day mortality was lower among
patients receiving colloids compared to crystalloids.
Novel Adjunct Drugs such as adenosine-lidocaine-Magnesium (ALM),
beta-hydroxybutyrate plus melatonin (BHB/M), and poloxamer 188 (P-188)
Reverse Endothelial Glycocalyx Damage After Hemorrhagic Shock.
Take home messages:
• ERAA is the core of ERAS.
• Fluids play important role in optimize organ perfusion and improving
surgical outcome.
• Advanced hemodynamic monitoring is important to be implemented.
• More research on the effect of different fluid and drugs on Glycocalyx are needed.
“Fluids play an important
role in optimize organ
perfusion and improving
surgical outcome.” (Prof.
Eldawlatly)
“More research on the
effect of different fluid
and drugs on Glycocalyx
are needed.”
(Prof. Eldawlatly)

Lecture 3
“Optimal Fluid
strategy in the
operating
Room”
Prof. Patricia Yazback
Head of the Department of Anesthisia & Critical Care
Hotel-Dieu De Francr University Hospital
Beirut School of Medicine at The Saint Joseph University
Beirut, Lebanon(Lebanon)
Main messages:
The administration of intravenous fluids before, during, and after surgery
at the right time and in the right amounts is of great importance.
For major surgeries with significant fluid shifts: it is preferable to use a
fluid restricted approach (GDT) associated with the use of a monitoring
to guide fluid therapy.
The low substituted HES solutions (tetrastarch +++) have minimal clinical
influence on hemostasis. No effect on the renal function of low to moderate
doses of HES 6%, 130/0,4 It is not recommended to use HES in ICU
patients, and in patients with severe sepsis, burns and risk of AKI.
“Dynamic parameters
should be preferred to
guide volume responsiveness
and more
specifically Oesophag.
Echo-Doppler.”
(Prof. Yazback)
Take home messages:
• Goal-Directed fluid approach is suggested.
• Dynamic parameters should be preferred to guide volume responsiveness and more specifically
Oesophag Echo-Doppler.
• Balanced Crystalloids (0,5-1ml/Kg/h) are recommended to replace sensible and insensible losses.
• Colloids (Balanced Tetrastarch) may be used to replace blood losses with respect of the actual
recommendations.

Lecture 4
“Fluid
Management
in Cardiac
Surgery”
Prof. Assem Abel Razek
Professor of Anesthesia and Surgical Intensive Care
Faculty of Medicine, Alexandria University
Alexandria, Egypt
Main messages:
HYPOVOLEMIA is common among cardiac surgical patient.
Optimization of perioperative fluid management may include a combination
of fixed crystalloid administration to replace extravascular losses and
avoiding fluid excess, together with individualized goal-directed colloid
administration to maintain a maximal stroke volume.
Tetrastarches are improved in regard to blood loss or need for transfusions
compared to older starches. HES130/0.4 is safe as albumin in adult and
children undergoing cardiac surgery.
Use more than 1000ml HES in cardiac surgery doesn’t associated with
increased risk of AKI & RBCs transfusion.
“Determining both the need
for augmented perfusion
and fluid responsiveness is
fundamental when making
fluid therapy decisions to
avoid unjustified fluid
administration.”
(Prof. Abel Razek)
There is no evidence to support routine administration of albumin in hypovolemic states.
The use of HES is associated with less fluid accumulation, which might have a significant
impact on postoperative morbidity and mortality.
We need well designed and categorized multi- centers double blind studies
Take home messages:
• fluids should be treated as any other intravenous drug therapy.
• Determining both the need for augmented perfusion and fluid responsiveness is fundamental
when making fluid therapy decisions to avoid unjustified fluid administration.
• No solid Evidences or Solid FACTS on the Harm of Colloids and even HES in normal Patients.

Lecture 5
“Spinal induced
hypotension”
Prof. Waleed Hamimy
Professor of Anesthesia
Cairo University
Cairo, Egypt
Main messages:
High incidence reaching 85%, lead to Maternal complications and Neonatal
complications.
Three basic components of management of spinal hypotension Fluid
load, Vasopressor and Positioning.
HES loading therapy for the prevention and treatment of hypotension
associated with SA in elective CS was found to be superior to the use of
crystalloids.
New generation colloids (HES 6% 130/0.4) are to be preferred, in view
of their superior safety profile. Colloid use should be combined with
phenylephrine treatment algorithms.
HES130/0.4 routine use for preloading prior to spinal anesthesia should
be considered.
Phenylephrine is preferred as vasopressor in the management of hypotension
in elective cesarean deliveries under spinal anesthesia.
Colloid preloading is associated with significant less need for vasopressor
when compared to crystalloid preloading. A HES preload of approxi-
“HES130/0.4 routine use
for preloading prior to
spinal anesthesia should
be considered.”
(Prof. Hamimy)
Take home messages:
• Colloid preloading is better than crystalloid.
• Colloid coloading is as effective as crystalloid coloading but provides a vasopressor sparing effect.
• Phenylephrine prophylactic infusion at a dose of 25-50 ug/min is preferred.
• Ephedrine still has its indications.

Lecture 6
“Fluid
Management
and Shock
Resuscitation”
Dr. Jawad Khaled
Consultant of Emergency Medicine
Armed Force Hospital, Southern Region
Khamis Mushait, Saudi Arabia
Main messages:
Shock is an abnormality of the circulatory system that results in inadequate
organ perfusion and tissue oxygenation. In the vast majority of trauma
patients, shock is due to blood loss.
Massive crystalloid resuscitation may be associated with development of
abdominal compartment syndrome in Trauma patients.
Colloids as adjunct to blood products in damage control resuscitation
are associated with lower mortality. Restrictive fluid therapy may support
better survival.
An adequate combination of fluids and vaso-pressors can reduce the risks
of fluid overload in trauma.
“An adequate combination
of fluids and vasopressors
can reduce the risks of
fluid overload in trauma.”
(Dr. Khaled)
Take home messages:
• Initial assessment of volume deficit, replace that (with crystalloid), and reassess.
• Continue volume resuscitation to target endpoints.
• Can use mixed venous oxygen saturation to estimate tissue perfusion and oxygenation.

Clinical nutrition day “Mind the Gap” offered a platform for 100 delegates including
oncologists, dietitians, Intensivists and clinical pharmacists from the middle east
countries to share the newest insights from research, exchange best practices and
discuss patient cases in the field of Clinical Nutrition. The meeting was chaired by
Prof. George Abi Saad and Prof. Mohamed Abd El Khalik, two leading regional experts
in the field of clinical nutrition therapy.
On the second day, under the title of “Time Always Matters” the focus of the meeting
was addressing the impact of the perioperative fluid administration on the clinical outcomes.
Perioperative fluid therapy is a highly debated topic. Its aim is to sustain or restore
effective circulating blood volume during the perioperative period. Enhanced Recovery
After Surgery (ERAS) included optimal perioperative fluid management as an important
component of its pathways.