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Li L, Du L, Chen G, Zhang W, Du B, Zhang L, Zheng J. Stroke volume variation induced by lung recruitment maneuver to predict fluid responsiveness in patients receiving mechanical ventilation: A systematic review and meta-analysis. J Clin Anesth 2024; 97:111545. [PMID: 38971135 DOI: 10.1016/j.jclinane.2024.111545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/04/2024] [Accepted: 06/30/2024] [Indexed: 07/08/2024]
Abstract
STUDY OBJECTIVE The aim of this study was to evaluate the accuracy of lung recruitment maneuver induced stroke volume variation (ΔSVLRM) in predicting fluid responsiveness in mechanically ventilated adult patients by systematic review and meta-analysis. METHODS A comprehensive electronic search of relevant literature was conducted in PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase and Chinese databases (including China National Knowledge Infrastructure, Wanfang and VIP databases). Review Manager 5.4, Meta-DiSc 1.4 and STATA 16.0 were selected for data analysis, and QUADAS-2 tool was used for quality assessment. Data from selected studies were pooled to obtain sensitivity, specificity, diagnostic likelihood ratio (DLR) of positive and negative, diagnostic odds ratio (DOR), and summary receiver operating characteristic curve. RESULTS A total of 6 studies with 256 patients were enrolled through March 2024. The risk of bias and applicability concerns for each included study were low, and there was no significant publication bias. There was moderate to substantial heterogeneity for the non-threshold effect, but not for the threshold effect. The combined sensitivity and specificity were 0.84 (95% CI, 0.77-0.90) and 0.79 (95% CI, 0.70-0.86), respectively. The DOR and the area under the curve (AUC) were 22.15 (95%CI, 7.62-64.34) and 0.90 (95% CI, 0.87-0.92), respectively. The positive and negative predictive values of DLR were 4.53 (95% CI, 2.50-8.18) and 0.19 (95% CI, 0.11-0.35), respectively. Fagan's nomogram showed that with a pre-test probability of 52%, the post-test probability reached 83% and 17% for the positive and negative tests, respectively. CONCLUSIONS Based on the currently available evidence, ΔSVLRM has a good diagnostic value for predicting the fluid responsiveness in adult patients undergoing mechanical ventilation. Given the heterogeneity and limitations of the published data, further studies with large sample sizes and different clinical settings are needed to confirm the diagnostic value of ΔSVLRM in predicting fluid responsiveness. PROSPERO registration number: CRD42023490598.
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Affiliation(s)
- Lu Li
- Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Li Du
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55th, People's South Road, Chengdu, Sichuan, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Weiyi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Bin Du
- Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Lu Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Jianqiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China.
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Böhm D, Bliesener B, Dieck T, Kruse M, Odenthal T, Stoppe C, Trojan S, Gille J. [Treatment of Burn Shock - The First 24 hours and Beyond]. HANDCHIR MIKROCHIR P 2024; 56:166-171. [PMID: 38412995 DOI: 10.1055/a-2208-8107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
Acute phase and resuscitation after burn trauma are challenging even for specialised burn centres due to the individual onset and differences compared with other forms of shock. The guidelines of the German Society of Burn Medicine (DGV) cover the scientific basis of modern burn treatment. Nevertheless, uncertainty remains regarding the detailed practical handling. This expert consensus focuses on best practices for the treatment of patients with major burns in specialised burn centres and by clinical first responders. The short version of this expert consensus can be downloaded at: https://verbrennungsmedizin.de/files/dgv_files/pdf/positionspapier/Pos%20Therapie%20des%20Verbrennungsschock%20AK%20Intensivmedizin%202023.pdf.
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Affiliation(s)
- Dorothee Böhm
- Klinik für Handchirurgie, Hochtaunuskliniken Usingen, Usingen, Germany
| | - Björn Bliesener
- Klinik für Hand-, Plastische- und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen, Germany
| | - Thorben Dieck
- PÄHW, Medizinische Hochschule Hannover, Hannover, Germany
| | - Marianne Kruse
- Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Tobias Odenthal
- Klinik für Anästhesie, Intensiv-, Rettungs- und Schmerzmedizin, BG Klinikum Hamburg, Hamburg, Germany
| | - Christian Stoppe
- Universitätsklinik Würzburg, University Hospital, Würzburg, Wurzburg, Germany
- Klinik für Anästhesiologie und Intensivmedizin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Trojan
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum Köln-Merheim, Klinikum der Universität Witten/ Herdecke, Ostmerheimer Straße 200, 51109 Köln, Köln, Germany
| | - Jochen Gille
- Klinik für Anästhesiologie, Intensiv- und Schmerztherapie, Klinikum St. Georg, Leipzig, Germany
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Messina A, Caporale M, Calabrò L, Lionetti G, Bono D, Matronola GM, Brunati A, Frassanito L, Morenghi E, Antonelli M, Chew MS, Cecconi M. Reliability of pulse pressure and stroke volume variation in assessing fluid responsiveness in the operating room: a metanalysis and a metaregression. Crit Care 2023; 27:431. [PMID: 37940953 PMCID: PMC10631038 DOI: 10.1186/s13054-023-04706-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Pulse pressure and stroke volume variation (PPV and SVV) have been widely used in surgical patients as predictors of fluid challenge (FC) response. Several factors may affect the reliability of these indices in predicting fluid responsiveness, such as the position of the patient, the use of laparoscopy and the opening of the abdomen or the chest, combined FC characteristics, the tidal volume (Vt) and the type of anesthesia. METHODS Systematic review and metanalysis of PPV and SVV use in surgical adult patients. The QUADAS-2 scale was used to assess the risk of bias of included studies. We adopted a metanalysis pooling of aggregate data from 5 subgroups of studies with random effects models using the common-effect inverse variance model. The area under the curve (AUC) of pooled receiving operating characteristics (ROC) curves was reported. A metaregression was performed using FC type, volume, and rate as independent variables. RESULTS We selected 59 studies enrolling 2,947 patients, with a median of fluid responders of 55% (46-63). The pooled AUC for the PPV was 0.77 (0.73-0.80), with a mean threshold of 10.8 (10.6-11.0). The pooled AUC for the SVV was 0.76 (0.72-0.80), with a mean threshold of 12.1 (11.6-12.7); 19 studies (32.2%) reported the grey zone of PPV or SVV, with a median of 56% (40-62) and 57% (46-83) of patients included, respectively. In the different subgroups, the AUC and the best thresholds ranged from 0.69 and 0.81 and from 6.9 to 11.5% for the PPV, and from 0.73 to 0.79 and 9.9 to 10.8% for the SVV. A high Vt and the choice of colloids positively impacted on PPV performance, especially among patients with closed chest and abdomen, or in prone position. CONCLUSION The overall performance of PPV and SVV in operating room in predicting fluid responsiveness is moderate, ranging close to an AUC of 0.80 only some subgroups of surgical patients. The grey zone of these dynamic indices is wide and should be carefully considered during the assessment of fluid responsiveness. A high Vt and the choice of colloids for the FC are factors potentially influencing PPV reliability. TRIAL REGISTRATION PROSPERO (CRD42022379120), December 2022. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=379120.
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Affiliation(s)
- Antonio Messina
- Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
| | - Mariagiovanna Caporale
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Calabrò
- Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Giulia Lionetti
- Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Daniele Bono
- Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Guia Margherita Matronola
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Andrea Brunati
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Luciano Frassanito
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuela Morenghi
- Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Massimo Antonelli
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maurizio Cecconi
- Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
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Sae-Phua V, Tanasittiboon S, Sangtongjaraskul S. The Effect of Goal-directed Fluid Management based on Stroke Volume Variation on ICU Length of Stay in Elderly Patients Undergoing Elective Craniotomy: A Randomized Controlled Trial. Indian J Crit Care Med 2023; 27:709-716. [PMID: 37908429 PMCID: PMC10613877 DOI: 10.5005/jp-journals-10071-24551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/13/2023] [Indexed: 11/02/2023] Open
Abstract
Background Inappropriate fluid management during neurosurgery can increase postoperative complications. In this study, we aimed to investigate the effect of goal-directed fluid therapy using stroke volume variation (SVV) in elderly patients undergoing elective craniotomy. Materials and methods We randomized 100 elderly patients scheduled for elective craniotomy into two groups: goal-directed therapy (GDT, n = 50) group and conventional group (n = 50). Fluid management protocol using SVV was applied in the GDT group. Decisions about fluid and hemodynamic management in the conventional group were made by the anesthesiologist. Perioperative variables including fluid balance, lactate level, and intensive care unit (ICU) length of stay were assessed. Results There was no significant difference in ICU length of stay between the two groups: 14 (12, 16.75) hours in GDT group vs 15 (13, 18) hours in control group (p = 0.116). Patients in the GDT group received a significantly less amount of crystalloid compared with the control group: 1311.5 (823, 2018) mL vs 2080 (1420, 2690) mL (p < 0.001). Our study demonstrated a better fluid balance in the GDT group as 342.5 (23, 607) mL compared with the conventional group 771 (462, 1269) mL (p < 0.001). Conclusion Intraoperative goal-directed fluid management based on SVV in elderly patients undergoing elective craniotomy did not reduce the ICU length of stay or postoperative complications. It did result in an improved fluid balance with no evidence of inadequate organ perfusion. Clinical trial registration number TCTR20190812003. How to cite this article Sae-Phua V, Tanasittiboon S, Sangtongjaraskul S. The Effect of Goal-directed Fluid Management based on Stroke Volume Variation on ICU Length of Stay in Elderly Patients Undergoing Elective Craniotomy: A Randomized Controlled Trial. Indian J Crit Care Med 2023;27(10):709-716.
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Affiliation(s)
- Vorrachai Sae-Phua
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sophitnapa Tanasittiboon
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sunisa Sangtongjaraskul
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Ling W, Jiang Z, Liu K, Zhang H, Qian Y, Tian J, Zhang Z, Chen Y, Qian G. Effect of Vigileo/FloTrac System-Guided Aggressive Hydration in Acute Myocardial Infarction Patients to Prevent Contrast-Induced Nephropathy After Urgent Percutaneous Coronary Intervention. Am J Cardiol 2023; 195:77-82. [PMID: 37018968 DOI: 10.1016/j.amjcard.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/04/2023] [Accepted: 03/01/2023] [Indexed: 04/07/2023]
Abstract
Tailored hydration strategies appear to provide an effective solution for preventing contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). The Vigileo/FloTrac system could predict the patients' fluid responsiveness and tolerance to hydration. This prospective multicenter, randomized controlled, open-label study evaluated the efficacy of aggressive hydration guided by the Vigileo/FloTrac system for CIN prevention in patients with acute myocardial infarction (AMI). This trial enrolled patients with AMI undergoing urgent PCI, and these patients were randomized (1:1) to receive either aggressive hydration guided by Vigileo/FloTrac system (intervention group) or general hydration (control group). Patients with AMI in the intervention group received a loading dose of saline, and the hydration speed was adjusted according to the change of Vigileo/FloTrac index. The primary end point is CIN, which was defined as a >25% or >0.5 mg/100 ml increase in serum creatinine compared with baseline during the first 72 hours after urgent PCI. This trial was registered in ClinicalTrials.gov (NCT04382313). A total of 344 patients with AMI were enrolled and randomized in our trial, and the baseline characteristics, including risk factors of CIN, of the Vigileo/FloTrac-guided hydration group (n = 173) and control group (n = 171) were well balanced (all p >0.05). The total hydration volume in Vigileo/FloTrac-guided hydration group was significantly much more than control group (1,910 ± 600 vs 440 ± 90 ml, p <0.001). The incidence of CIN in the Vigileo/FloTrac-guided hydration group was significantly decreased than that in the control group (12.1% [21/173] vs 22.2% [38/171], p = 0.013). There was not significantly different in the incidence of acute heart failure after PCI (9.2% [16/173] vs 7.6% [13/171], p = 0.583). The incidence of main adverse cardiovascular events in the Vigileo/FloTrac-guided hydration group was lower than that in the control group but without statistically difference (30 events [17.3%] vs 38 events [22.2%], p = 0.256). In conclusion, Vigileo/FloTrac system-guided aggressive hydration could effectively decrease the risk of CIN for patients with AMI undergoing urgent PCI and avoid attack of acute heart failure at the same time.
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Affiliation(s)
- Weiwei Ling
- Department of Cardiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zichao Jiang
- Department of Cardiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ke Liu
- Department of Cardiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Han Zhang
- Department of Cardiology, Lujiang People Hospital, Anhui, China
| | - Yongan Qian
- Department of Cardiology, Lujiang People Hospital, Anhui, China
| | - Jinwen Tian
- Department of Cardiology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Zhao Zhang
- Department of Cardiology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Yundai Chen
- Department of Cardiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Geng Qian
- Department of Cardiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
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Starke H, von Dossow V, Karsten J. Intraoperative Circulatory Support in Lung Transplantation: Current Trend and Its Evidence. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071005. [PMID: 35888094 PMCID: PMC9322250 DOI: 10.3390/life12071005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
Lung transplantation has a high risk of haemodynamic complications in a highly vulnerable patient population. The effects on the cardiovascular system of the various underlying end-stage lung diseases also contribute to this risk. Following a literature review and based on our own experience, this review article summarises the current trends and their evidence for intraoperative circulatory support in lung transplantation. Identifiable and partly modifiable risk factors are mentioned and corresponding strategies for treatment are discussed. The approach of first identifying risk factors and then developing an adjusted strategy is presented as the ERSAS (early risk stratification and strategy) concept. Typical haemodynamic complications discussed here include right ventricular failure, diastolic dysfunction caused by left ventricular deconditioning, and reperfusion injury to the transplanted lung. Pre- and intra-operatively detectable risk factors for the occurrence of haemodynamic complications are rare, and the therapeutic strategies applied differ considerably between centres. However, all the mentioned risk factors and treatment strategies can be integrated into clinical treatment algorithms and can influence patient outcome in terms of both mortality and morbidity.
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Affiliation(s)
- Henning Starke
- Institute of Anaesthesiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum, 44801 Bochum, Germany;
| | - Vera von Dossow
- Institute of Anaesthesiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum, 44801 Bochum, Germany;
- Correspondence: ; Tel.: +49-(0)-5731-97-1128; Fax: +49-(0)-5731-97-2196
| | - Jan Karsten
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany;
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Huan S, Dai J, Song S, Zhu G, Ji Y, Yin G. Stroke volume variation for predicting responsiveness to fluid therapy in patients undergoing cardiac and thoracic surgery: a systematic review and meta-analysis. BMJ Open 2022; 12:e051112. [PMID: 35584881 PMCID: PMC9119189 DOI: 10.1136/bmjopen-2021-051112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the reliability of stroke volume variation (SVV) for predicting responsiveness to fluid therapy in patients undergoing cardiac and thoracic surgery. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE, Cochrane Library, Web of Science up to 9 August 2020. METHODS Quality of included studies were assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We conducted subgroup analysis according to different anaesthesia and surgical methods with Stata V.14.0, Review Manager V.5.3 and R V.3.6.3. We used random-effects model to pool sensitivity, specificity and diagnostic odds ratio with 95% CI. The area under the curve (AUC) of receiver operating characteristic was calculated. RESULTS Among the 20 relevant studies, 7 were conducted during thoracic surgery, 8 were conducted during cardiac surgery and the remaining 5 were conducted in intensive critical unit (ICU) after cardiac surgery. Data from 854 patients accepting mechanical ventilation were included in our systematic review. The pooled sensitivity and specificity were 0.73 (95% CI: 0.59 to 0.83) and 0.62 (95% CI: 0.46 to 0.76) in the thoracic surgery group, 0.71 (95% CI: 0.65 to 0.77) and 0.76 (95% CI: 0.69 to 0.82) in the cardiac surgery group, 0.85 (95% CI: 0.60 to 0.96) and 0.85 (95% CI: 0.74 to 0.92) in cardiac ICU group. The AUC was 0.73 (95% CI: 0.69 to 0.77), 0.80 (95% CI: 0.77 to 0.83) and 0.88 (95% CI: 0.86 to 0.92), respectively. Results of subgroup of FloTrac/Vigileo system (AUC=0.80, Youden index=0.38) and large tidal volume (AUC=0.81, Youden index=0.48) in thoracic surgery, colloid (AUC=0.85, Youden index=0.55) and postoperation (AUC=0.85, Youden index=0.63) in cardiac surgery, passive leg raising (AUC=0.90, Youden index=0.72) in cardiac ICU were reliable. CONCLUSION SVV had good predictive performance in cardiac surgery or ICU after cardiac surgery and had moderate predictive performance in thoracic surgery. Nevertheless, technical and clinical variables may affect the predictive value potentially.
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Affiliation(s)
- Sheng Huan
- Department of Anesthesiology, Nanjing Second Hospital, Nanjing, Jiangsu, China
- Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, Jangsu, China
| | - Jin Dai
- Department of Anesthesiology, Nanjing Second Hospital, Nanjing, Jiangsu, China
| | - Shilian Song
- Department of Anesthesiology, Nanjing Second Hospital, Nanjing, Jiangsu, China
| | - Guining Zhu
- Department of Anesthesiology, Nanjing Second Hospital, Nanjing, Jiangsu, China
| | - Yihao Ji
- Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, Jangsu, China
- Department of Critical Medicine, The Second Hospital of Nanjing, Nanjing, Jiangsu, China
| | - Guoping Yin
- Department of Anesthesiology, Nanjing Second Hospital, Nanjing, Jiangsu, China
- Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, Jangsu, China
- College of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
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Akyol D, Cukurova Z, Tulubas E, Yıldız G, Sabaz M. Goal-directed fluid therapy in gastrointestinal cancer surgery: A prospective randomized study. JOURNAL OF ACUTE DISEASE 2022. [DOI: 10.4103/2221-6189.342661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Graessler MF, Wodack KH, Pinnschmidt HO, Nishimoto S, Behem CR, Reuter DA, Trepte CJC. Assessing volume responsiveness using right ventricular dynamic indicators of preload. J Anesth 2021; 35:488-494. [PMID: 33950295 PMCID: PMC8096889 DOI: 10.1007/s00540-021-02937-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Dynamic indicators of preload currently only do reflect preload requirements of the left ventricle. To date, no dynamic indicators of right ventricular preload have been established. The aim of this study was to calculate dynamic indicators of right ventricular preload and assess their ability to predict ventricular volume responsiveness. MATERIALS AND METHODS The study was designed as experimental trial in 20 anaesthetized pigs. Micro-tip catheters and ultrasonic flow probes were used as experimental reference to enable measurement of right ventricular stroke volume and pulse pressure. Hypovolemia was induced (withdrawal of blood 20 ml/kg) and thereafter three volume-loading steps were performed. ROC analysis was performed to assess the ability of dynamic right ventricular parameters to predict volume response. RESULTS ROC analysis revealed an area under the curve (AUC) of 0.82 (CI 95% 0.73-0.89; p < 0.001) for right ventricular stroke volume variation (SVVRV), an AUC of 0.72 (CI 95% 0.53-0.85; p = 0.02) for pulmonary artery pulse pressure variation (PPVPA) and an AUC of 0.66 (CI 95% 0.51-0.79; p = 0.04) for pulmonary artery systolic pressure variation (SPVPA). CONCLUSIONS In our experimental animal setting, calculating dynamic indicators of right ventricular preload is possible and appears promising in predicting volume responsiveness.
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Affiliation(s)
- Michael F Graessler
- Department of Anesthesiology, Centre for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Karin H Wodack
- Department of Anesthesiology, Centre for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans O Pinnschmidt
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Nishimoto
- Department of Anesthesiology, Centre for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | | | - Daniel A Reuter
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany
| | - Constantin J C Trepte
- Department of Anesthesiology, Centre for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Dalmagro TL, Teixeira-Neto FJ, Celeita-Rodríguez N, Garofalo NA, López-Castañeda B, Nascimento-Junior PD. Comparison between pulse pressure variation and systolic pressure variation measured from a peripheral artery for accurately predicting fluid responsiveness in mechanically ventilated dogs. Vet Anaesth Analg 2021; 48:501-508. [PMID: 34020897 DOI: 10.1016/j.vaa.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 12/17/2020] [Accepted: 01/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare pulse pressure variation (PPV) and systolic pressure variation (SPV) measured from a peripheral artery to predict fluid responsiveness in anesthetized healthy dogs. STUDY DESIGN Prospective study. ANIMALS A total of 39 dogs (13.8-26.8 kg) anesthetized with isoflurane for elective ovariohysterectomy. METHODS Ventilation was controlled (tidal volume 12 mL kg-1; 40% inspiratory pause). PPV and SPV were recorded from a dorsal pedal artery catheter using an automated algorithm. A fluid challenge (FC) with lactated Ringer's solution (20 mL kg-1 over 15 minutes) was administered once (21 animals) or twice (18 animals) before surgery. Increases in transpulmonary thermodilution stroke volume index > 15% from values recorded before each FC defined responders to volume expansion. Final fluid responsiveness status was based on the response to single FC or second FC. Predictive ability of PPV and SPV was compared by receiver operating characteristic (ROC) curve analysis and by the range of cut-off values associated with uncertain results (gray zone). RESULTS All animals after the single FC were responders; all animals administered two FCs were nonresponders after the second FC. The area under the ROC curve (AUROC) of PPV (0.968) did not differ from that of SPV (0.937) (p = 0.45). Best cut-off thresholds to discriminate responders from nonresponders were >11.7% (PPV) and >7.4 mmHg (SPV). The gray zone of PPV and SPV was 8.2-14.6% and 7.0-7.4 mmHg, respectively. The percentage of animals with PPV and SPV values within the gray zone was less for SPV (10.2%) than for PPV (30.8%). CONCLUSIONS AND CLINICAL RELEVANCE PPV and SPV obtained from the dorsal pedal artery are useful predictors of fluid responsiveness in dogs. Using an automated algorithm, SPV may more accurately predict fluid responsiveness than PPV, with responders identifiable by PPV > 14.6% and SPV > 7.4 mmHg.
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Affiliation(s)
- Tábata L Dalmagro
- Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Francisco J Teixeira-Neto
- Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, Brazil; Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, Brazil.
| | | | - Natache A Garofalo
- Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
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Boehm D, Menke H. A History of Fluid Management-From "One Size Fits All" to an Individualized Fluid Therapy in Burn Resuscitation. ACTA ACUST UNITED AC 2021; 57:medicina57020187. [PMID: 33672128 PMCID: PMC7926800 DOI: 10.3390/medicina57020187] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/08/2021] [Accepted: 02/14/2021] [Indexed: 12/26/2022]
Abstract
Fluid management is a cornerstone in the treatment of burns and, thus, many different formulas were tested for their ability to match the fluid requirements for an adequate resuscitation. Thereof, the Parkland-Baxter formula, first introduced in 1968, is still widely used since then. Though using nearly the same formula to start off, the definition of normovolemia and how to determine the volume status of burn patients has changed dramatically over years. In first instance, the invention of the transpulmonary thermodilution (TTD) enabled an early goal directed fluid therapy with acceptable invasiveness. Furthermore, the introduction of point of care ultrasound (POCUS) has triggered more individualized schemes of fluid therapy. This article explores the historical developments in the field of burn resuscitation, presenting different options to determine the fluid requirements without missing the red flags for hyper- or hypovolemia. Furthermore, the increasing rate of co-morbidities in burn patients calls for a more sophisticated fluid management adjusting the fluid therapy to the actual necessities very closely. Therefore, formulas might be used as a starting point, but further fluid therapy should be adjusted to the actual need of every single patient. Taking the developments in the field of individualized therapies in intensive care in general into account, fluid management in burn resuscitation will also be individualized in the near future.
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Affiliation(s)
- Dorothee Boehm
- Correspondence: ; Tel.: +69-8405-5141; Fax: +69-8405-5144
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12
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Broyles MG, Subramanyam S, Barker AB, Tolwani AJ. Fluid Responsiveness in the Critically Ill Patient. Adv Chronic Kidney Dis 2021; 28:20-28. [PMID: 34389133 DOI: 10.1053/j.ackd.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/04/2021] [Accepted: 06/13/2021] [Indexed: 12/19/2022]
Abstract
Accurate assessment of intravascular volume status in critically ill patients remains a very challenging task. Recent data have shown adverse outcomes in critically ill patients with either inadequate or overaggressive fluid therapy. Understanding the tools and techniques available for accurate volume assessment is imperative. This article discusses the concept of fluid responsiveness and reviews methods for assessing fluid responsiveness in critically ill patients.
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13
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Iwasaki Y, Ono Y, Inokuchi R, Ishida T, Kumada Y, Shinohara K. Intraoperative fluid management in hepato-biliary-pancreatic operation using stroke volume variation monitoring: A single-center, open-label, randomized pilot study. Medicine (Baltimore) 2020; 99:e23617. [PMID: 33327334 PMCID: PMC7738119 DOI: 10.1097/md.0000000000023617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
TRIAL DESIGN This investigator-initiated, single-center, open-label, parallel-group, randomized-controlled pilot study was designed to compare the intraoperative fluid balance and perioperative complications in patients undergoing hepato-biliary-pancreatic surgery with or without stroke volume variation (SVV)-guided fluid management. METHODS Patients who were aged >18 years and underwent elective major hepato-biliary-pancreatic surgery between June 30, 2015, and August 31, 2016 at our center were randomly assigned to receive SVV-guided or conventional fluid therapy. The intervention group used SVV to determine the patients' volume status. The primary outcome was the total fluid balance per body weight per operation time, and the secondary outcomes were the total amount of intravenous infusion per body weight per operation time and the Sequential Organ Failure Assessment score on postoperative day 1. Patients were randomized by a two-block computer-generated assignment sequence. Masking of patients and assessors was conducted. The patients and assessors were each blinded to the details of the trial; however, the clinicians were not. RESULTS Of the 69 patients who were initially eligible, 60 provided informed consent for participation in the study. After randomization, three patients dropped out of the study because of deviations from the protocol or unexpected hypotension, leaving 28 and 29 patients in the intervention and control groups, respectively. Patients in both groups had similar characteristics at baseline. The median (interquartile range [IQR]) intraoperative fluid balance in the control and SVV groups was 6.2 (IQR, 4.9-7.9) and 8.1 (IQR, 5.7-10.5) ml/kg/h, respectively (P = .103). The administered intravenous infusion was significantly higher in the SVV group (median, 10.9; IQR, 8.3-15.3 ml/kg/h) than in the control group (median, 9.5; IQR, 7.7-10.3 ml/kg/h) (P = .011). On postoperative day 1, the PaO2/FiO2 ratio was lower in the SVV group (median, 266; IQR, 261-341) than in the control group (median, 346; IQR, 299-380) (P = .019). CONCLUSIONS Use of the SVV-guided fluid management protocol did not reduce intraoperative fluid balance but increased the intraoperative fluid administration and might worsen postoperative oxygenation. TRIAL REGISTRATION UMIN000018111.
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Affiliation(s)
- Yudai Iwasaki
- Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital
| | - Yuko Ono
- Emergency and Critical Care Medical Centre, Fukushima Medical University, Fukushima
| | - Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, JR General Hospital, Tokyo, Japan
| | - Tokiya Ishida
- Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital
| | - Yoshibumi Kumada
- Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital
| | - Kazuaki Shinohara
- Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital
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Aceto P, Lococo F, Del Tedesco F, Gualtieri E, Margaritora S, Sollazzi L. Pleurectomy Combined With Hyperthermic Intrathoracic Chemotherapy: Hemodynamic Optimization in a Challenging Case. J Cardiothorac Vasc Anesth 2020; 35:2454-2457. [PMID: 33189534 DOI: 10.1053/j.jvca.2020.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Paola Aceto
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia.
| | - Filippo Lococo
- Università Cattolica del Sacro Cuore, Roma, Italia; Department of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Filippo Del Tedesco
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
| | - Elisabetta Gualtieri
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
| | - Stefano Margaritora
- Università Cattolica del Sacro Cuore, Roma, Italia; Department of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Liliana Sollazzi
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
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Algahtani R, Merenda A. Multimorbidity and Critical Care Neurosurgery: Minimizing Major Perioperative Cardiopulmonary Complications. Neurocrit Care 2020; 34:1047-1061. [PMID: 32794145 PMCID: PMC7426068 DOI: 10.1007/s12028-020-01072-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/28/2020] [Indexed: 11/19/2022]
Abstract
With increasing prevalence of chronic diseases, multimorbid patients have become commonplace in the neurosurgical intensive care unit (neuro-ICU), offering unique management challenges. By reducing physiological reserve and interacting with one another, chronic comorbidities pose a greatly enhanced risk of major postoperative medical complications, especially cardiopulmonary complications, which ultimately exert a negative impact on neurosurgical outcomes. These premises underscore the importance of perioperative optimization, in turn requiring a thorough preoperative risk stratification, a basic understanding of a multimorbid patient’s deranged physiology and a proper appreciation of the potential of surgery, anesthesia and neurocritical care interventions to exacerbate comorbid pathophysiologies. This knowledge enables neurosurgeons, neuroanesthesiologists and neurointensivists to function with a heightened level of vigilance in the care of these high-risk patients and can inform the perioperative neuro-ICU management with individualized strategies able to minimize the risk of untoward outcomes. This review highlights potential pitfalls in the intra- and postoperative neuro-ICU period, describes common preoperative risk stratification tools and discusses tailored perioperative ICU management strategies in multimorbid neurosurgical patients, with a special focus on approaches geared toward the minimization of postoperative cardiopulmonary complications and unplanned reintubation.
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Affiliation(s)
- Rami Algahtani
- Department of Neurology, University of Miami Health System, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Amedeo Merenda
- Department of Neurology, University of Miami Health System, 1120 NW 14th Street, Miami, FL, 33136, USA. .,Department of Neurosurgery, University of Miami Health System, 1120 NW 14th Street, Miami, FL, 33136, USA.
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Lee YH, Jang HW, Park CH, An SM, Lee EK, Choi BM, Noh GJ. Changes in plasma volume before and after major abdominal surgery following stroke volume variation-guided fluid therapy: a randomized controlled trial. Minerva Anestesiol 2020; 86:507-517. [DOI: 10.23736/s0375-9393.19.13952-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Küpeli İ, Subaşı F, Eren N, Arslan YK. Evaluating the Relationship between the Pleth Variability Index and Hypotension and Assessing the Fluid Response in Geriatric Hip Fracture under Spinal Anaesthesia: An Observational Study. Turk J Anaesthesiol Reanim 2020; 48:208-214. [PMID: 32551448 PMCID: PMC7279881 DOI: 10.5152/tjar.2019.59251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/18/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We aimed to test the efficacy of the pre-operative Pleth variability index (PVI) in evaluating hypotension that developed after spinal anaesthesia in patients who were spontaneously breathing, pre-operatively hypovolemic, and were at an advanced age. METHODS This observational study included 94 patients aged >65 years with hip fracture. Demographic data, pre-operative heart rate, non-invasive arterial pressures, PVI values, and haemogram values were continuously measured following spinal anaesthesia. The measurements with and without hypotension were distinguished and their data were compared. RESULTS The mean age of the patients was 77.4±8.2 years. In total, 56.4% of the patients developed hypotension after spinal anaesthesia, and hypotension was higher in women (p=0.037). Low pre-operative diastolic arterial pressures values were associated with the development of hypotension (p=0.037). The relationship between PVI and post-spinal hypotension was negative but significant (r=-0.239; p<0.05). Depending on the volume loss, an increase in the PVI (p<0.001) and its subsequent significant decrease after treatment in patients with hypotension (p<0.001) was observed. The correlation between noninvasively measured haemoglobin values and the values obtained from arterial blood gas samples was significant (p<0.001). CONCLUSION This study showed that post-spinal hypotension may be associated with increased as well as decreased PVI values. However, these values cannot be clinically used for predicting pre-operative hypotension in hypovolemic patients.
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Affiliation(s)
- İlke Küpeli
- Department of Anaesthesiology and Reanimation, Erzincan Binali Yıldırım University School of Medicine, Erzincan, Turkey
| | - Faruk Subaşı
- Department of Anaesthesiology and Reanimation, Erzincan Binali Yıldırım University School of Medicine, Erzincan, Turkey
| | - Nurhan Eren
- Department of Anaesthesiology and Reanimation, Erzincan Binali Yıldırım University School of Medicine, Erzincan, Turkey
| | - Yusuf Kemal Arslan
- Department of Biostatistics and Medical Informatics, Erzincan Binali Yıldırım University School of Medicine, Erzincan, Turkey
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18
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Ma GG, Tu GW, Zheng JL, Zhu DM, Hao GW, Hou JY, Su Y, Luo JC, Liu K, Luo Z. Changes in Stroke Volume Variation Induced by Passive Leg Raising to Predict Fluid Responsiveness in Cardiac Surgical Patients With Protective Ventilation. J Cardiothorac Vasc Anesth 2020; 34:1526-1533. [PMID: 31753747 DOI: 10.1053/j.jvca.2019.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Stroke volume variation (SVV) has been used to predict fluid responsiveness. The authors hypothesized the changes in SVV induced by passive leg raising (PLR) might be an indicator of fluid responsiveness in patients with protective ventilation after cardiac surgery. DESIGN A prospective single-center observational study. SETTING A single cardiac surgery intensive care unit at a tertiary hospital. PARTICIPANTS A total of 123 patients undergoing cardiac surgery with hemodynamic instability. Tidal volume was set between 6 and 8 mL/kg of ideal body weight. INTERVENTIONS PLR maneuver, fluid challenge. MEASUREMENTS AND MAIN RESULTS SVV was continuously recorded using pulse contour analysis before and immediately after a PLR test and after fluid challenge (500 mL of colloid given over 30 min). Sixty-three (51.22%) patients responded to fluid challenge, in which PLR and fluid challenge significantly increased the SV and decreased the SVV. The decrease in SVV induced by PLR was correlated with the SV changes induced by fluid challenge. A 4% decrease in the SVV induced by PLR-discriminated responders to fluid challenge with an area under the curve of 0.90. The gray zone identified a range of SVV changes induced by PLR (between -3.94% and -2.91%) for which fluid responsiveness could not be predicted reliably. The gray zone included 15.45% of the patients. The SVV at baseline predicted fluid responsiveness with an area under the curve of 0.72. CONCLUSIONS Changes in the SVV induced by PLR predicted fluid responsiveness in cardiac surgical patients with protective ventilation.
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Affiliation(s)
- Guo-Guang Ma
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ji-Li Zheng
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Du-Ming Zhu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guang-Wei Hao
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun-Yi Hou
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Su
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing-Chao Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kai Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.
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Kinoshita K, Yamanaga S, Kaba A, Tanaka K, Ogata M, Fujii M, Hidaka Y, Kawabata C, Toyoda M, Uekihara S, Kashima M, Miyata A, Inadome A, Kobayashi T, Yokomizo H. Optimizing Intraoperative Blood Pressure to Improve Outcomes in Living Donor Renal Transplantation. Transplant Proc 2020; 52:1687-1694. [PMID: 32448661 DOI: 10.1016/j.transproceed.2020.01.166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Adequate renal perfusion at the time of unclamping is important because it has been known to affect outcomes in renal transplantation. Nevertheless, the ideal intraoperative systolic arterial pressure (SAP) has not been well defined. METHODS We performed a retrospective analysis of 106 living donor renal transplants performed at our center from June 2010 to May 2019. We divided the cohort into 2 groups according to our center's goal SAP of ≥150 mm Hg: 57 patients had SAP ≥150 mm Hg and 49 patients had SAP <150 mm Hg. We analyzed pretransplant characteristics, intraoperative measurements, and postoperative laboratory values to validate our center's target SAP at the time of reperfusion. This study strictly complied with the Helsinki Congress and the Istanbul Declaration regarding donor sources. RESULTS Patients with SAP ≥150 mm Hg had been on dialysis for a significantly shorter duration before transplant compared with those who had SAP <150 mm Hg. In the SAP ≥150 mm Hg group, urinary sodium excretion normalized earlier, and they had a significantly smaller stroke volume variation, higher cardiac output and cardiac index, earlier initial urination, and higher intraoperative urine output. There were no differences in intraoperative volume repletion, central venous pressure, or postoperative estimated glomerular filtration rate. CONCLUSION Achieving SAP ≥150 mm Hg at the time of reperfusion may be associated with early stabilization of graft function. Nevertheless, our data suggested that recipients with a prolonged dialysis history are less likely to achieve SAP ≥150 mm Hg at the time of unclamping in living donor renal transplantation.
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Affiliation(s)
- Kohei Kinoshita
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan; Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Shigeyoshi Yamanaga
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
| | - Akari Kaba
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kosuke Tanaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Masatomo Ogata
- Department of Internal Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Mika Fujii
- Department of Internal Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Yuji Hidaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Chiaki Kawabata
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Mariko Toyoda
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Soichi Uekihara
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Masayuki Kashima
- Department of Internal Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Akira Miyata
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Akito Inadome
- Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiroshi Yokomizo
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
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Nakashima T, Kawazoe Y, Iseri T, Miyamoto K, Fujimoto Y, Kato S. The effect of positive-end-expiratory pressure on stroke volume variation: An experimental study in dogs. Clin Exp Pharmacol Physiol 2020; 47:1014-1019. [PMID: 31984534 DOI: 10.1111/1440-1681.13262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 01/10/2023]
Abstract
Stroke volume variation (SVV) may be affected by ventilation settings. However, it is unclear whether positive-end-expiratory pressure (PEEP) affects SVV independently of the effect of driving pressure. We aimed to investigate the effect of driving pressure and PEEP on SVV under various preload conditions using beagle dogs as the animal model. We prepared three preload model, baseline, mild and moderate haemorrhage model. Mild and moderate haemorrhage models were created in nine anaesthetized, mechanically ventilated dogs by sequentially removing 10 mL/kg, and then an additional 10 mL/kg of blood, respectively. We measured cardiac output, stroke volume (SV), SVV, heart rate, central venous pressure, pulmonary capillary wedge pressure and the mean arterial pressure under varying ventilation settings. Peak inspiratory pressure (PIP) was incrementally increased by 4 cmH2 O, from 9 cmH2 O to 21 cmH2 O, under PEEP values of 4, 8, and 12 cmH2 O. The driving pressure did not significantly decrease SV under each preload condition and PEEP; however, significantly increased SVV. In contrast, the increased PEEP decreased SV and increased SVV under each preload condition and driving pressure, but these associations were not statistically significant. According to multiple regression analysis, an increase in PEEP and decrease in preload significantly decreased SV (P < .05). In addition, an increase in the driving pressure and decrease in preload significantly increased SVV (P < .05). Driving pressure had more influence than PEEP on SVV.
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Affiliation(s)
- Tsuyoshi Nakashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
| | - Yu Kawazoe
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshie Iseri
- Department of Veterinary Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi City, Japan
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
| | - Yuka Fujimoto
- Veterinary Science, Osaka Prefecture University, Izumisano City, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
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Marklin GF, Klinkenberg WD, Helmers B, Ahrens T. A stroke volume-based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain-dead donors. Clin Transplant 2020; 34:e13784. [PMID: 31957104 DOI: 10.1111/ctr.13784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/13/2020] [Indexed: 11/29/2022]
Abstract
Brain-dead donors are frequently hypovolemic and hypotensive requiring vasopressor support. We studied a stroke volume-based fluid resuscitation and vasopressor weaning protocol prospectively on 64 hypotensive donors, with a recent control cohort of 30 hypotensive donors treated without a protocol. Stroke volume was measured every 30 minutes for 4 hours by pulse contour analysis or esophageal Doppler. A 500 mL saline fluid bolus was infused over 30 minutes and repeated if the stroke volume increased by 10%. No fluid was infused if the stroke volume did not increase by 10%. Vasopressors were weaned every 10 minutes if the mean arterial pressure was greater than 65 mm Hg. The protocol group received 1937 ± 906 mL fluid compared to 1323 ± 919 mL in the control group (P = .003). Mean time on vasopressors was decreased from 957.6 ± 586.2 to 176.3 ± 82.2 minutes (P<.001). Donors in the protocol group were more likely to donate four or more organs than donors in the control group (OR = 4.114, 95% Confidence Interval (CI) = 1.003-16.876). While more organs were transplanted per donor in the protocol group (3.39 ± 1.52) than in the control group (2.93 ± 1.44) (P = .268), the difference did not reach statistical significance. A goal-directed fluid resuscitation protocol decreased organ ischemia and may increase organs transplanted.
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Lee JH, Kwon YL, Na JH, Jang YE, Kim EH, Kim HS, Kim JT. Is dynamic arterial elastance a predictor of an increase in blood pressure after fluid administration in pediatric patients with hypotension? Reanalysis of prospective observational studies. Paediatr Anaesth 2020; 30:34-42. [PMID: 31730254 DOI: 10.1111/pan.13769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/03/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dynamic arterial elastance (Eadyn ) has been proposed to predict an increase in mean arterial pressure (MAP) after volume expansion in hypotensive adults. We aimed to evaluate the clinical usefulness of Eadyn as a predictor of arterial pressure response after fluid loading in pediatric patients with hypotension. METHODS We re-analyzed data of 63 hypotensive children (age, ≤5 years), collected from three previous prospective observational studies about fluid responsiveness. Pulse pressure variation (PPV), stroke volume variation (SVV), and respiratory variation in aortic blood flow velocity (ΔVpeak) were used to calculate Eadyn (PPV/SVV) and modified Eadyn (PPV/ΔVpeak). Preload-dependent patients were defined as those with ΔVpeak ≥12% before fluid loading. Patients were classified as pressure responders, if their MAP increased ≥15% after fluid administration. RESULTS Mean Eadyn (SD) was 1.06 (0.47) in pressure responders (n=39) and 0.99 (0.48) in nonresponders (n = 24) (mean difference, 0.08; 95% confidence interval [CI], -0.19-0.34; P = .567). Additionally, mean modified Eadyn was 1.27 (0.64) in responders and 1.11 (0.43) in nonresponders (mean difference, 0.17; 95% CI, -0.13-0.46; P = 0.269). Both Eadyn (AUC 0.506; 95% confidence interval [CI], 0.337 to 0.675; P = 0.948) and modified Eadyn (AUC 0.498; 95% CI, 0.328-0.669; P = 0.983), as well as other dynamic variables, could not predict pressure responsiveness in children. Sub-group analysis revealed similar findings in both in 39 preload-dependent and hypotensive patients (26 pressure responders and 13 nonpressure responders). CONCLUSION Both Eadyn and modified Eadyn cannot predict whether blood pressure increases with fluid administration in pediatric patients with hypotension.
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Affiliation(s)
- Ji-Hyun Lee
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yea-La Kwon
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hwan Na
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Eun Jang
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Hee Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Moon EJ, Lee S, Yi JW, Kim JH, Lee BJ, Seo H. Stroke Volume Variation and Stroke Volume Index Can Predict Fluid Responsiveness after Mini-Volume Challenge Test in Patients Undergoing Laparoscopic Cholecystectomy. MEDICINA-LITHUANIA 2019; 56:medicina56010003. [PMID: 31861707 PMCID: PMC7022270 DOI: 10.3390/medicina56010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 12/15/2022]
Abstract
Background and Objectives: For using appropriate goal-directed fluid therapy during the surgical conditions of pneumoperitoneum in the reverse Trendelenburg position, we investigated the predictability of various hemodynamic parameters for fluid responsiveness by using a mini-volume challenge test. Materials and Methods: 42 adult patients scheduled for laparoscopic cholecystectomy were enrolled. After general anesthesia was induced, CO2 pneumoperitoneum was applied and the patient was placed in the reverse Trendelenburg position. The mini-volume challenge test was carried out with crystalloid 4 mL/kg over 10 min. Hemodynamic parameters, including stroke volume variation (SVV), cardiac index (CI), stroke volume index (SVI), mean arterial pressure (MAP), and heart rate (HR), were measured before and after the mini-volume challenge test. The positive fluid responsiveness was defined as an increase in stroke volume index ≥10% after the mini-volume challenge. For statistical analysis, a Shapiro-Wilk test was used to test the normality of the data. Continuous variables were compared using an unpaired t-test or the Mann-Whitney rank-sum test. Categorical data were compared using the chi-square test. A receiver operating characteristic curve analysis was used to assess the predictability of fluid responsiveness after the mini-volume challenge. Results: 31 patients were fluid responders. Compared with the MAP and HR, the SVV, CI, and SVI showed good predictability for fluid responsiveness after the mini-volume challenge test (area under the curve was 0.900, 0.833, and 0.909, respectively; all p-values were <0.0001). Conclusions: SVV and SVI effectively predicted fluid responsiveness after the mini-volume challenge test in patients placed under pneumoperitoneum and in the reverse Trendelenburg position.
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Affiliation(s)
- Eun-Jin Moon
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, Korea; (E.-J.M.); (J.-W.Y.); (J.H.K.); (B.-J.L.)
| | - Seunghwan Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, Korea;
| | - Jae-Woo Yi
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, Korea; (E.-J.M.); (J.-W.Y.); (J.H.K.); (B.-J.L.)
| | - Ju Hyun Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, Korea; (E.-J.M.); (J.-W.Y.); (J.H.K.); (B.-J.L.)
| | - Bong-Jae Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, Korea; (E.-J.M.); (J.-W.Y.); (J.H.K.); (B.-J.L.)
| | - Hyungseok Seo
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, Korea; (E.-J.M.); (J.-W.Y.); (J.H.K.); (B.-J.L.)
- Correspondence: ; Tel.: +82-2-440-7809; Fax: +82-2-440-7808
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Pena-Hernandez C, Nugent K. One approach to circulation and blood flow in the critical care unit. World J Crit Care Med 2019; 8:36-48. [PMID: 31667132 PMCID: PMC6817932 DOI: 10.5492/wjccm.v8.i4.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/24/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023] Open
Abstract
Evaluating and managing circulatory failure is one of the most challenging tasks for medical practitioners involved in critical care medicine. Understanding the applicability of some of the basic but, at the same time, complex physiological processes occurring during a state of illness is sometimes neglected and/or presented to the practitioners as point-of-care protocols to follow. Furthermore, managing hemodynamic shock has shown us that the human body is designed to fight to sustain life and that the compensatory mechanisms within organ systems are extraordinary. In this review article, we have created a minimalistic guide to the clinical information relevant when assessing critically ill patients with failing circulation. Measures such as organ blood flow, circulating volume, and hemodynamic biomarkers of shock are described. In addition, we will describe historical scientific events that led to some of our current medical practices and its validation for clinical decision making, and we present clinical advice for patient care and medical training.
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Affiliation(s)
- Camilo Pena-Hernandez
- Department of Internal Medicine, Division of Nephrology and Hypertension, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
| | - Kenneth Nugent
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
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Ali A, Dorman Y, Abdullah T, Yasa C, Orhan-Sungur M, Akinci IO, Ergin-Ozcan P. Ability of mini-fluid challenge to predict fluid responsiveness in obese patients undergoing surgery in the prone position. Minerva Anestesiol 2019; 85:981-988. [PMID: 30994311 DOI: 10.23736/s0375-9393.19.13276-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Pulse pressure variation (PPV) and stroke volume variation (SVV) can predict fluid responsiveness effectively. However, high Body Mass Index (BMI) can restrict their use due to changes in respiratory system compliance (CS), intra-abdominal pressure, and stroke volume (SV) in the prone position. Therefore, we aimed to investigate the effectiveness of mini-fluid challenge (MFC) in predicting fluid responsiveness in obese (BMI ≥30 kg/m2) patients in the prone position. METHODS A total of 33 patients undergoing neurosurgery were included. After standardized anesthesia induction, patients' PPV, SVV, stroke volume index (SVI) and CS values were recorded in the prone position (T1), after the infusion of 100 mL of crystalloid named as MFC (T2) and after fluid loading was completed with additional 400 mL of crystalloid. Patients whose SVI increased more than 15% after the fluid loading were defined as volume responders. RESULTS Fifteen (45%) patients were responders to 500 mL fluid loading. After the 100 mL fluid load, a higher percentage increase in SVI was observed among responders (P<0.001), with values of 6.6% (6.2-8.6%) and 3.5% (1.7-4.8%) in responders and non-responders, respectively. Areas under the receiver operating characteristic curves of MFC, PPV, and SVV were 0.967 (95% CI: 0.838-0.999), 0.683 (95% CI: 0.499-0.834), and 0.709 (95% CI: 0.526-0.853), respectively. The area under the curve of MFC was significantly higher than that of PPV (P=0.003) and SVV (P=0.005). CONCLUSIONS The increase in SVI after a rapid infusion of 100 mL crystalloid could predict fluid responsiveness in patients with BMI ≥30 kg/m2 in the prone position.
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Affiliation(s)
- Achmet Ali
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yeser Dorman
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Taner Abdullah
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey -
| | - Ceren Yasa
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mukadder Orhan-Sungur
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ibrahim O Akinci
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Perihan Ergin-Ozcan
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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26
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Chin JH, Lee EH, Hwang GS, Hwang JH, Choi WJ. Prediction of Fluid Responsiveness Using Dynamic Preload Indices in Patients Undergoing Robot-Assisted Surgery with Pneumoperitoneum in the Trendelenburg Position. Anaesth Intensive Care 2019; 41:515-22. [DOI: 10.1177/0310057x1304100413] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- J. H. Chin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - E. H. Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G. S. Hwang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J. H. Hwang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - W. J. Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Wang Y, Jiang Y, Wu H, Wang R, Wang Y, Du C. Assessment of fluid responsiveness by inferior vena cava diameter variation in post-pneumonectomy patients. Echocardiography 2018; 35:1922-1925. [PMID: 30338549 PMCID: PMC6587495 DOI: 10.1111/echo.14172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/16/2018] [Accepted: 09/20/2018] [Indexed: 11/30/2022] Open
Abstract
AIM First, the inferior vena cava dilatation index (DIVC) was measured by ultrasound, and then the reliability of DIVC as an indicator to predict volume responsiveness in patients undergoing mechanical ventilation after pneumonectomy was evaluated. METHODS Pulse indicator continuous cardiac output (Picco) as gold standard was performed to sedated mechanically ventilated post-pneumonectomy patients in intensive care unit of Nanjing Thoracic Hospital from August 2014 to December 2016. Meanwhile, ultrasound measurement to inferior vena cava (IVC) diameter at the end inspiration (Dmax ) and the end of expiration (Dmin ) was performed. DIVC = (Dmax - Dmin )/Dmin . Above values were recorded at baseline and then after fluid resuscitation challenge (7 mL/kg hydroxyethyl starch). An increase in cardiac index of more than 15% was used as the standard for fluid responsiveness. Patients were divided into responsive group and non-responsive group. A receiver operating characteristic (ROC) curve was then used to determine the sensitivity and specificity of DIVC in predicting fluid responsiveness after pneumonectomy. RESULTS Eighteen patients were enrolled. 10 patients were divided into responsive group and eight in non-responsive group. DIVC in responsive group was significantly higher than in non-responsive group (P < 0.01). By setting DIVC ≥ 15% as a measure of fluid responsiveness, sensitivity was 81.8% and specificity was 85.7%. CONCLUSION DIVC is a reliable indicator of capacity responsiveness in mechanically ventilated post-pneumonectomy patients.
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Affiliation(s)
- Yan Wang
- Intensive Care Unit, Nanjing Chest Hospital, Nanjing, China
| | - Yinghou Jiang
- Intensive Care Unit, Nanjing Chest Hospital, Nanjing, China
| | - Hongning Wu
- Ultrasonic Department, Nanjing Chest Hospital, Nanjing, China
| | - Runfeng Wang
- Intensive Care Unit, Nanjing Chest Hospital, Nanjing, China
| | - Ying Wang
- Intensive Care Unit, Nanjing Chest Hospital, Nanjing, China
| | - Cheng Du
- Intensive Care Unit, Nanjing Chest Hospital, Nanjing, China
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Messina A, Pelaia C, Bruni A, Garofalo E, Bonicolini E, Longhini F, Dellara E, Saderi L, Romagnoli S, Sotgiu G, Cecconi M, Navalesi P. Fluid Challenge During Anesthesia. Anesth Analg 2018; 127:1353-1364. [DOI: 10.1213/ane.0000000000003834] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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29
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Predicting fluid responsiveness: A review of literature and a guide for the clinician. Am J Emerg Med 2018; 36:2093-2102. [DOI: 10.1016/j.ajem.2018.08.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/27/2018] [Accepted: 08/13/2018] [Indexed: 01/04/2023] Open
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Sasaki K, Mutoh T, Yamamoto S, Taki Y, Kawashima R. Comparison of Noninvasive Dynamic Indices of Fluid Responsiveness Among Different Ventilation Modes in Dogs Recovering from Experimental Cardiac Surgery. Med Sci Monit 2018; 24:7736-7741. [PMID: 30372425 PMCID: PMC6216474 DOI: 10.12659/msm.910135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Fluid resuscitation is a cornerstone of minimizing morbidity and mortality in critically ill patients, but the techniques for predicting fluid responsiveness is still a matter of debate. In this study, we aimed to evaluate the utility of noninvasive stroke volume variation (SVV), pulse pressure variation (PPV), and systolic pressure variation (SPV) as a dynamic predictor for assessing fluid responsiveness during different ventilation modes in anaesthetized, intubated dogs recovering from cardiac surgery. Material/Methods Thirty-six adult Beagle dogs undergoing experimental surgery for isolated right ventricular failure were monitored for SVV, PPV, and SPV simultaneously using electrical velocimetry device. The relationships between each indicator and SVI before and after volume loading were compared in 3 ventilatory modes: assist control (A/C), synchronized intermittent mandatory ventilation (SIMV), and continuous positive airway pressure (CPAP). Responders were defined as those whose stroke volume index increased by ≥10%. Results In all of the indices, the baseline values were greater in responders than in nonresponders (P<0.01) under A/C and SIMV. Receiver operating curve analysis confirmed the best predictive value during A/C [area under the curve (AUC): SVV, 0.90; PPV, 0.88; SPV, 0.85; P<0.05] followed by SIMV (AUC: SVV, 0.86; PPV, 0.83; CPAP, 0.80; P<0.05), with their sensitivities and specificities of ≥7 5%. By contrast, no statistically significance detected in any parameter during CPAP (AUC: SVV, 0.71; PPV, 0.66; CPAP, 0.65; P>0.05). Conclusions SVV, PPV, and SVV are all useful to predict cardiac response to fluid loading in dogs during A/C and SIMV, while their reliabilities during CPAP are poor.
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Affiliation(s)
- Kazumasu Sasaki
- Small Animal Emergency and Critical Care Service, Sendai Animal Care and Research Center (SACRC), Sendai, Miyagi, Japan.,Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Tatsushi Mutoh
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Shuzo Yamamoto
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Yasuyuki Taki
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Ryuta Kawashima
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
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Ali A, Abdullah T, Sabanci PA, Dogan L, Orhan-Sungur M, Akinci IO. Comparison of ability of pulse pressure variation to predict fluid responsiveness in prone and supine position: an observational study. J Clin Monit Comput 2018; 33:573-580. [DOI: 10.1007/s10877-018-0195-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/09/2018] [Indexed: 01/10/2023]
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32
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Aref A, Zayan T, Sharma A, Halawa A. Utility of central venous pressure measurement in renal transplantation: Is it evidence based? World J Transplant 2018; 8:61-67. [PMID: 29988941 PMCID: PMC6033741 DOI: 10.5500/wjt.v8.i3.61] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/05/2018] [Accepted: 04/01/2018] [Indexed: 02/05/2023] Open
Abstract
Adequate intravenous fluid therapy is essential in renal transplant recipients to ensure a good allograft perfusion. Central venous pressure (CVP) has been considered the cornerstone to guide the fluid therapy for decades; it was the only available simple tool worldwide. However, the revolutionary advances in assessing the dynamic preload variables together with the availability of new equipment to precisely measure the effect of intravenous fluids on the cardiac output had created a question mark on the future role of CVP. Despite the critical role of fluid therapy in the field of transplantation. There are only a few clinical studies that compared the CVP guided fluid therapy with the other modern techniques and their relation to the outcome in renal transplantation. Our work sheds some light on the available published data in renal transplantation, together with data from other disciplines evaluating the utility of central venous pressure measurement. Although lager well-designed studies are still required to consolidate the role of new techniques in the field of renal transplantation, we can confidently declare that the new techniques have the advantages of providing more accurate haemodynamic assessment, which results in a better patient outcome.
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Affiliation(s)
- Ahmed Aref
- Department of Nephrology, Sur hospital, Sur 411, Sultanate of Oman
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3GB, United Kingdom
| | - Tariq Zayan
- Department of Nephrology, Sur hospital, Sur 411, Sultanate of Oman
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3GB, United Kingdom
| | - Ajay Sharma
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3GB, United Kingdom
- Department of Transplantation Surgery, Royal Liverpool University Hospital, Liverpool L7 8XP, United Kingdom
| | - Ahmed Halawa
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3GB, United Kingdom
- Department of Transplantation Surgery, Sheffield Teaching Hospitals, Sheffield S5 7AU, United Kingdom
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Yamada T, Vacas S, Gricourt Y, Cannesson M. Improving Perioperative Outcomes Through Minimally Invasive and Non-invasive Hemodynamic Monitoring Techniques. Front Med (Lausanne) 2018; 5:144. [PMID: 29868596 PMCID: PMC5966660 DOI: 10.3389/fmed.2018.00144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/25/2018] [Indexed: 01/10/2023] Open
Abstract
An increasing number of patients require precise intraoperative hemodynamic monitoring due to aging and comorbidities. To prevent undesirable outcomes from intraoperative hypotension or hypoperfusion, appropriate threshold settings are required. These setting can vary widely from patient to patient. Goal-directed therapy techniques allow for flow monitoring as the standard for perioperative fluid management. Based on the concept of personalized medicine, individual assessment and treatment are more advantageous than conventional or uniform interventions. The recent development of minimally and noninvasive monitoring devices make it possible to apply detailed control, tracking, and observation of broad patient populations, all while reducing adverse complications. In this manuscript, we review the monitoring features of each device, together with possible advantages and disadvantages of their use in optimizing patient hemodynamic management.
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Affiliation(s)
- Takashige Yamada
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Susana Vacas
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yann Gricourt
- Departement Anesthesie Réanimation Douleur Urgence, Centre Hospitalaire Universitaire Caremeau, Nimes, France
| | - Maxime Cannesson
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Pybus DA. Real-time, spectral analysis of the arterial pressure waveform using a wirelessly-connected, tablet computer: a pilot study. J Clin Monit Comput 2018; 33:53-63. [PMID: 29705865 PMCID: PMC6314984 DOI: 10.1007/s10877-018-0145-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/23/2018] [Indexed: 11/26/2022]
Abstract
Spectral analysis of the arterial pressure waveform, using specialized hardware, has been used for the retrospective calculation of the 'Spectral Peak Ratio' (SPeR) of the respiratory and cardiac arterial spectral peaks. The metric can quantify the cardiovascular response to volume loading by analysing the effect of changing tidal volume (indexed to body weight) (VTI) on pulse pressure variability. In this pilot study, the feasibility of real-time SPeR calculation, using a mobile computer which was wirelessly connected to the patient monitor, was evaluated by examining the determinants of SPeR in 60 cardiac-surgical patients. In 30 patients undergoing aortic valve replacement (AVR), graded cyclical changes in ventricular loading were induced by increasing VTI over 2 min, while performing spectral analysis at 1 Hz, before and after AVR. A strong, linear correlation between SPeR and VTI was found and the slope of the regression line (β) changed significantly after AVR. The change in β correlated with the width of the preoperative vena contracta. In another 30 patients, SPeR at constant VTI was calculated at 1 Hz during passive leg raising. β fell significantly on leg raising. The mean arterial pressure change during the manoeuvre was linearly related to the change in β. Real-time spectral analysis of the arterial waveform was easily accomplished. The regression of SPeR on VTI was linear. β appeared to represent the slope of the cardiac response curve at the venous return curve equilibrium point. Measurements were possible at a significantly lower VTI than the equivalent time domain metrics.
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Affiliation(s)
- David Andrew Pybus
- St. George Private Hospital, 1 South St., Kogarah, NSW, 2217, Australia.
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35
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Hofer CK, Geisen M, Hartnack S, Dzemali O, Ganter MT, Zollinger A. Reliability of Passive Leg Raising, Stroke Volume Variation and Pulse Pressure Variation to Predict Fluid Responsiveness During Weaning From Mechanical Ventilation After Cardiac Surgery: A Prospective, Observational Study. Turk J Anaesthesiol Reanim 2018; 46:108-115. [PMID: 29744245 DOI: 10.5152/tjar.2018.29577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/06/2018] [Indexed: 11/22/2022] Open
Abstract
Objective During assisted ventilation and spontaneous breathing, functional haemodynamic parameters, including stroke volume variation (SVV) and pulse pressure variation (PPV), are of limited value to predict fluid responsiveness, and the passive leg raising (PLR) manoeuvre has been advocated as a surrogate method. We aimed to study the predictive value of SVV, PPV and PLR for fluid responsiveness during weaning from mechanical ventilation after cardiac surgery. Methods Haemodynamic variables and fluid responsiveness were assessed in 34 patients. Upon arrival at the intensive care unit, measurements were performed during continuous mandatory ventilation (CMV) and spontaneous breathing with pressure support (PSV) and after extubation (SPONT). The prediction of a positive fluid responsiveness (defined as stroke volume increase >15% after fluid administration) was tested by calculating the specific receiver operating characteristic (ROC) curves. Results A significant increase in stroke volumes was observed during CMV, PSV and SPONT after fluid administration. There were 19 fluid responders (55.9%) during CMV, with 22 (64.7%) and 13 (40.6%) during PSV and SPONT, respectively. The predictive value for a positive fluid responsiveness (area under the ROC curve) for SVV was 0.88, 0.70 and 0.56; was 0.83, 0.69 and 0.48 for PPV; was 0.72, 0.74 and 0.70 for PLR during CMV, PSV and SPONT, respectively. Conclusion During mechanical ventilation, adequate prediction of fluid responsiveness using SVV and PPV was observed. However, during spontaneous breathing, the reliability of SVV and PPV was poor. In this period, PLR as a surrogate was able to predict fluid responsiveness better than SVV or PPV but was less reliable than previously reported.
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Affiliation(s)
- Christoph Karl Hofer
- Institute of Anaesthesiology and Intensive Care Medicine, Triemli Hospital Zurich, Switzerland
| | - Martin Geisen
- Institute of Anaesthesiology and Intensive Care Medicine, Triemli Hospital Zurich, Switzerland
| | - Sonja Hartnack
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Omer Dzemali
- Division of Cardiac Surgery, Triemli City Hospital Zurich, Switzerland
| | | | - Andreas Zollinger
- Institute of Anaesthesiology and Intensive Care Medicine, Triemli Hospital Zurich, Switzerland
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Sahutoglu C, Turksal E, Kocabas S, Askar FZ. Influence of stroke volume variation on fluid treatment and postoperative complications in thoracic surgery. Ther Clin Risk Manag 2018; 14:575-581. [PMID: 29593416 PMCID: PMC5865562 DOI: 10.2147/tcrm.s154093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Fluid management in critically ill patients usually relies on increasing preload to augment cardiac output. In the present study, we aimed to evaluate whether stroke volume variation (SVV) can guide fluid therapy and reduce complications. Patients and methods In this retrospective study, a total of 88 patients who underwent lobectomy were divided into two groups: group 1 (SVV, n=43) and group 2 (conventional or central venous pressure [CVP], n=45). Heart rate, blood pressure, oxygen saturation, SVV (only group 1), CVP (all patients), urea, creatinine, and hemoglobin levels before and after surgery, use of fluid, blood and inotropic agents, and postoperative complications were recorded retrospectively. Results The mean age of the study population was 56.9±14.4 years and 75% of the patients were male. SVV was used in fluid therapy in 48.9% of the patients. The use of SVV resulted in an increased use of crystalloids and colloids with increased urine output per hour (p<0.05). Of patients in the SVV group and the CVP group, 44.1% and 51.1% developed at least one complication, respectively (p=0.531). The rate of respiratory complications including atelectasis, pneumonia, hypoxemia, and an increased production of secretions was 21% in the SVV group and 37.7% in the CVP group (p=0.104). The rate of complications and the length of hospital stay were comparable between the groups (p>0.05). Conclusion Our study results showed that the use of SVV increased the use of crystalloids and colloids and favorably affected urine output per hour but did not reduce complications in thoracic surgery.
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Affiliation(s)
- Cengiz Sahutoglu
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Erbil Turksal
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Seden Kocabas
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Fatma Zekiye Askar
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
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Lentini P, Zanoli L, Fatuzzo P, Husain-Syed F, Stramanà R, Cognolato D, Catena V, Baiocchi M, Granata A, Dell'Aquila R. Stroke volume variation and serum creatinine changes during abdominal aortic aneurysm surgery: a time-integrated analysis. J Nephrol 2018; 31:561-569. [PMID: 29344813 DOI: 10.1007/s40620-018-0467-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/28/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients undergoing abdominal aortic aneurysm (AAA) surgery with suprarenal clamping are at high risk for acute kidney injury (AKI) and major cardiac and cerebrovascular events (MACCE). We aimed to assess whether the stroke volume variation (SVV), a measure of hemodynamic instability, is associated with AKI in hypertensive patients undergoing elective AAA surgery with suprarenal clamping. METHODS In a cohort of 51 hypertensive patients, we performed serial measurements of SVV (n = 459) and serum creatinine (sCr) (n = 255). AKI was defined according to the KDIGO clinical practice guidelines. Data were analyzed by repeated-measures ANOVA and regression analysis of time-integrated changes of both SVV and sCr. RESULTS AKI developed in 45% of patients (stage 1: 31%; stage 2: 10%; stage 3: 2%). The diuresis during surgery (beta - 0.29 Z-score 95% [CI - 0.54, - 0.05]; p = 0.02), clamp time (beta 0.29 Z-score [0.05-0.52]; p = 0.02), and time-integrated changes in SVV from baseline to 12 h after surgery (beta 0.31 Z-score [0.03-0.60]; p = 0.03) were independent predictors of the time-integrated changes in sCr from baseline to 48 h after the end of surgery. In a model adjusted for age and sex, patients with AKI had an increased risk for MACCE during a mean follow-up of 3.5 ± 1.1 years (HR 5.53 [1.52-20.06]; p = 0.004). CONCLUSIONS SVV increases progressively during and after AAA surgery in subjects who will develop AKI. The increase of SVV precedes and predicts the rise in sCr and is a good discriminator of the development of AKI. AKI is associated with an increased long-term risk for MACCE.
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Affiliation(s)
- Paolo Lentini
- Nephrology and Dialysis, "St. Bassiano" Hospital, Bassano del Grappa, Italy.
| | - Luca Zanoli
- Internal Medicine, School of Nephrology, University of Catania, Catania, Italy
| | - Pasquale Fatuzzo
- Internal Medicine, School of Nephrology, University of Catania, Catania, Italy
| | - Faeq Husain-Syed
- Pneumology and Intensive Care Medicine, University Hospital Giessen and Marburg, Giessen, Germany
| | - Rudi Stramanà
- Vascular Surgery, "St. Bassiano" Hospital, Bassano del Grappa, Italy
| | - Diego Cognolato
- Vascular Surgery, "St. Bassiano" Hospital, Bassano del Grappa, Italy
| | - Vincenzo Catena
- Intensive Care Medicine, "St. Bassiano" Hospital, Bassano del Grappa, Italy
| | - Marco Baiocchi
- Intensive Care Medicine, "St. Bassiano" Hospital, Bassano del Grappa, Italy
| | - Antonio Granata
- Nephrology and Dialysis, "St. Giovanni di Dio" Hospital, Agrigento, Italy
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Zlicar M, Novak-Jankovic V, Blagus R, Cecconi M. Predictive values of pulse pressure variation and stroke volume variation for fluid responsiveness in patients with pneumoperitoneum. J Clin Monit Comput 2017; 32:825-832. [PMID: 29149433 DOI: 10.1007/s10877-017-0081-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
Animal studies suggest that dynamic predictors remain useful in patients with pneumoperitoneum, but human data is conflicting. Our aim was to determine predictive values of pulse pressure variation (PPV) and stroke volume variation (SVV) in patients with pneumoperitoneum using LiDCORapid™ haemodynamic monitor. Standardised fluid challenges of colloid were administered to patients undergoing laparoscopic procedures, one fluid challenge per patient. Intra-abdominal pressure was automatically held at 12 mmHg. Fluid responsiveness was defined as an increase in nominal stroke index (nSI) ≥ 10%. Linear regression was used to assess the ability of PPV and SVV to track the changes of nSI and logistic regression and area under the receiver operating curve (AUROC) to assess the predictive value of PPV and SVV for fluid responsiveness. Threshold values for PPV and SVV were obtained using the "gray zone" approach. A p < 0.05 was considered as statistically significant. 56 patients were included in analysis. 41 patients (73%) responded to fluids. Both PPV and SVV tracked changes in nSI (Spearman correlation coefficients 0.34 for PPV and 0.53 for SVV). Odds ratio for fluid responsiveness for PPV was 1.163 (95% CI 1.01-1.34) and for SVV 1.341 (95% CI 1.10-1.63). PPV achieved an AUROC of 0.674 (95% CI 0.518-0.830) and SVV 0.80 (95% CI 0.668-0.932). The gray zone of PPV ranged between 6.5 and 20.5% and that of SVV between 7.5 and 13%. During pneumoperitoneum, as measured by LiDCORapid™, PPV and SVV can predict fluid responsiveness, however their sensitivity is lower than the one reported in conditions without pneumoperitoneum. Trial registry number: (with the Australian New Zealand Clinical Trials Registry): ACTRN12612000456853.
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Affiliation(s)
- Marko Zlicar
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, Ljubljana, Slovenia.
| | - Vesna Novak-Jankovic
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, Ljubljana, Slovenia
| | - Rok Blagus
- Institute for Biostatistics and Medical Informatics, Medical Faculty, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia
| | - Maurizio Cecconi
- Adult Critical Care, St. George's Healthcare NHS Trust, London, SW170QT, UK
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Endo Y, Kawase K, Miyasho T, Sano T, Yamashita K, Muir WW. Plethysmography variability index for prediction of fluid responsiveness during graded haemorrhage and transfusion in sevoflurane-anaesthetized mechanically ventilated dogs. Vet Anaesth Analg 2017; 44:1303-1312. [PMID: 29113716 DOI: 10.1016/j.vaa.2017.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/29/2017] [Accepted: 07/29/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the accuracy of plethysmography variability index (PVI) as a noninvasive indicator of fluid responsiveness in hypovolaemic dogs. STUDY DESIGN Prospective experimental study. ANIMALS Six adult healthy sevoflurane-anaesthetized Beagle dogs. METHODS Dogs were anaesthetized with 1.3-fold their individual minimum alveolar concentration of sevoflurane. The lungs were mechanically ventilated after neuromuscular blockade with vecuronium bromide. Cardiopulmonary variables including mean arterial blood pressure (MAP), central venous pressure (CVP), transpulmonary thermodilution cardiac output (TPTDCO), stroke volume (SV), perfusion index (PI), pulse pressure variation (PPV), stroke volume variation (SVV) and PVI were determined during six stages of graded venous blood withdrawal (5 mL kg-1 increments) and six stages of graded blood infusion (5 mL kg-1 increments). The cardiopulmonary variables were analysed using paired t test or Wilcoxon signed rank test. Correlations between PPV and SVV or PVI were analysed by linear regression. The accuracy of PPV, SVV and PVI for predicting fluid responsiveness was examined by using receiver operating characteristic curve analysis. A value of p < 0.05 was considered statistically significant. RESULTS Blood withdrawal resulted in significant increases in PPV and PVI and decreases in MAP, CVP, TPTDCO, SV and PI. Blood infusion resulted in significant increases in MAP, CVP, TPTDCO, SV and PI and decreases in PPV and PVI. PPV and PVI showed a relevant correlation (p < 0.001, r2 = 0.62) and threshold values of PPV ≥ 16% (sensitivity 71%, specificity 82%) and PVI ≥ 12% (sensitivity 78%, specificity 72%) for identifying fluid responsiveness. SVV did not change. CONCLUSIONS AND CLINICAL RELEVANCE Noninvasive measurement of PVI predicted fluid responsiveness with moderate accuracy equal to PPV in sevoflurane-anaesthetized mechanically ventilated dogs. Provisional threshold values for identification of fluid responsiveness were PPV ≥ 16% and PVI ≥ 12%. Clinical trials are needed to confirm these threshold values in dogs.
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Affiliation(s)
- Yusuke Endo
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Koudai Kawase
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Taku Miyasho
- Department of Veterinary Nursing Science, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Tadashi Sano
- Department of Veterinary Nursing Science, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Kazuto Yamashita
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan.
| | - William W Muir
- College of Veterinary Medicine, Lincoln Memorial University, Harrogate, TN, USA
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Audimoolam VK, McPhail MJW, Willars C, Bernal W, Wendon JA, Cecconi M, Auzinger G. Predicting Fluid Responsiveness in Acute Liver Failure: A Prospective Study. Anesth Analg 2017; 124:480-486. [PMID: 27984249 DOI: 10.1213/ane.0000000000001585] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The profound hemodynamic changes seen in acute liver failure (ALF) resemble the hyperdynamic state found in the later stages of septic shock. Vasopressor support frequently is required after initial volume therapy. Markers of preload dependency have not been studied in this patient group. Dynamic maneuvers such as passive leg raising or end-expiratory hold, which have shown good predictive accuracy in a general intensive care unit population, cannot be considered safe in this cohort because of the concerns of intracranial hypertension. METHODS Mechanically ventilated patients with ALF admitted to a tertiary specialist intensive care unit in shock and multiorgan failure were enrolled. Markers of fluid responsiveness derived from transpulmonary thermodilution, pulse contour analysis, and echocardiography were compared between responders (cardiac index ≥15%) and nonresponders to a colloid fluid challenge (5 mL/kg predicted body weight). The ability to predict fluid responsiveness of stroke volume variation, pulse pressure variation (PPV), and respiratory change in peak (delta V peak) left ventricular outflow tract velocity for preload dependency were analyzed. RESULTS Thirty-five patients (mean ± SD age, 38 [14] years, 13 male, 22 female]) were assessed after a single fluid challenge. Ten patients (29%) were fluid responders. Changes in cardiac index and stroke volume index in the cohort of 35 patients were correlated (R = 0.726 [99% confidence interval, 0.401-0.910]; P < .001). PPV predicted fluid responsiveness (area under the receiver operating characteristic curve [AUROC], 0.752 [95% confidence interval, 0.565-0.889]; P = .005; cutoff >9%). The AUROC for stroke volume variation was 0.678 ([95% confidence interval, 0.499-0.825]; P = .084; cutoff >11%). The AUROC for [delta] V peak before fluid bolus was 0.637 (95% confidence interval, 0.413-0.825; P = .322). CONCLUSIONS PPV based on pulse contour analysis predicted fluid responsiveness in ALF.
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Affiliation(s)
- Vinod Kumar Audimoolam
- From the *Liver Intensive Care Unit and Institute of Liver Studies and Transplantation, King's College London School of Medicine at King's College Hospital, Denmark Hill, London, UK; †Liver and Anti-viral Centre, St. Mary's Hospital, Imperial College London, Paddington, London, UK; and ‡Anaesthesia and Intensive Care, St. George's Hospital London and St. George's University of London, London, UK
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Endo Y, Tamura J, Ishizuka T, Itami T, Hanazono K, Miyoshi K, Sano T, Yamashita K, Muir WW. Stroke volume variation (SVV) and pulse pressure variation (PPV) as indicators of fluid responsiveness in sevoflurane anesthetized mechanically ventilated euvolemic dogs. J Vet Med Sci 2017; 79:1437-1445. [PMID: 28690287 PMCID: PMC5573834 DOI: 10.1292/jvms.16-0287] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Changes in stroke volume variation (SVV) and pulse pressure variation (PPV) in response to fluid infusion were experimentally evaluated during vecuronium infusion and sevoflurane anesthesia in 5 adult, mechanically ventilated, euvolemic, beagle dogs. Sequential increases in central venous pressure (CVP; 3-7[baseline], 8-12, 13-17, 18-22 and 23-27 mmHg) were produced by infusing lactated Ringer's solution and 6% hydroxyethyl starch solution. Heart rate (beats/min), right atrial pressure (RAP, mmHg), pulmonary arterial pressure (PAP, mmHg), pulmonary capillary wedge pressure (PCWP, mmHg), transpulmonary thermodilution cardiac output (TPTDCO, l/min), stroke volume (SV, ml/beat), arterial blood pressure (ABP, mmHg), extravascular lung water (EVLW, ml), pulmonary vascular permeability index (PVPI, calculated), SVV (%), PPV (%) and systemic vascular resistance (SVR, dynes/sec/cm5) were determined at each predetermined CVP range. Heart rate (P=0.019), RAP (P<0.001), PAP (P<0.001), PCWP (P<0.001), TPTDCO (P=0.009) and SV (P=0.04) increased and SVR (P<0.001), SVV (P<0.001) and PPV (P<0.001) decreased associated with each stepwise increase in CVP. Arterial blood pressure, EVLW, PVPI and the arterial partial pressures of oxygen and carbon dioxide did not change. The changes in SVV and PPV directly reflected the fluid load and the minimum threshold values for detecting fluid responsiveness were SVV ≥11% and PPV ≥7% in dogs.
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Affiliation(s)
- Yusuke Endo
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
| | - Jun Tamura
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
| | - Tomohito Ishizuka
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan
| | - Takaharu Itami
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan
| | - Kiwamu Hanazono
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan
| | - Kenjiro Miyoshi
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
| | - Tadashi Sano
- Department of Veterinary Nursing Science, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
| | - Kazuto Yamashita
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
| | - William W Muir
- College of Veterinary Medicine, Lincoln Memorial University, Harrogate, Tennessee 37752, U.S.A
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Abstract
Intravenous fluid management of trauma patients is fraught with complex decisions that are often complicated by coagulopathy and blood loss. This review discusses the fluid management in trauma patients from the perspective of the developing world. In addition, the article describes an approach to specific circumstances in trauma fluid decision-making and provides recommendations for the resource-limited environment.
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Evaluation of augmented pulse pressure variation using the Valsalva manoeuvre as a predictor of fluid responsiveness under open-chest conditions. Eur J Anaesthesiol 2017; 34:254-261. [DOI: 10.1097/eja.0000000000000613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
PURPOSE OF REVIEW Standard hemodynamic monitoring such as heart rate and systemic blood pressure may only provide a crude estimation of organ perfusion during neonatal intensive care. Pulse oximetry monitoring allows for continuous noninvasive monitoring of hemoglobin oxygenation and thus provides estimation of end-organ oxygenation. This review aims to provide an overview of pulse oximetry and discuss its current and potential clinical use during neonatal intensive care. RECENT FINDINGS Technological advances in continuous assessment of dynamic changes in systemic oxygenation with pulse oximetry during transition to extrauterine life and beyond provide additional details about physiological interactions among the key hemodynamic factors regulating systemic blood flow distribution along with the subtle changes that are frequently transient and undetectable with standard monitoring. SUMMARY Noninvasive real-time continuous systemic oxygen monitoring has the potential to serve as biomarkers for early-organ dysfunction, to predict adverse short-term and long-term outcomes in critically ill neonates, and to optimize outcomes. Further studies are needed to establish values predicting adverse outcomes and to validate targeted interventions to normalize abnormal values to improve outcomes.
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Abstract
PURPOSE OF REVIEW Evidence-based fluid therapy is complicated by blurred boundaries toward other fields of therapy and the majority of trials not focusing on patient-relevant outcomes. Additionally, recent trials unsettled the faith in traditional concepts on fluid therapy. The article reviews the evidence on diagnosis and treatment of hypovolemia and discusses the use of balanced solutions and early goal-directed therapy (EGDT) in septic shock resuscitation. RECENT FINDINGS Hypovolemia should be diagnosed and its treatment guided by a multifaceted approach, including medical history, physical examination, volume responsiveness, and technical parameters - dynamic indicators, volumetric indicators, sonography, and metabolic indicators. Central venous pressure and pulmonary artery occlusion pressure should be avoided. In ICU patients, balanced crystalloids should primarily be used, because unbalanced infusions (especially saline) cause hyperchloremic acidosis which is associated with renal impairment and infections. Colloids are beneficial to restore blood volume rapidly. Hydroxyethyl starch may be harmful although the validity of the respective recent studies is limited by methodological flaws. Early aggressive fluid therapy is still beneficial in septic shock resuscitation, despite recent trials challenging the EGDT concept. Today, 10 years after Rivers, 'usual care' includes aggressive fluid resuscitation that is as effective as formal EGDT. SUMMARY Evidence-based fluid therapy includes a multifaceted diagnostic approach, the primary use of balanced crystalloids and early aggressive (septic) shock resuscitation.
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Diagnosis Accuracy of Mean Arterial Pressure Variation during a Lung Recruitment Maneuver to Predict Fluid Responsiveness in Thoracic Surgery with One-Lung Ventilation. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3623710. [PMID: 27819002 PMCID: PMC5081435 DOI: 10.1155/2016/3623710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/22/2016] [Indexed: 12/02/2022]
Abstract
Background. Lung recruitment maneuver (LRM) during thoracic surgery can reduce systemic venous return and resulting drop in systemic blood pressure depends on the patient's fluid status. We hypothesized that changes in systemic blood pressure during the transition in LRM from one-lung ventilation (OLV) to two-lung ventilation (TLV) may provide an index to predict fluid responsiveness. Methods. Hemodynamic parameters were measured before LRM (T0); after LRM at the time of the lowest mean arterial blood pressure (MAP) (T1) and at 3 minutes (T2); before fluid administration (T3); and 5 minutes after ending it (T4). If the stroke volume index increased by >25% following 10 mL/kg colloid administration for 30 minutes, then the patients were assigned to responder group. Results. Changes in MAP, central venous pressure (CVP), and stroke volume variation (SVV) between T0 and T1 were significantly larger in responders. Areas under the curve for change in MAP, CVP, and SVV were 0.852, 0.759, and 0.820, respectively; the optimal threshold values for distinguishment of responders were 9.5 mmHg, 0.5 mmHg, and 3.5%, respectively. Conclusions. The change in the MAP associated with LRM at the OLV to TLV conversion appears to be a useful indicator of fluid responsiveness after thoracic surgery. Trial Registration. This trial is registered at Clinical Research Information Service with KCT0000774.
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Murias G, Montanyà J, Chacón E, Estruga A, Subirà C, Fernández R, Sales B, de Haro C, López-Aguilar J, Lucangelo U, Villar J, Kacmarek RM, Blanch L. Automatic detection of ventilatory modes during invasive mechanical ventilation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:258. [PMID: 27522580 PMCID: PMC4983761 DOI: 10.1186/s13054-016-1436-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/22/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Expert systems can help alleviate problems related to the shortage of human resources in critical care, offering expert advice in complex situations. Expert systems use contextual information to provide advice to staff. In mechanical ventilation, it is crucial for an expert system to be able to determine the ventilatory mode in use. Different manufacturers have assigned different names to similar or even identical ventilatory modes so an expert system should be able to detect the ventilatory mode. The aim of this study is to evaluate the accuracy of an algorithm to detect the ventilatory mode in use. METHODS We compared the results of a two-step algorithm designed to identify seven ventilatory modes. The algorithm was built into a software platform (BetterCare® system, Better Care SL; Barcelona, Spain) that acquires ventilatory signals through the data port of mechanical ventilators. The sample analyzed compared data from consecutive adult patients who underwent >24 h of mechanical ventilation in intensive care units (ICUs) at two hospitals. We used Cohen's kappa statistics to analyze the agreement between the results obtained with the algorithm and those recorded by ICU staff. RESULTS We analyzed 486 records from 73 patients. The algorithm correctly labeled the ventilatory mode in 433 (89 %). We found an unweighted Cohen's kappa index of 84.5 % [CI (95 %) = (80.5 %: 88.4 %)]. CONCLUSIONS The computerized algorithm can reliably identify ventilatory mode.
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Affiliation(s)
- Gastón Murias
- Clínica Bazterrica y Clínica Santa Isabel, Departamento de Ciencias Fisiológicas, Farmacológicas y Bioquímicas, Facultad de Medicina, Universidad Favaloro, Buenos Aires, Argentina
| | - Jaume Montanyà
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, c. ParcTaulí 1, 08208, Sabadell, Spain
| | - Encarna Chacón
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, c. ParcTaulí 1, 08208, Sabadell, Spain
| | - Anna Estruga
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, c. ParcTaulí 1, 08208, Sabadell, Spain
| | - Carles Subirà
- Servei de Medicina Intensiva, Hospital Sant Joan de Deu-Fundació Althaia, Universitat Internacional de Catalunya, Manresa, Spain
| | - Rafael Fernández
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Servei de Medicina Intensiva, Hospital Sant Joan de Deu-Fundació Althaia, Universitat Internacional de Catalunya, Manresa, Spain
| | | | - Candelaria de Haro
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, c. ParcTaulí 1, 08208, Sabadell, Spain
| | - Josefina López-Aguilar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, c. ParcTaulí 1, 08208, Sabadell, Spain
| | - Umberto Lucangelo
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University, Trieste, Italy
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Robert M Kacmarek
- Department of Respiratory Care, Massachusetts General Hospital and Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Lluís Blanch
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. .,Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, c. ParcTaulí 1, 08208, Sabadell, Spain.
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Theerawit P, Morasert T, Sutherasan Y. Inferior vena cava diameter variation compared with pulse pressure variation as predictors of fluid responsiveness in patients with sepsis. J Crit Care 2016; 36:246-251. [PMID: 27591389 DOI: 10.1016/j.jcrc.2016.07.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/23/2016] [Accepted: 07/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Currently, physicians employ pulse pressure variation (PPV) as a gold standard for predicting fluid responsiveness. However, employing ultrasonography in intensive care units is increasing, including using the ultrasonography for assessment of fluid responsiveness. Data comparing the performance of both methods are still lacking. This is the reason for the present study. MATERIALS AND METHODS We conducted a prospective observational study in patients with sepsis requiring fluid challenge. The PPV, inferior vena cava diameter variation (IVDV), stroke volume variation (SVV), and the other hemodynamic variables were recorded before and after fluid challenges. Fluid responders were identified when cardiac output increased more than 15% after fluid loading. RESULTS A total of 29 patients with sepsis were enrolled in this study. Sixteen (55.2%) were fluid responders. Threshold values to predict fluid responsiveness were 13.8% of PPV (sensitivity 100% and specificity 84.6%), 10.2% of IVDV (sensitivity 75% and specificity 76.9%) and 10.7% of SVV (sensitivity 81.3% and specificity 76.9%). The area under the curves of receiver operating characteristic showed that PPV (0.909, 95% confidence interval [CI], 0.784-1.00) and SVV (0.812, 95% CI, 0.644-0.981) had greater performance than IVDV (0.688, 95% CI, 0.480-0.895) regarding fluid responsiveness assessment. CONCLUSIONS The present study demonstrated better performance of the PPV than the IVDV. A threshold value more than 10% may be used for identifying fluid responders.
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Affiliation(s)
- Pongdhep Theerawit
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 270, Rama 6 Road, Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand.
| | - Thotsaporn Morasert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 270, Rama 6 Road, Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand.
| | - Yuda Sutherasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 270, Rama 6 Road, Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand.
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Sawa T, Kinoshita M, Kainuma A, Akiyama K, Naito Y, Kato H, Amaya F, Shigemi K. Effective evaluation of arterial pulse waveform analysis by two-dimensional stroke volume variation-stroke volume index plots. J Clin Monit Comput 2016; 31:927-941. [PMID: 27492429 DOI: 10.1007/s10877-016-9916-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Abstract
Arterial pulse waveform analysis (APWA) with a semi-invasive cardiac output monitoring device is popular in perioperative hemodynamic and fluid management. However, in APWA, evaluation of hemodynamic data is not well discussed. In this study, we analyzed how we visually interpret hemodynamic data, including stroke volume variation (SVV) and stroke volume (SV) derived from APWA. We performed arithmetic estimation of the SVV-SV relationship and applied measured values to this estimation. We then collected measured values in six anesthesia cases, including three liver transplantations and three other types of surgeries, to apply them to this SVV-SVI (stroke volume variation index) plot. Arithmetic analysis showed that the relationship between SVV and SV can be drawn as hyperbolic curves. Plotting SVV-SV values in the semi-logarithmic scale showed linear correlations, and the slopes of the linear regression lines theoretically represented average mean cardiac contractility. In clinical measurements in APWA, plotting SVV and SVI values in the linear scale and the semi-logarithmic scale showed the correlations represented by hyperbolic curves and linear regression lines. The plots approximately shifted on the rectangular hyperbolic curves, depending on blood loss and blood transfusion. Arithmetic estimation is close to real measurement of the SVV-SV interaction in hyperbolic curves. In APWA, using SVV as an index of preload and the cardiac index or SVI derived from arterial pressure-based cardiac output as an index of cardiac function, is likely to be appropriate for categorizing hemodynamic stages as a substitute for Forrester subsets.
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Affiliation(s)
- Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
| | - Mao Kinoshita
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Atsushi Kainuma
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Koichi Akiyama
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Yoshifumi Naito
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Hideya Kato
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Fumimasa Amaya
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Keiji Shigemi
- Department of Anesthesiology and Reanimatology, School of Medicine, University of Fukui, Fukui, 910-1193, Japan
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50
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Hemodynamic monitoring of the injured patient: From central venous pressure to focused echocardiography. J Trauma Acute Care Surg 2016; 80:499-510. [PMID: 26713977 DOI: 10.1097/ta.0000000000000938] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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