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Alves DR, Ribeiras R. [Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?]. Rev Bras Anestesiol 2017; 67:172-179. [PMID: 28040236 DOI: 10.1016/j.bjan.2016.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/09/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Preoperative fasting was long regarded as an important cause of fluid depletion, leading to hemodynamic instability during surgery should replenishment not be promptly instituted. Lately, this traditional point of view has been progressively challenged, and a growing number of authors now propose a more restrictive approach to fluid management, although doubt remains as to the true hemodynamic influence of preoperative fasting. METHODS We designed an observational, analytic, prospective, longitudinal study in which 31 ASA 1 and ASA 2 volunteers underwent an echocardiographic examination both before and after a fasting period of at least 6h. Data from both static and dynamic preload indices were obtained on both periods, and subsequently compared. RESULTS Static preload indices exhibited a markedly variable behaviour with fasting. Dynamic indices, however, were far more consistent with one another, all pointing in the same direction, i.e., evidencing no statistically significant change with the fasting period. We also analysed the reliability of dynamic indices to respond to known, intentional preload changes. Aortic velocity time integral (VTI) variation with the passive leg raise manoeuvre was the only variable that proved to be sensitive enough to consistently signal the presence of preload variation. CONCLUSION Fasting does not appear to cause a change in preload of conscious volunteers nor does it significantly alter their position in the Frank-Starling curve, even with longer fasting times than usually recommended. Transaortic VTI variation with the passive leg raise manoeuvre is the most robust dynamic index (of those studied) to evaluate preload responsiveness in spontaneously breathing patients.
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Alves DR, Ribeiras R. Does fasting influence preload responsiveness in ASA 1 and 2 volunteers? Braz J Anesthesiol 2016; 67:172-179. [PMID: 28236865 DOI: 10.1016/j.bjane.2015.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/09/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Preoperative fasting was long regarded as an important cause of fluid depletion, leading to hemodynamic instability during surgery should replenishment is not promptly instituted. Lately, this traditional point of view has been progressively challenged, and a growing number of authors now propose a more restrictive approach to fluid management, although doubt remains as to the true hemodynamic influence of preoperative fasting. METHODS We designed an observational, analytic, prospective, longitudinal study in which 31 ASA 1 and ASA 2 volunteers underwent an echocardiographic examination both before and after a fasting period of at least 6hours (h). Data from both static and dynamic preload indices were obtained on both periods, and subsequently compared. RESULTS Static preload indices exhibited a markedly variable behaviour with fasting. Dynamic indices, however, were far more consistent with one another, all pointing in the same direction, i.e., evidencing no statistically significant change with the fasting period. We also analysed the reliability of dynamic indices to respond to known, intentional preload changes. Aortic velocity time integral (VTI) variation with the passive leg raise manoeuvre was the only variable that proved to be sensitive enough to consistently signal the presence of preload variation. CONCLUSION Fasting does not appear to cause a change in preload of conscious volunteers nor does it significantly alter their position in the Frank-Starling curve, even with longer fasting times than usually recommended. Transaortic VTI variation with the passive leg raise manoeuvre is the most robust dynamic index (of those studied) to evaluate preload responsiveness in spontaneously breathing patients.
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Ochagavía A, Baigorri F, Mesquida J, Ayuela JM, Ferrándiz A, García X, Monge MI, Mateu L, Sabatier C, Clau-Terré F, Vicho R, Zapata L, Maynar J, Gil A. [Hemodynamic monitoring in the critically patient. Recomendations of the Cardiological Intensive Care and CPR Working Group of the Spanish Society of Intensive Care and Coronary Units]. Med Intensiva 2013; 38:154-69. [PMID: 24296336 DOI: 10.1016/j.medin.2013.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/20/2013] [Indexed: 12/14/2022]
Abstract
Hemodynamic monitoring offers valuable information on cardiovascular performance in the critically ill, and has become a fundamental tool in the diagnostic approach and in the therapy guidance of those patients presenting with tissue hypoperfusion. From introduction of the pulmonary artery catheter to the latest less invasive technologies, hemodynamic monitoring has been surrounded by many questions regarding its usefulness and its ultimate impact on patient prognosis. The Cardiological Intensive Care and CPR Working Group (GTCIC-RCP) of the Spanish Society of Intensive Care and Coronary Units (SEMICYUC) has recently impulsed the development of an updating series in hemodynamic monitoring. Now, a final series of recommendations are presented in order to analyze essential issues in hemodynamics, with the purpose of becoming a useful tool for residents and critical care practitioners involved in the daily management of critically ill patients.
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Affiliation(s)
- A Ochagavía
- Servicio de Medicina Intensiva, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Corporació, Sanitària Parc Taulí, Institut Universitari Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España.
| | - F Baigorri
- Servicio de Medicina Intensiva, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Corporació, Sanitària Parc Taulí, Institut Universitari Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - J Mesquida
- Servicio de Medicina Intensiva, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Corporació, Sanitària Parc Taulí, Institut Universitari Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - J M Ayuela
- Servicio de Medicina Intensiva, Hospital de Burgos, Burgos, España
| | - A Ferrándiz
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - X García
- Servicio de Medicina Intensiva, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Corporació, Sanitària Parc Taulí, Institut Universitari Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - M I Monge
- Servicio de Cuidados Críticos y Urgencias, Hospital del SAS Jerez, Jerez de la Frontera, Cádiz, España
| | - L Mateu
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - C Sabatier
- Servicio de Medicina Intensiva, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Corporació, Sanitària Parc Taulí, Institut Universitari Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - F Clau-Terré
- Institut Reçerca, Hospital de Vall d'Hebron y Consorci Sanitàri Terrasa, Barcelona, España
| | - R Vicho
- Servicio de Medicina Intensiva, Clínica USP-Palmaplanas, Palma de Mallorca, España
| | - L Zapata
- Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Maynar
- Servicio de Medicina Intensiva, Hospital Universitario Araba, Vitoria, Álava, España
| | - A Gil
- Servicio de Cuidados Críticos y Urgencias, Hospital del SAS Jerez, Jerez de la Frontera, Cádiz, España
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