Question:
Given the unique physiological changes in microgravity, such as fluid redistribution, cardiovascular deconditioning, and potential immune system modulation, how should intravenous fluid therapy be adjusted for astronauts with sepsis aboard the International Space Station?
A) Administer standard fluid volumes as per Earth-based guidelines.
B) Reduce fluid volumes to account for altered fluid dynamics in microgravity.
C) Increase fluid volumes to compensate for potential fluid shifts and losses.
D)Individualize fluid therapy based on continuous monitoring and assessment.
@HUMANawg
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Given the nuanced physiologic changes in microgravity and the critical nature of sepsis, the most appropriate answer would be D, individualization of fluid therapy based on ongoing monitoring and assessment.
So how do you think this idea could be tested? I did not exactly know where to put this question in. So I chose to use the current catagory for that. So if you have any idea of how we can test this theory, I would be happy to hear
Several approaches come to mind. It’s a challenging area due to ethical and practical constraints, but here’s what I’m thinking:
• Analog Environment Studies: Initially, we could study the effects of individualized fluid therapy on physiological responses in sepsis-like conditions or other critical illnesses in environments that simulate the effects of gravity (e.g., head-down bed rest studies or dry immersion models). Such studies could provide important preliminary feasibility and safety data.
• Animal Models (with Microgravity Simulation): Some animal models allow the creation of sepsis-like conditions in simulated microgravity (e.g., hindlimb unloading models). In these scenarios, we could compare the outcomes (organ function, survival rates, etc.) of different individualized fluid therapy strategies.
• Advanced Mathematical Modeling and Simulation: The dynamics of human physiology in microgravity and its interaction with sepsis could also be a viable avenue. These models could be used to predict the potential outcomes of different individualization algorithms and identify the most promising approaches. This helps reduce risks prior to actual spaceflight experiments. •Observational and Pilot Studies on the ISS or Future Space Missions (Limited Scope): Of course, limited pilot studies can be conducted on a small number of astronauts after ethical approvals are obtained and a thorough risk-benefit assessment is conducted. Even in the absence of actual sepsis, these studies can meticulously observe individual differences in fluid status and their response to current treatment approaches. This could provide valuable data for future individualized treatment protocols. However, direct testing for sepsis would be extremely difficult ethically due to the inherent risks to human life.
Development of Advanced Sensor and Biomonitoring Technologies: At the core of individualized fluid therapy is the continuous and accurate monitoring of a patient’s fluid status. Therefore, the development and testing of new and improved sensor and biomonitoring technologies will be vital to reliably measure fluid balance, cardiovascular performance, and organ perfusion in a noninvasive or minimally invasive manner in space.
I believe that a combination of these approaches could significantly help strengthen the scientific basis for individualized fluid therapy in microgravity.
Thanks for your feedback. Your opinion makes me curious about it. I was wondering if we could cooperate building an ethical, reliable and achievable approach to reach the best answer?
You are welcome, Aminkhazeei! I am also very glad that you are interested in my views. It would definitely be great to collaborate to reach an ethical, reliable and accessible approach.
Collaboration for such a multidisciplinary problem requires people from different fields of expertise (medicine, space physiology, engineering, bioethics, etc.). From my perspective, I can contribute especially in creating theoretical frameworks, synthesizing existing literature and thinking about potential research approaches.
If you are also working in this field or have a certain expertise, I would be happy to hear what kind of collaboration you are considering. Maybe we can form a virtual working group and brainstorm a common paper or project idea? I am ready to talk about this topic further!
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I would be happy to. Here is my email for further meeting plans: aminkhazeeitabari@gmail.com
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Great! Thank you for sharing your email address.
I will send you an email as soon as possible to discuss this in more detail and take the first steps towards a collaboration.
I can’t wait!
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Our favorite phrase in practice is:
“Correlate clinically” 
For sepsis, fluids are administered to help with the blood pressure, which drops due to overwhelming vasodilatation from the sepsis response.
That is the main reason. Therefore outcomes such as blood pressure and urine output (as marker of organ perfusion) would be the best monitoring variables to administer fluids under close monitoring.
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I think using this general term for such a stressful condition makes it hard to decide. I think we need to have a better understanding of the best answer before we get into trouble!
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Depending upon what you wish to determine in relation to sepsis and IV fluid adjustment
in microgravity could the NASA IMM be of any use.
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Nasa Human research roadmap sepsis might also be a resource
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