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Elwan MH, Roshdy A, Elsharkawy EM, Eltahan SM, Coats TJ. Can passive leg raise predict the response to fluid resuscitation in ED? BMC Emerg Med 2022; 22:172. [PMID: 36289475 PMCID: PMC9608892 DOI: 10.1186/s12873-022-00721-6] [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: 06/24/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Passive leg raise (PLR) can be used as a reversible preload challenge to stratify patients according to preload response. We aim to evaluate the accuracy of PLR, monitored by a non-invasive cardiac output monitor in predicting to response to fluid resuscitation in emergency department (ED). Methods We recruited adult patients planned to receive a resuscitation fluid bolus. Patients were monitored using a thoracic electrical bioimpedance (TEB) cardiac output monitor (Niccomo, Medis, Germany). A 3-min PLR was carried out before and after fluid infusion. Stroke volume changes (ΔSV) were calculated and a positive response was defined as ≥ 15% increase. Results We recruited 39 patients, of which 37 were included into the analysis. The median age was 63 (50–77) years and 19 patients were females. 17 patients (46%) were fluid responders compared to 11 (30%) with positive response to PLR1. ΔSV with PLR1 and fluid bolus showed moderate correlation (r = 0.47, 95% confidence interval, CI 0.17–0.69) and 62% concordance rate. For the prediction of the response to a fluid bolus the PLR test had a sensitivity of 41% (95% CI 22–64) and specificity of 80% (95% CI 58–92) with an area under the curve of 0.59 (95% CI 0.41–0.78). None of the standard parameters showed a better predictive ability compared to PLR. Conclusion Using TEB, ΔSV with PLR showed a moderate correlation with fluid bolus, with a limited accuracy to predict fluid responsiveness. The PLR test was a better predictor of fluid responsiveness than the parameters commonly used in emergency care (such as heart rate and blood pressure). These data suggest the potential for a clinical trial in sepsis comparing TEB monitored, PLR directed fluid management with standard care.
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Affiliation(s)
- MH Elwan
- grid.9918.90000 0004 1936 8411Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Level G Jarvis Building RMO, Infirmary Square, Leicester, LE1 5WW UK ,grid.415192.a0000 0004 0400 5589Emergency Department, Kettering General Hospital, Kettering, UK ,grid.7155.60000 0001 2260 6941Department of Emergency Medicine, Alexandria University, Alexandria, Egypt
| | - A Roshdy
- grid.7155.60000 0001 2260 6941Department of Critical Care Medicine, Alexandria University, Alexandria, Egypt ,grid.439355.d0000 0000 8813 6797Intensive Care Unit, North Middlesex University Hospital, London, UK
| | - EM Elsharkawy
- grid.7155.60000 0001 2260 6941Department of Cardiology, Alexandria University, Alexandria, Egypt
| | - SM Eltahan
- grid.7155.60000 0001 2260 6941Department of Cardiology, Alexandria University, Alexandria, Egypt
| | - TJ Coats
- grid.9918.90000 0004 1936 8411Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Level G Jarvis Building RMO, Infirmary Square, Leicester, LE1 5WW UK
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Abou-Arab O, Beyls C, Moussa MD, Huette P, Beaudelot E, Guilbart M, De Broca B, Yzet T, Dupont H, Bouzerar R, Mahjoub Y. Portal Vein Pulsatility Index as a Potential Risk of Venous Congestion Assessed by Magnetic Resonance Imaging: A Prospective Study on Healthy Volunteers. Front Physiol 2022; 13:811286. [PMID: 35574483 PMCID: PMC9101294 DOI: 10.3389/fphys.2022.811286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/18/2022] [Indexed: 11/25/2022] Open
Abstract
High values of the portal vein pulsatility index (PI) have been associated with adverse outcomes in perioperative or critically ill patients. However, data on dynamic changes of PI related to fluid infusion are scarce. We aimed to determine if dynamic changes in PI are associated with the fluid challenge (FC). To address this challenge, we conducted a prospective single-center study. The population study included healthy subjects. FC consisted in the administration of 500 ml of Ringer lactate infusion over 5 min. The portal blood flow and PI were assessed by magnetic resonance imaging. The responsiveness to FC was defined as an increase in the cardiac stroke volume of at least 10% as assessed by echocardiography. We included 24 healthy volunteers. A total of fourteen (58%) subjects were responders, and 10 (42%) were non-responders. In the responder group, FC induced a significant increase in portal blood flow from 881 (762–1,001) at the baseline to 1,010 (778–1,106) ml min−1 (p = 0.005), whilst PI remained stable (from 31 [25–41] to 35 (25–42) %; p = 0.12). In the non-responder group, portal blood flow remained stable after FC (from 1,042 to 1,034 ml min−1; p = 0.084), whereas PI significantly increased from 32 (22–40) to 48% *(25–85) after FC (p = 0.027). PI was negatively correlated to portal blood flow (Rho coefficient = −0.611; p = 0.002). To conclude, PI might be a sensitive marker of early congestion in healthy subjects that did not respond to FC. This finding requires further validation in clinical settings with a larger sample size.
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Affiliation(s)
- Osama Abou-Arab
- Anesthesia and Critical Care Department, Amiens Hospital University, Amiens, France
- *Correspondence: Osama Abou-Arab,
| | - Christophe Beyls
- Anesthesia and Critical Care Department, Amiens Hospital University, Amiens, France
| | | | - Pierre Huette
- Anesthesia and Critical Care Department, Amiens Hospital University, Amiens, France
| | - Elodie Beaudelot
- Anesthesia and Critical Care Department, Amiens Hospital University, Amiens, France
| | - Mathieu Guilbart
- Anesthesia and Critical Care Department, Amiens Hospital University, Amiens, France
| | - Bruno De Broca
- Anesthesia and Critical Care Department, Amiens Hospital University, Amiens, France
| | - Thierry Yzet
- Department of Radiology, Amiens Picardy University Hospital, Amiens, France
| | - Hervé Dupont
- Anesthesia and Critical Care Department, Amiens Hospital University, Amiens, France
| | - Roger Bouzerar
- Department of Biophysics and image processing, Amiens Picardy University Hospital, Amiens, France
| | - Yazine Mahjoub
- Anesthesia and Critical Care Department, Amiens Hospital University, Amiens, France
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Fudim M, Sobotka PA, Dunlap ME. Extracardiac Abnormalities of Preload Reserve: Mechanisms Underlying Exercise Limitation in Heart Failure with Preserved Ejection Fraction, Autonomic Dysfunction, and Liver Disease. Circ Heart Fail 2021; 14:e007308. [PMID: 33464948 DOI: 10.1161/circheartfailure.120.007308] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
While many of the cardiac limitations to exercise performance are now well-characterized, extracardiac limitations to exercise performance have been less well recognized but are nevertheless important. We propose that abnormalities of cardiac preload reserve represents an under-recognized but common cause of exercise limitations. We further propose that mechanistic links exist between conditions as seemingly disparate as heart failure with preserved ejection fraction, nonalcoholic fatty liver disease, and pelvic venous compression/obstruction syndromes (eg, May-Thurner). We conclude that extracardiac abnormalities of preload reserve serve as a major pathophysiologic mechanism underlying these and other disease states.
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Affiliation(s)
- Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (M.F.). Duke Clinical Research Institute, Durham, NC (M.F.)
| | - Paul A Sobotka
- Affiliated Faculty, Department of Medicine, Division of Cardiology, The Ohio State University, Columbus (P.A.S.)
| | - Mark E Dunlap
- Heart and Vascular Center, MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.)
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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: 0.7] [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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Gordon D, Spiegel R. Fluid Resuscitation: History, Physiology, and Modern Fluid Resuscitation Strategies. Emerg Med Clin North Am 2020; 38:783-793. [PMID: 32981617 DOI: 10.1016/j.emc.2020.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intravenous (IV) fluids are among the most common interventions performed in the emergency department. They are at times lifesaving, but if used recklessly can be harmful. Given their ubiquity, it is important to understand the history, physiology, and current strategies that govern the use of IV fluids during the resuscitation of the critically ill.
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Affiliation(s)
- David Gordon
- Department of Medicine, University of Maryland Medical Center, 110 South Paca Pratt Street, Baltimore, MD 21201, USA
| | - Rory Spiegel
- Attending Emergency Medicine, Georgetown University Hospital, Washington Hospital Center, Faculty Critical Care, 110 Irving Street, East Building Room 3124, Washington, DC 20010, USA.
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Chopra S, Thompson J, Shahangian S, Thapamagar S, Moretta D, Gasho C, Cohen A, Nguyen HB. Precision and consistency of the passive leg raising maneuver for determining fluid responsiveness with bioreactance non-invasive cardiac output monitoring in critically ill patients and healthy volunteers. PLoS One 2019; 14:e0222956. [PMID: 31560711 PMCID: PMC6764744 DOI: 10.1371/journal.pone.0222956] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/04/2019] [Indexed: 12/29/2022] Open
Abstract
Objective The passive leg raising (PLR) maneuver has become standard practice in fluid resuscitation. We aim to investigate the precision and consistency of the PLR for determining fluid responsiveness in critically ill patients and healthy volunteers using bioreactance non-invasive cardiac output monitoring (NiCOM™, Cheetah Medical, Inc., Newton Center, Massachusetts, USA). Methods This study is prospective, single-center, observational cohort with repeated measures in critically ill patients admitted to the medical intensive care unit and healthy volunteers at a tertiary academic medical center. Three cycles of PLR were performed, each at 20–30 minutes apart. Fluid responsiveness was defined as a change in stroke volume index (ΔSVI) > 10% with each PLR as determined by NiCOM™. Precision was the variability in ΔSVI after the 3 PLR’s, and determined by range, average deviation and standard deviation. Consistency was the same fluid responsiveness determination of “Yes” (ΔSVI > 10%) or “No” (ΔSVI ≤ 10%) for all 3 PLR’s. Results Seventy-five patients and 25 volunteers were enrolled. In patients, the precision was range of 17.2±13.3%, average deviation 6.5±4.0% and standard deviation 9.0±5.2%; and for volunteers, 17.4±10.3%, 6.6±3.8% and 9.0±6.7%, respectively. There was no statistical difference in the precision measurements between patients and volunteers. Forty-nine (65.3%) patients vs. twenty-four (96.0%) volunteers had consistent results, p < 0.01. Among those with consistent results, twenty-four (49.0%) patients and 24 (100%) volunteers were fluid responsive. Conclusions The precision and consistency of determining ΔSVI with NiCOM™ after PLR may have clinical implication if ΔSVI > 10% is the absolute cutoff to determine fluid responsiveness.
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Affiliation(s)
- Sahil Chopra
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Jordan Thompson
- School of Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Shahab Shahangian
- Department of Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Suman Thapamagar
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Dafne Moretta
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Chris Gasho
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Avi Cohen
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - H. Bryant Nguyen
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America
- * E-mail:
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Zieleskiewicz L, Bouvet L, Einav S, Duclos G, Leone M. Diagnostic point‐of‐care ultrasound: applications in obstetric anaesthetic management. Anaesthesia 2018; 73:1265-1279. [DOI: 10.1111/anae.14354] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 12/13/2022]
Affiliation(s)
- L. Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Aix Marseille university C2VN France
| | - L. Bouvet
- Department of Anaesthesia and Intensive Care Medicine Hospices Civils de Lyon Hôpital Femme Mère Enfant Bron France
| | - S. Einav
- General Intensive Care Shaare Zedek Medical Centre Hebrew University Faculty of Medicine Jerusalem Israel
| | - G. Duclos
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Marseille France
| | - M. Leone
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Marseille France
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Burlinson CEG, Sirounis D, Walley KR, Chau A. Sepsis in pregnancy and the puerperium. Int J Obstet Anesth 2018; 36:96-107. [PMID: 29921485 DOI: 10.1016/j.ijoa.2018.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 12/30/2022]
Abstract
Sepsis remains a leading cause of maternal morbidity and mortality. Recognition and treatment of maternal sepsis are often delayed due to the physiological adaptations of pregnancy and vague or absent signs and symptoms during its initial presentation. Over the past decade, our understanding of sepsis has evolved and maternal early warning systems have been developed in an effort to help providers promptly identify and stratify parturients who are at risk. In addition, new consensus definitions and care bundles have recently been published by the World Health Organization and the Surviving Sepsis Campaign to facilitate earlier recognition and timely management of sepsis. In this narrative review, we summarize the available evidence about sepsis and provide an overview of the research efforts focused on maternal sepsis to date. Controversies and challenges surrounding the anesthetic management of parturients with sepsis or at risk of developing sepsis during pregnancy or the puerperium will be highlighted.
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Affiliation(s)
- C E G Burlinson
- Department of Anesthesia, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - D Sirounis
- Division of Critical Care Medicine, Department of Medicine, St. Paul's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - K R Walley
- Division of Critical Care Medicine, Department of Medicine, St. Paul's Hospital, Vancouver, BC, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - A Chau
- Department of Anesthesia, British Columbia Women's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.
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9
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Elwan MH, Roshdy A, Reynolds JA, Elsharkawy EM, Eltahan SM, Coats TJ. What is the normal haemodynamic response to passive leg raise? A study of healthy volunteers. Emerg Med J 2018; 35:544-549. [PMID: 29728410 DOI: 10.1136/emermed-2017-206836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/13/2017] [Accepted: 04/27/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Passive leg raise (PLR) is used as self-fluid challenge to optimise fluid therapy by predicting preload responsiveness. However, there remains uncertainty around the normal haemodynamic response to PLR with resulting difficulties in application and interpretation in emergency care. We aim to define the haemodynamic responses to PLR in spontaneously breathing volunteers using a non-invasive cardiac output monitor, thoracic electrical bioimpedance, TEB (PLR-TEB). METHODS We recruited healthy volunteers aged 18 or above. Subjects were monitored using TEB in a semirecumbent position, followed by PLR for 3 min. The procedure was repeated after 6 min at the starting position. Correlation between the two PLRs was assessed using Spearman's r (rs). Agreement between the two PLRs was evaluated using Cohen Kappa with responsiveness defined as ≥10% increase in stroke volume. Parametric and non-parametric tests were used as appropriate to evaluate statistical significance of baseline variables between responders and non-responders. RESULTS We enrolled 50 volunteers, all haemodynamically stable at baseline, of whom 49 completed the study procedure. About half of our subjects were preload responsive. The ∆SV in the two PLRs was correlated (rs=0.68, 95% CI 0.49 to 0.8) with 85% positive concordance. Good agreement was observed with Cohen Kappa of 0.67 (95% CI 0.45 to 0.88). Responders were older and had significantly lower baseline stroke volume and cardiac output. CONCLUSION Our results suggest that the PLR-TEB is a feasible method in spontaneously breathing volunteers with reasonable reproducibility. The age and baseline stroke volume effect suggests a more complex underlying physiology than commonly appreciated. The fact that half of the volunteers had a positive preload response, against the 10% threshold, leads to questions about how this measurement should be used in emergency care and will help shape future patient studies.
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Affiliation(s)
- Mohammed H Elwan
- Department of Emergency Medicine, Alexandria University, Alexandria, Egypt.,Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ashraf Roshdy
- Department of Critical Care Medicine, Alexandria University, Alexandria, Egypt.,General Intensive Care Unit, Queen Elizabeth, Lewisham and Greenwich NHS Trust, London, UK
| | - Joseph A Reynolds
- Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Salah M Eltahan
- Department of Cardiology, Alexandria University, Alexandria, Egypt
| | - Timothy J Coats
- Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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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: 0.9] [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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Ukor IF, Hilton AK, Bailey MJ, Bellomo R. The haemodynamic effects of bolus versus slower infusion of intravenous crystalloid in healthy volunteers. J Crit Care 2017; 41:254-259. [PMID: 28599199 DOI: 10.1016/j.jcrc.2017.05.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/19/2017] [Accepted: 05/30/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE This pilot study aimed to characterise the haemodynamic effect of 1L of IV normal saline (NS) administered as a rapid versus slow infusion on cardiac output (CO), heart rate (HR), systemic blood pressures, and carotid blood flow in six healthy volunteers. MATERIALS AND METHODS Six healthy male volunteers aged 18-65years were randomized to receive 1L NS given over 30min or 120min. On a subsequent study session the alternate fluid regimen was administered. Haemodynamic data was gathered using a non-invasive finger arterial pressure monitor (Nexfin®), echocardiography and carotid duplex sonography. Time to micturition and urine volume was also assessed. RESULTS Compared to baseline, rapid infusion of 1L of saline over 30min produced a fall in Nexfin®-measured CO by 0.62L/min (p<0.001), whereas there was a marginal but significant increase during infusion of 1L NS over 120min of 0.02L/min (p<0.001). This effect was mirrored by changes in HR and blood pressure (BP) (p<0.001). There were no significant changes in carotid blood flow, time to micturition, or urine volume produced. CONCLUSIONS Slower infusion of 1L NS in healthy male volunteers produced a greater increase in CO, HR and BP than rapid infusion.
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Affiliation(s)
- Ida F Ukor
- Department of Intensive Care, Austin Hospital, Heidelberg 3081, Melbourne, VIC, Australia; Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, Clayton 3168, Melbourne, VIC, Australia.
| | - Andrew K Hilton
- Department of Intensive Care, Austin Hospital, Heidelberg 3081, Melbourne, VIC, Australia
| | - Michael J Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Alfred Centre, Prahran 3181, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg 3081, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Alfred Centre, Prahran 3181, Melbourne, VIC, Australia
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12
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Meng L, Heerdt P. Perioperative goal-directed haemodynamic therapy based on flow parameters: a concept in evolution. Br J Anaesth 2016; 117:iii3-iii17. [DOI: 10.1093/bja/aew363] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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