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Lipszyc AC, Walker SCD, Beech AP, Wilding H, Akhlaghi H. Predicting Fluid Responsiveness Using Carotid Ultrasound in Mechanically Ventilated Patients: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies. Anesth Analg 2024; 138:1174-1186. [PMID: 38289868 DOI: 10.1213/ane.0000000000006820] [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: 02/01/2024]
Abstract
BACKGROUND A noninvasive and accurate method of determining fluid responsiveness in ventilated patients would help to mitigate unnecessary fluid administration. Although carotid ultrasound has been previously studied for this purpose, several studies have recently been published. We performed an updated systematic review and meta-analysis to evaluate the accuracy of carotid ultrasound as a tool to predict fluid responsiveness in ventilated patients. METHODS Studies eligible for review investigated the accuracy of carotid ultrasound parameters in predicting fluid responsiveness in ventilated patients, using sensitivity and specificity as markers of diagnostic accuracy (International Prospective Register of Systematic Reviews [PROSPERO] CRD42022380284). All included studies had to use an independent method of determining cardiac output and exclude spontaneously ventilated patients. Six bibliographic databases and 2 trial registries were searched. Medline, Embase, Emcare, APA PsycInfo, CINAHL, and the Cochrane Library were searched on November 4, 2022. Clinicaltrials.gov and Australian New Zealand Clinical Trials Registry were searched on February 24, 2023. Results were pooled, meta-analysis was conducted where possible, and hierarchical summary receiver operating characteristic models were used to compare carotid ultrasound parameters. Bias and evidence quality were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines. RESULTS Thirteen prospective clinical studies were included (n = 648 patients), representing 677 deliveries of volume expansion, with 378 episodes of fluid responsiveness (58.3%). A meta-analysis of change in carotid Doppler peak velocity (∆CDPV) yielded a sensitivity of 0.79 (95% confidence interval [CI], 0.74-0.84) and a specificity of 0.85 (95% CI, 0.76-0.90). Risk of bias relating to recruitment methodology, the independence of index testing to reference standards and exclusionary clinical criteria were evaluated. Overall quality of evidence was low. Study design heterogeneity, including a lack of clear parameter cutoffs, limited the generalizability of our results. CONCLUSIONS In this meta-analysis, we found that existing literature supports the ability of carotid ultrasound to predict fluid responsiveness in mechanically ventilated adults. ∆CDPV may be an accurate carotid parameter in certain contexts. Further high-quality studies with more homogenous designs are needed to further validate this technology.
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Affiliation(s)
- Adam C Lipszyc
- From the Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Samuel C D Walker
- Department of Emergency Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander P Beech
- From the Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Helen Wilding
- Library Service, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hamed Akhlaghi
- Department of Emergency Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
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Demir I, Turktan M, Gulec E, Arslan YK, Ozalevli M. The predictive role of carotid artery flow time for anesthesia-induced hypotension in high-risk elderly patients. J Clin Monit Comput 2024:10.1007/s10877-024-01145-2. [PMID: 38609724 DOI: 10.1007/s10877-024-01145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/25/2024] [Indexed: 04/14/2024]
Abstract
Hypotension induced by general anesthesia is associated with postoperative complications, increased mortality, and morbidity, particularly elderly patients. The aim of this study was to investigate the effectiveness of corrected carotid artery flow time (FTc) for predicting hypotension following anesthesia induction in patients over 65 years old. After faculty ethical committee approval and written informed consent, 138 patients (65 years and older, ASA physical status I-III) who scheduled for elective surgery were included in this study. In the pre-operative anesthesia unit, the carotid artery FTc value was measured by ultrasound and hemodynamic values were recorded. Following anesthesia induction with propofol, hemodynamic data were recorded at 1-minute intervals for 3 min. Measurements were terminated prior to endotracheal intubation, as direct laryngoscopy and endotracheal intubation could cause sympathetic stimulation and hemodynamic changes. Hypotension occurred in 52 patients (37.7%). The preoperative FTc value of the patients who developed hypotension was statistically lower (312.5 ms) than the patients who did not (345.0 ms) (p < 0.001). The area under the ROC curve for carotid artery FTc was 0.93 (95% CI for AUC:0.89-0.97; p < 0.001) with an optimal cut-off of value for predicting post-anesthesia hypotension 333 ms, a sensitivity of 90.4% and a specificity of 84.9%. As a result of the multiple logistic regression model, carotid artery FTc emerged as the sole independent risk factor for hypotension following anesthesia induction. Preoperative carotid artery FTc measurement is a simple, bedside, noninvasive, and reliable method for predicting anesthesia-induced hypotension in elderly patients.
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Affiliation(s)
- Ismail Demir
- Department of Anesthesiology and Reanimation, Cukurova University, Adana, Turkey
| | - Mediha Turktan
- Department of Anesthesiology and Reanimation, Cukurova University, Adana, Turkey.
| | - Ersel Gulec
- Department of Anesthesiology and Reanimation, Cukurova University, Adana, Turkey
| | | | - Mehmet Ozalevli
- Department of Anesthesiology and Reanimation, Cukurova University, Adana, Turkey
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Tang X, Liang J, Tan D, Chen Q, Zhou C, Yang T, Liu H. Value of carotid corrected flow time or changes value of FTc could be more useful in predicting fluid responsiveness in patients undergoing robot-assisted gynecologic surgery: a prospective observational study. Front Med (Lausanne) 2024; 11:1387433. [PMID: 38638936 PMCID: PMC11024293 DOI: 10.3389/fmed.2024.1387433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Background The aim of this study was to evaluate the ability of point-of-care Doppler ultrasound measurements of carotid corrected flow time and its changes induced by volume expansion to predict fluid responsiveness in patients undergoing robot-assisted gynecological surgery. Methods In this prospective study, carotid corrected flow time was measured using Doppler images of the common carotid artery before and after volume expansion. The stroke volume index at each time point was recorded using noninvasive cardiac output monitoring with MostCare. Of the 52 patients enrolled, 26 responded. Results The areas under the receiver operating characteristic curves of the carotid corrected flow time and changes in carotid corrected flow time induced by volume expansion were 0.82 and 0.67, respectively. Their optimal cut-off values were 357 and 19.5 ms, respectively. Conclusion Carotid corrected flow time was superior to changes in carotid corrected flow time induced by volume expansion for predicting fluid responsiveness in this population.
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Affiliation(s)
- Xixi Tang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jingqiu Liang
- Chongqing Cancer Multi-Omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Dongling Tan
- Department of Anesthesiology, People’s Hospital of Shizhu, Chongqing, China
| | - Qi Chen
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chengfu Zhou
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Tingjun Yang
- Department of Anesthesiology, People’s Hospital of Shizhu, Chongqing, China
| | - Hongliang Liu
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
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Bilgili B, Saracoglu A, Saracoglu KT, Ratajczyk P, Kararmaz A. The Reliability of Carotid Artery Doppler Ultrasonography Indices in Predicting Fluid Responsiveness during Surgery for Geriatric Patients: A Prospective, Observational Study. Healthcare (Basel) 2024; 12:783. [PMID: 38610205 PMCID: PMC11011830 DOI: 10.3390/healthcare12070783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The reliability of determining fluid responsiveness during surgery in geriatric patients is challenging. Our primary outcome was to determine the reliability of Corrected Flow Time (FTc) in predicting fluid responsiveness. METHODS Elderly patients undergoing major surgery under general anesthesia were included. Measurements of common carotid artery diameter, velocity time integral, and systolic flow time (FT) were performed before and after a fluid challenge. FTc and carotid blood flow (CBF) were subsequently calculated. RESULTS The median change in carotid diameter was significantly higher in the fluid-responder (R) compared to the non-responder (NR) (6.51% vs. 0.65%, p = 0.049). The median change in CBF was notably higher in R compared to NR (30.04% vs. 9.72%, p = 0.024). Prior to the fluid challenge, systolic FT was significantly shorter in R than NR (285 ms vs. 315 ms, p = 0.027), but after the fluid challenge, these measurements became comparable among the groups. The change in systolic FT was higher in R (15.38% vs. 7.49%, p = 0.027). FTc and the change in FTc exhibited similarities among the groups at all study time points. Receiver operating characteristic analysis demonstrated an area under the curve of 0.682 (95% CI: 0.509-0.855, p = 0.039) for carotid diameter, 0.710 (95% CI: 0.547-0.872, p = 0.011) for CBF, 0.706 (95% CI: 0.540-0.872, p = 0.015) for systolic FT, and 0.580 (95% CI = 0.389-0.770, p = 0.413) for FTc. CONCLUSIONS In geriatric patients, potential endothelial changes in the carotid artery may influence the dynamic markers of fluid responsiveness. Despite the demonstrated effectiveness of FTc in predicting fluid responsiveness in the general population, this study underscores the limited reliability of carotid Doppler ultrasonography indices for prediction in a geriatric patient population.
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Affiliation(s)
- Beliz Bilgili
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, 34899 Istanbul, Turkey; (B.B.); (A.K.)
| | - Ayten Saracoglu
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Aisha bint Hamad Al Attiah Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
| | - Kemal T. Saracoglu
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Pawel Ratajczyk
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 90-419 Lodz, Poland
| | - Alper Kararmaz
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, 34899 Istanbul, Turkey; (B.B.); (A.K.)
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Juri T, Suehiro K, Yasuda S, Kimura A, Fujimoto Y, Mori T. Changes in the corrected carotid flow time can predict spinal anesthesia-induced hypotension in patients undergoing cesarean delivery: an observational study. J Anesth 2024; 38:105-113. [PMID: 38172292 DOI: 10.1007/s00540-023-03293-2] [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: 08/07/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Spinal anesthesia is a standard technique for cesarean delivery; however, it possesses a risk of hypotension. We hypothesised that the changes in the corrected flow time induced by the Trendelenburg position could predict the incidence of hypotension after spinal anesthesia for cesarean delivery. METHODS Patients undergoing elective cesarean delivery under spinal anesthesia were enrolled. Before anesthesia induction, corrected flow time was measured in the supine and Trendelenburg positions (FTc-1 and FTc-2, respectively). Additionally, a percent change in corrected flow time induced by the Trendelenburg position was defined as ΔFTc. The primary endpoint was to investigate the ability of ΔFTc to predict the incidence of spinal anesthesia-induced hypotension until delivery. The receiver operating characteristics curves to assess the ability of FTc-1, FTc-2, and ΔFTc to predict the incidence of hypotension were generated. RESULTS Finally, 40 patients were included, and of those, 26 (65%) developed spinal anesthesia-induced hypotension. The areas under the curve for FTc-1, FTc-2, and ΔFTc were 0.591 (95% CI: 0.424 to 0.743) (P = 0.380), 0.742 (95% CI: 0.579 to 0.867) (P = 0.004), and 0.882 (95% CI: 0.740 to 0.962) (P < 0.001) respectively, indicating ΔFTc as the best predictor among these three parameters. The best threshold for ΔFTc was 6.4% (sensitivity: 80.8% (95% CI: 53.8 to 96.2), specificity: 85.7% (95% CI: 42.9 to 100.0)). CONCLUSIONS This study demonstrated that changes in the corrected carotid flow time induced by the Trendelenburg position could serve as a good predictor of spinal anesthesia-induced hypotension for cesarean delivery.
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Affiliation(s)
- Takashi Juri
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka, 545-8586, Japan
| | - Koichi Suehiro
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka, 545-8586, Japan.
| | - Shinta Yasuda
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka, 545-8586, Japan
| | - Aya Kimura
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka, 545-8586, Japan
| | - Yohei Fujimoto
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka, 545-8586, Japan
| | - Takashi Mori
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka, 545-8586, Japan
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Huang S, Liao Z, Chen A, Wang J, Xu X, Zhang L. Effect of carotid corrected flow time combined with perioperative fluid therapy on preventing hypotension after general anesthesia induction in elderly patients: a prospective cohort study. Int J Surg 2024; 110:799-809. [PMID: 37983823 PMCID: PMC10871564 DOI: 10.1097/js9.0000000000000863] [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: 08/10/2023] [Accepted: 10/22/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Hypotension often occurs following the induction of general anesthesia in elderly patients undergoing surgery and can lead to severe complications. This study assessed the effect of carotid corrected flow time (FTc) combined with perioperative fluid therapy on preventing hypotension after general anesthesia induction in elderly patients. MATERIALS AND METHODS The prospective cohort study was divided into two parts. The first part (Part I) consisted of 112 elderly patients. Carotid FTc was measured using Color Doppler Ultrasound 5 min before anesthesia induction. Hypotension was defined as a decrease of greater than 30% in systolic blood pressure (SBP) or a decrease of greater than 20% in mean arterial pressure (MAP) from baseline, or an absolute SBP below 90 mmHg and MAP below 60 mmHg within 3 min after induction of general anesthesia. The predictive value of carotid FTc was determined using receiver operating characteristic (ROC) curve. The second part (Part II) consisted of 65 elderly patients. Based on the results in Part I, elderly patients with carotid FTc below the optimal cut-off value received perioperative fluid therapy at a volume of 8 ml/kg of balanced crystalloids (lactated Ringer's solution) in 30 min before induction. The effect of carotid FTc combined with perioperative fluid therapy was assessed by comparing observed incidence of hypotension after induction. RESULTS The area under the ROC for carotid FTc to predict hypotension after induction was 0.876 [95% confidence interval (CI) 0.800-0.952, P <0.001]. The optimal cut-off value was 334.95 ms (sensitivity of 87.20%; specificity of 82.20%). The logistic regression analysis revealed that carotid FTc is an independent predictor for post-induction hypotension in elderly patients. The incidence of post-induction hypotension was significantly lower ( P <0.001) in patients with carotid FTc less than 334.95 ms who received perioperative fluid therapy (35.71%) compared to those who did not (92.31%). CONCLUSIONS Carotid FTc combined with the perioperative fluid therapy could significantly reduce the incidence of hypotension after the induction of general anesthesia in elderly patients.
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Affiliation(s)
- Shishi Huang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
| | - Zhenqi Liao
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
| | - Andi Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
| | - Jiali Wang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
| | - Xiaodong Xu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
| | - Liangcheng Zhang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
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Kerrebijn I, Atwi S, Elfarnawany M, Eibl AM, Eibl JK, Taylor JL, Kim CH, Johnson BD, Kenny JÉS. The correlation between carotid artery Doppler and stroke volume during central blood volume loss and resuscitation. Acute Crit Care 2024; 39:162-168. [PMID: 38476069 PMCID: PMC11002613 DOI: 10.4266/acc.2023.01095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/14/2023] [Accepted: 01/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Using peripheral arteries to infer central hemodynamics is common among hemodynamic monitors. Doppler ultrasound of the common carotid artery has been used in this manner with conflicting results. We investigated the relationship between changing common carotid artery Doppler measures and stroke volume (SV), hypothesizing that more consecutively-averaged cardiac cycles would improve SV-carotid Doppler correlation. METHODS Twenty-seven healthy volunteers were recruited and studied in a physiology laboratory. Carotid artery Doppler pulse was measured with a wearable, wireless ultrasound during central hypovolemia and resuscitation induced by a stepped lower body negative pressure protocol. The change in maximum velocity time integral (VTI) and corrected flow time of the carotid artery (ccFT) were compared with changing SV using repeated measures correlation. RESULTS In total, 73,431 cardiac cycles were compared across 27 subjects. There was a strong linear correlation between changing SV and carotid Doppler measures during simulated hemorrhage (repeated-measures linear correlation [Rrm ]=0.91 for VTI; 0.88 for ccFT). This relationship improved with larger numbers of consecutively-averaged cardiac cycles. For ccFT, beyond four consecutively-averaged cardiac cycles the correlation coefficient remained strong (i.e., Rrm of at least 0.80). For VTI, the correlation coefficient with SV was strong for any number of averaged cardiac cycles. For both ccFT and VTI, Rrm remained stable around 25 consecutively-averaged cardiac cycles. CONCLUSIONS There was a strong linear correlation between changing SV and carotid Doppler measures during central blood volume loss. The strength of this relationship was dependent upon the number of consecutively-averaged cardiac cycles.
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Affiliation(s)
| | | | | | - Andrew M. Eibl
- Flosonics Medical, Toronto, ON, Canada
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Joseph K. Eibl
- Flosonics Medical, Toronto, ON, Canada
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Jenna L. Taylor
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Physiology and Ultrasound Laboratory in Science and Exercise, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Chul-Ho Kim
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Bruce D. Johnson
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Jon-Émile S. Kenny
- Flosonics Medical, Toronto, ON, Canada
- Health Sciences North Research Institute, Sudbury, ON, Canada
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Jin G, Liu F, Yang Y, Chen J, Wen Q, Wang Y, Yu L, He J. Carotid blood flow changes following a simulated end-inspiratory occlusion maneuver measured by ultrasound can predict hypotension after the induction of general anesthesia: an observational study. BMC Anesthesiol 2024; 24:13. [PMID: 38172775 PMCID: PMC10763470 DOI: 10.1186/s12871-023-02393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The primary purpose of this study was to investigate the predictive value of alterations in cervical artery hemodynamic parameters induced by a simulated end-inspiratory occlusion test (sEIOT) measured by ultrasound for predicting postinduction hypotension (PIH) during general anesthesia. METHODS Patients undergoing gastrointestinal tumor resection under general anesthesia were selected for this study. Ultrasound has been utilized to assess hemodynamic parameters in carotid artery blood flow before induction, specifically focusing on variations in corrected flow time (ΔFTc) and peak blood flow velocity (ΔCDPV), both before and after sEIOT. Anesthesia was induced by midazolam, sufentanil, propofol, and rocuronium, and blood pressure (BP) and heart rate (HR) were recorded within the first 10 min following endotracheal intubation. PIH was defined as fall in systolic blood pressure (SBP) or mean arterial pressure (MAP) by > 30% of baseline or MAP to < 60 mm Hg. RESULTS The area under the receiver operating characteristic curves (AUC) for carotid artery ΔFTc was 0.88 (95%CI, 0.81 to 0.96; P < 0.001), and the optimal cutoff value was -16.57%, with a sensitivity of 91.4% and specificity of 77.60%. The gray zone for carotid artery ΔFTc was -16.34% to -15.36% and included 14% of the patients. The AUC for ΔCDPV was 0.54, with an optimal cutoff value of -1.47%. The sensitivity and specificity were calculated as 55.20% and 57.10%, respectively. CONCLUSION The corrected blood flow time changes in the carotid artery induced by sEIOT can predict hypotension following general anesthesia-induced hypotension, wherein ΔFTc less than 16.57% is the threshold. TRIAL REGISTRATION Chinese Clinical Trial Registry ( www.chictr.org.cn ; 20/06/2023; ChiCTR2300072632).
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Affiliation(s)
- Guangshan Jin
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China
| | - Fuqiang Liu
- Department of Anesthesiology, Jiangsu Cancer Hospital, The Affricated Cancer Hospital of Nanjing Medical University, Jiangsu, China
| | - Yiwen Yang
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China
| | - Jiahui Chen
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China
| | - Qian Wen
- Department of Anesthesiology, Jiangsu Cancer Hospital, The Affricated Cancer Hospital of Nanjing Medical University, Jiangsu, China
| | - Yudong Wang
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China
| | - Ling Yu
- Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu, China
| | - Jianhua He
- School of Anesthesiology, Xuzhou Medical University, Jiangsu, China.
- Department of Anesthesiology, Jiangsu Cancer Hospital, The Affricated Cancer Hospital of Nanjing Medical University, Jiangsu, China.
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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: 3] [Impact Index Per Article: 3.0] [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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10
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Zhang NR, Zheng ZN, Wang K, Li H. Incidence, characteristics and risk factors for alveolar recruitment maneuver-related hypotension in patients undergoing laparoscopic colorectal cancer resection. World J Gastrointest Surg 2023; 15:1454-1464. [PMID: 37555120 PMCID: PMC10405128 DOI: 10.4240/wjgs.v15.i7.1454] [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: 01/30/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Alveolar recruitment maneuvers (ARMs) may lead to transient hypotension, but the clinical characteristics of this induced hypotension are poorly understood. We investigated the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection. AIM To investigate the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection. METHODS This was a secondary analysis of the PROtective Ventilation using Open Lung approach Or Not trial and included 140 subjects. An ARM was repeated every 30 min during intraoperative mechanical ventilation. The primary endpoint was ARM-related hypotension, defined as a mean arterial pressure (MAP) < 60 mmHg during an ARM or within 5 min after an ARM. The risk factors for hypotension were identified. The peri-ARM changes in blood pressure were analyzed for the first three ARMs (ARM1,2,3) and the last ARM (ARMlast). RESULTS Thirty-four subjects (24.3%) developed ARM-related hypotension. Of all 1027 ARMs, 37 (3.61%) induced hypotension. More ARMs under nonpneumoperitoneum (33/349, 9.46%) than under pneumoperitoneum conditions (4/678, 0.59%) induced hypotension (P < 0.01). The incidence of hypotension was higher at ARM1 points than at non-ARM1 points (18/135, 13.3% vs 19/892, 2.1%; P < 0.01). The median percentage decrease in the MAP at ARM1 was 14%. Age ≥ 74 years, blood loss ≥ 150 mL and peak inspiratory pressure under pneumoperitoneum < 24 cm H2O were risk factors for ARM-related hypotension. CONCLUSION When the ARM was repeated intraoperatively, a quarter of subjects developed ARM-related hypotension, but only 3.61% of ARMs induced hypotension. ARM-related hypotension most occurred in a hemodynamically unstable state or a hypovolemic state, and in elderly subjects. Fortunately, ARMs that were performed under pneumoperitoneum conditions had less impact on blood pressure.
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Affiliation(s)
- Nan-Rong Zhang
- Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Zhi-Nan Zheng
- Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Kai Wang
- Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Hong Li
- Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
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11
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Suriani I, van Houte J, de Boer EC, van Knippenberg L, Manzari S, Mischi M, Bouwman RA. Carotid Doppler ultrasound for non-invasive haemodynamic monitoring: a narrative review. Physiol Meas 2023; 43. [PMID: 36179705 DOI: 10.1088/1361-6579/ac96cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022]
Abstract
Objective.Accurate haemodynamic monitoring is the cornerstone in the management of critically ill patients. It guides the optimization of tissue and organ perfusion in order to prevent multiple organ failure. In the past decades, carotid Doppler ultrasound (CDU) has been explored as a non-invasive alternative for long-established invasive haemodynamic monitoring techniques. Considering the large heterogeneity in reported studies, we conducted a review of the literature to clarify the current status of CDU as a haemodynamic monitoring tool.Approach.In this article, firstly an overview is given of the equipment and workflow required to perform a CDU exam in clinical practice, the limitations and technical challenges potentially faced by the CDU sonographer, and the cerebrovascular mechanisms that may influence CDU measurement outcomes. The following chapter describes alternative techniques for non-invasive haemodynamic monitoring, detailing advantages and limitations compared to CDU. Next, a comprehensive review of the literature regarding the use of CDU for haemodynamic monitoring is presented. Furthermore, feasibility aspects, training requirements and technical developments of CDU are addressed.Main results.Based on the outcomes of these studies, we assess the applicability of CDU-derived parameters within three clinical domains (cardiac output, volume status, and fluid responsiveness), and amongst different patient groups. Finally, recommendations are provided to improve the quality and standardization of future research and clinical practice in this field.Significance.Although CDU is not yet interchangeable with invasive 'gold standard' cardiac output monitoring, the present work shows that certain CDU-derived parameters prove promising in the context of functional haemodynamic monitoring.
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Affiliation(s)
- Irene Suriani
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
| | - Joris van Houte
- Catharina Hospital Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
| | - Esmée C de Boer
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
| | - Luuk van Knippenberg
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
| | - Sabina Manzari
- Philips Research High Tech Campus 34, 5656 AE Eindhoven, The Netherlands
| | - Massimo Mischi
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
| | - R Arthur Bouwman
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands.,Catharina Hospital Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
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12
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Kenny JÉS, Gibbs SO, Johnston D, Yang Z, Hofer LM, Elfarnawany M, Eibl JK, Johnson A, Buecker AJ, Lau VC, Kemp BO. The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasound. J Intensive Care 2023; 11:7. [PMID: 36793079 PMCID: PMC9933329 DOI: 10.1186/s40560-023-00655-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Little data exist on the time spent by emergency department (ED) personnel providing intravenous (IV) fluid to 'responsive' versus 'unresponsive' patients. METHODS A prospective, convenience sample of adult ED patients was studied; patients were enrolled if preload expansion was indicated for any reason. Using a novel, wireless, wearable ultrasound, carotid artery Doppler was obtained before and throughout a preload challenge (PC) prior to each bag of ordered IV fluid. The treating clinician was blinded to the results of the ultrasound. IV fluid was deemed 'effective' or 'ineffective' based on the greatest change in carotid artery corrected flow time (ccFT∆) during the PC. The duration, in minutes, of each bag of IV fluid administered was recorded. RESULTS 53 patients were recruited and 2 excluded for Doppler artifact. There were 86 total PCs included in the investigation comprising 81.7 L of administered IV fluid. 19,667 carotid Doppler cardiac cycles were analyzed. Using ccFT∆ ≥ + 7 ms to discriminate 'physiologically effective' from 'ineffective' IV fluid, we observed that 54 PCs (63%) were 'effective', comprising 51.7 L of IV fluid, whereas, 32 (37%) were 'ineffective' comprising 30 L of IV fluid. 29.75 total hours across all 51 patients were spent in the ED providing IV fluids categorized as 'ineffective.' CONCLUSIONS We report the largest-known carotid artery Doppler analysis (i.e., roughly 20,000 cardiac cycles) in ED patients requiring IV fluid expansion. A clinically significant amount of time was spent providing physiologically ineffective IV fluid. This may represent an avenue to improve ED care efficiency.
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Affiliation(s)
- Jon-Émile S. Kenny
- grid.420638.b0000 0000 9741 4533Health Sciences North Research Institute, 56 Walford Road, Sudbury, ON P3E2H3 Canada ,Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada
| | - Stanley O. Gibbs
- Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada
| | - Delaney Johnston
- Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada
| | - Zhen Yang
- Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada
| | - Lisa M. Hofer
- Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada
| | - Mai Elfarnawany
- Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada
| | - Joseph K. Eibl
- grid.420638.b0000 0000 9741 4533Health Sciences North Research Institute, 56 Walford Road, Sudbury, ON P3E2H3 Canada ,Flosonics Medical 325 W. Front Street, Toronto, ON M5V2Y1 Canada ,grid.436533.40000 0000 8658 0974Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON P3E2C6 Canada
| | - Amanda Johnson
- grid.416495.b0000 0004 0383 0587OSF Saint Francis Medical Center, 530 NE Glen Oak Ave, Peoria, IL 61637 USA
| | - Anthony J. Buecker
- grid.416495.b0000 0004 0383 0587OSF Saint Francis Medical Center, 530 NE Glen Oak Ave, Peoria, IL 61637 USA
| | - Vivian C. Lau
- grid.416495.b0000 0004 0383 0587OSF Saint Francis Medical Center, 530 NE Glen Oak Ave, Peoria, IL 61637 USA
| | - Benjamin O. Kemp
- grid.416495.b0000 0004 0383 0587OSF Saint Francis Medical Center, 530 NE Glen Oak Ave, Peoria, IL 61637 USA
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13
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Suehiro K. Assessing fluid responsiveness during spontaneous breathing. J Anesth 2022; 36:579-582. [PMID: 35606608 DOI: 10.1007/s00540-022-03075-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Koichi Suehiro
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan.
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14
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Bai FR, Li HM, Yi ML, Yin H, Wu W. The efficacy of different alveolar recruitment maneuvers in holmium laser lithotripsy surgery under general anesthesia using a laryngeal mask. BMC Anesthesiol 2022; 22:134. [PMID: 35501676 PMCID: PMC9063066 DOI: 10.1186/s12871-022-01664-y] [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: 11/24/2021] [Accepted: 04/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background Alveolar recruitment maneuvers (ARMs) is an important part of lung-protective ventilation strategies (LPVSs), but the optimal duration and interval Remain unclear. Methods Patients:252 patients who underwent holmium laser lithotripsy surgery and meet inclusion criteria were included and randomized into three groups based on the duration and frequency of ARMs (Regular, one 30 s ARM (RARMs); Improved and intermittent, three 10s ARMs (IARMs); and Control (C), no ARMs).Interventions: Groups R and I received ARMs at 20 cmH2O pressures every 30 min. All patients received the same anesthesia and mechanical ventilation. Measurements:Outcomes included heart rate and mean arterial pressure changes during ARMs and postoperative pulmonary complications (PPCs) within the first 7 postoperative days. Main results Incidences of PPCs in groups R(7.1%) and I (5.0%)were slightly lower than those in group C (8.9%).This indicated the potential to reduce lung injury. Heart rate and mean arterial pressure fluctuations during ARMs were significantly higher in groups R and I than in group C (P < 0.01). The rate of blood pressure decrease was significantly higher in group R than in group I (P < 0.01). Conclusions IARMs can reduce cycle fluctuations than RARMs in patients Undergoing holmium laser lithotripsy surgery with laryngeal mask general anesthesia. Low tidal volume ventilation and low PEEP combined with ARM did not significantly reduce the incidence of PPCs in healthy lung patients, but tended to reduce lung injury. Trial registration The study was registered on the Chinese Clinical Trial Registry. (ChiCTR2000030815,15/03/2020). This study was approved by the ethics committee of Chengdu Fifth People’s Hospital with approval number(2020–005(Study)-1). Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01664-y.
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Affiliation(s)
- Fu-Rong Bai
- Department of Anesthesiology, Chengdu Fifth People's Hospital, 33 Mashi Road, Wenjiang District, Chengdu, 611130, China
| | - Hong-Mei Li
- Department of Anesthesiology, Chengdu Fifth People's Hospital, 33 Mashi Road, Wenjiang District, Chengdu, 611130, China
| | - Ming-Liang Yi
- Department of Anesthesiology, Chengdu Fifth People's Hospital, 33 Mashi Road, Wenjiang District, Chengdu, 611130, China
| | - Hong Yin
- Department of Anesthesiology, Chengdu Fifth People's Hospital, 33 Mashi Road, Wenjiang District, Chengdu, 611130, China
| | - Wei Wu
- Department of Anesthesiology, Chengdu Fifth People's Hospital, 33 Mashi Road, Wenjiang District, Chengdu, 611130, China. .,Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, 610083, China.
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15
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Watanabe R, Suehiro K, Mukai A, Tanaka K, Yamada T, Mori T, Nishikawa K. Changes in stroke volume induced by lung recruitment maneuver can predict fluid responsiveness during intraoperative lung-protective ventilation in prone position. BMC Anesthesiol 2021; 21:303. [PMID: 34856928 PMCID: PMC8638171 DOI: 10.1186/s12871-021-01527-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 11/18/2021] [Indexed: 12/16/2022] Open
Abstract
Background The present study aimed to evaluate the reliability of hemodynamic changes induced by lung recruitment maneuver (LRM) in predicting stroke volume (SV) increase after fluid loading (FL) in prone position. Methods Thirty patients undergoing spine surgery in prone position were enrolled. Lung-protective ventilation (tidal volume, 6–7 mL/kg; positive end-expiratory pressure, 5 cmH2O) was provided to all patients. LRM (30 cmH2O for 30 s) was performed. Hemodynamic variables including mean arterial pressure (MAP), heart rate, SV, SV variation (SVV), and pulse pressure variation (PPV) were simultaneously recorded before, during, and at 5 min after LRM and after FL (250 mL in 10 min). Receiver operating characteristic curves were generated to evaluate the predictability of SVV, PPV, and SV decrease by LRM (ΔSVLRM) for SV responders (SV increase after FL > 10%). The gray zone approach was applied for ΔSVLRM. Results Areas under the curve (AUCs) for ΔSVLRM, SVV, and PPV to predict SV responders were 0.778 (95% confidence interval: 0.590–0.909), 0.563 (0.371–0.743), and 0.502 (0.315–0.689), respectively. The optimal threshold for ΔSVLRM was 30% (sensitivity, 92.3%; specificity, 70.6%). With the gray zone approach, the inconclusive values ranged 25 to 75% for ΔSVLRM (including 50% of enrolled patients). Conclusion In prone position, LRM-induced SV decrease predicted SV increase after FL with higher reliability than traditional dynamic indices. On the other hand, considering the relatively large gray zone in this study, future research is needed to further improve the clinical significance. Trial registration UMIN Clinical Trial Registry UMIN000027966. Registered 28th June 2017.
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Affiliation(s)
- Ryota Watanabe
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Koichi Suehiro
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan.
| | - Akira Mukai
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Katsuaki Tanaka
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Tokuhiro Yamada
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Takashi Mori
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Kiyonobu Nishikawa
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
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