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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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Meng L, Sun Y, Zhao X, Meng DM, Liu Z, Adams DC, McDonagh DL, Rasmussen M. Effects of phenylephrine on systemic and cerebral circulations in humans: a systematic review with mechanistic explanations. Anaesthesia 2024; 79:71-85. [PMID: 37948131 DOI: 10.1111/anae.16172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
We conducted a systematic review of the literature reporting phenylephrine-induced changes in blood pressure, cardiac output, cerebral blood flow and cerebral tissue oxygen saturation as measured by near-infrared spectroscopy in humans. We used the proportion change of the group mean values reported by the original studies in our analysis. Phenylephrine elevates blood pressure whilst concurrently inducing a reduction in cardiac output. Furthermore, despite increasing cerebral blood flow, it decreases cerebral tissue oxygen saturation. The extent of phenylephrine's influence on cardiac output (r = -0.54 and p = 0.09 in awake humans; r = -0.55 and p = 0.007 in anaesthetised humans), cerebral blood flow (r = 0.65 and p = 0.002 in awake humans; r = 0.80 and p = 0.003 in anaesthetised humans) and cerebral tissue oxygen saturation (r = -0.72 and p = 0.03 in awake humans; r = -0.24 and p = 0.48 in anaesthetised humans) appears closely linked to the magnitude of phenylephrine-induced blood pressure changes. When comparing the effects of phenylephrine in awake and anaesthetised humans, we found no evidence of a significant difference in cardiac output, cerebral blood flow or cerebral tissue oxygen saturation. There was also no evidence of a significant difference in effect on systemic and cerebral circulations whether phenylephrine was given by bolus or infusion. We explore the underlying mechanisms driving the phenylephrine-induced cardiac output reduction, cerebral blood flow increase and cerebral tissue oxygen saturation decrease. Individualised treatment approaches, close monitoring and consideration of potential risks and benefits remain vital to the safe and effective use of phenylephrine in acute care.
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Affiliation(s)
- L Meng
- Department of Anesthesia, Indiana University School of Medicine, IA, Indianapolis, USA
| | - Y Sun
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - X Zhao
- Department of Anesthesiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - D M Meng
- Choate Rosemary Hall School, CT, Wallingford, USA
| | - Z Liu
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, IA, Indianapolis, USA
| | - D C Adams
- Department of Anesthesia, Indiana University School of Medicine, IA, Indianapolis, USA
| | - D L McDonagh
- Departments of Anesthesiology and Pain Management, Neurological Surgery, Neurology and Neurotherapeutics, UT Southwestern Medical Center, TX, Dallas, USA
| | - M Rasmussen
- Department of Anesthesiology, Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark
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Ochiai R, Terada T, Sakamoto N. Comparative evaluation of stroke volume variation measured by pulse wave transit time and arterial pressure wave. Technol Health Care 2024; 32:651-662. [PMID: 37483029 PMCID: PMC10977375 DOI: 10.3233/thc-220849] [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: 12/11/2022] [Accepted: 05/15/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Several monitors have been developed that measure stroke volume (SV) in a beat-to-beat manner. Accordingly, Stroke volume variation (SVV) induced by positive pressure ventilation is widely used to predict fluid responsiveness. OBJECTIVE The purpose of this study was to compare the ability of two different methods to predict fluid responsiveness using SVV, stroke volume variation by esCCO (esSVV) and stroke volume variation by FloTrac/VigileoTM (flSVV). METHODS esSVV, flSVV, and stroke volume index (SVI) by both monitoring devices of 37 adult patients who underwent laparotomy surgery, were measured. Receiver operating characteristic (ROC) analysis was performed. RESULTS The area under the ROC curve (AUC) of esSVV was significantly higher than that of flSVV (p= 0.030). esSVV and flSVV showed cutoff values of 6.1% and 10% respectively, to predict an increase of more than 10% in SVI after fluid challenge. The Youden index for esSVV was higher than flSVV, even with a cutoff value between 6% and 8%. CONCLUSION Since esSVV and flSVV showed significant differences in AUC and cutoff values, the two systems were not comparable in predicting fluid responsiveness. Furthermore, it seems that SVV needs to be personalized to accurately predict fluid responsiveness for each patient.
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Affiliation(s)
| | - Takashi Terada
- Department of Anesthesiology, Japan Community Health Care Organization Mishima General Hospital, Fujikubo, Mishima, Japan
| | - Noriaki Sakamoto
- Department of Anesthesiology, Toho University Omori Medical Centre, Oota, Japan
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Shi Y, Zhu B, Zhang Y, Huang Y. Anesthetic management of a huge retroperitoneal leiomyoma: a case report. Perioper Med (Lond) 2023; 12:64. [PMID: 38017529 PMCID: PMC10683212 DOI: 10.1186/s13741-023-00352-w] [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: 08/21/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Retroperitoneal leiomyomas are rare, with just over 100 cases reported in the literature. Perioperative management of retroperitoneal leiomyomas can be challenging due to the large tumor size and the risk of hemorrhage. CASE PRESENTATION We report a case of a 40-year-old Han woman with a 40-cm retroperitoneal leiomyoma. General anesthesia was performed for the surgical resection. Key flow parameters like cardiac output and stroke volume variation, as shown by the Vigileo™-FloTrac™ system, enabled the anesthesiologist to implement goal-directed fluid optimization. Acute normovolemic hemodilution and cell salvage technique were used resulting in a successful en bloc tumor resection with a 6000-mL estimated blood loss. Although the patient experienced postoperative bowel obstruction, no other significant complications were observed. CONCLUSION Advanced hemodynamic monitoring and modern patient blood management strategies are particularly helpful for anesthetic management of huge retroperitoneal leiomyomas.
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Affiliation(s)
- Yue Shi
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Bo Zhu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yu Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
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Belin O, Casteres C, Alouini S, Le Pape M, Dupont A, Boulain T. Manually Controlled, Continuous Infusion of Phenylephrine or Norepinephrine for Maintenance of Blood Pressure and Cardiac Output During Spinal Anesthesia for Cesarean Delivery: A Double-Blinded Randomized Study. Anesth Analg 2023; 136:540-550. [PMID: 36279409 DOI: 10.1213/ane.0000000000006244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND To counteract the vasoplegia induced by spinal anesthesia (SA) and maintain blood pressure (BP) during cesarean delivery, phenylephrine is currently recommended, but norepinephrine might offer superior preservation of cardiac output. We aimed to compare the hemodynamic effects of phenylephrine and norepinephrine administered by manually adjusted continuous infusion during elective cesarean delivery. METHODS In this pragmatic, parallel-group, double-blind randomized controlled trial, 124 parturients scheduled for elective cesarean delivery under SA in a tertiary maternity in France, between February 2019 and December 2020, were randomized to receive norepinephrine at a starting rate of 0.05 μg·kg -1 ·min -1 (n = 62) or phenylephrine at a starting rate of 0.5 μg·kg -1 ·min -1 (n = 62). In both groups, the vasopressor infusion rate was then manually adjusted to maintain maternal systolic BP above 90% of the baseline value. The primary outcome, the change in cardiac index (CI) measured by thoracic bioreactance from SA to umbilical cord clamping, was analyzed through repeated measures analysis of variance and post hoc t tests. Secondary outcomes included maternal BP and neonatal outcomes. RESULTS In the norepinephrine group, cardiac index was maintained between 90% and 100% of baseline from SA to umbilical cord clamping, whereas it was maintained at significantly lower values (81%-88%) in the phenylephrine group ( P = .001). The percentage of elapsed time with a mean maternal BP <65 mm Hg and with systolic BP <80% of the baseline value was higher in the phenylephrine group: 2.9% (7.3) vs 0.5% (1.8) (absolute risk difference [ARD], -2.4%; 95% confidence interval, -4.4 to -0.5; P = .012) and 8.5% (16.6) vs 2.3% (5.2) (ARD, -6.2%; 95% confidence interval, -10.6 to -1.8; P = .006). Excluding parturients with gestational diabetes, severe neonatal hypoglycemia was more common in the phenylephrine group at 19.6% (9/46) vs 4.1% (2/49) ( P = .02). The other neonatal outcomes did not differ significantly between the groups. CONCLUSIONS When administered by manually adjusted infusion during SA for cesarean delivery, norepinephrine was associated with a higher CI; both infusions were effective for maintaining BP.
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Affiliation(s)
| | | | | | | | | | - Thierry Boulain
- Medical Intensive Care Unit, Centre Hospitalier Régional d'Orléans, Orléans, France
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Fiorelli S, Capua G, Menna C, Andreetti C, Giorni E, Riva E, Agostini E, D'Andrea F, Massullo E, Peritore V, Rocco M, Massullo D. Intraoperative cardiac function assessment by transesophageal echocardiography versus FloTrac/Vigileo™ system during pectus excavatum surgical repair. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2021; 1:21. [PMID: 37386660 DOI: 10.1186/s44158-021-00025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/23/2021] [Indexed: 07/01/2023]
Abstract
BACKGROUND Pectus excavatum (PE), a congenital deformity of the chest wall, can lead to cardiac compression and related symptoms. PE surgical repair can improve cardiac function. Intraoperative transesophageal echocardiography (TEE) has been successfully employed to assess intraoperative hemodynamic variations in patients undergoing PE repair. FloTrac/Vigileo™ system (Edwards Life-sciences Irvine, CA) (FT/V) is a minimally invasive cardiac output monitoring system. This retrospective study aimed to assess hemodynamic changes in surgical repair of PE using FT/V and concordance with parameters measured by TEE. RESULTS N=19 patients submitted to PE repair via Ravitch or Nuss technique were enrolled. Intraoperative cardiac assessments simultaneously obtained via TEE and FT/V system were investigated. The agreement between TEE-derived cardiac output (CO-TEE) and FT/V system parameter (COAP) was evaluated. The relationship between COTEE and COAP was analyzed for all data using linear regression analysis. A significant correlation between COAP and COTEE values (R = 0.65, p < 0.001) was found. Bland-Altman analysis of COAP and COTEE showed a bias of 0.13 L/min and a limit of agreement of - 2.33 to 2.58 L/min, with a percentage error of 48%. Intraoperative measurements by TEE and FT/V both showed a significant increase in CO after surgical correction of PE (p < 0.005). CONCLUSIONS FT/V system compared to TEE in hemodynamic monitoring during PE surgery yielded clinically unacceptable results due to a high percentage error. After surgical correction of PE, CO, measured by TEE and FT/V, significantly improved.
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Affiliation(s)
- Silvia Fiorelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy.
| | - Gelsomina Capua
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy
| | - Cecilia Menna
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Rome, Italy
| | - Claudio Andreetti
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Rome, Italy
| | - Elisabetta Giorni
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy
| | - Ettore Riva
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy
| | - Elisabetta Agostini
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy
| | - Fabrizio D'Andrea
- Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome, Via di Grottarossa, 1035 00189, Rome, Italy
| | - Elisa Massullo
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Rome, Italy
| | - Valentina Peritore
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Rome, Italy
| | - Monica Rocco
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy
| | - Domenico Massullo
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy
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Reshetnik A, Gjolli J, van der Giet M, Compton F. Non-invasive Oscillometry-Based Estimation of Cardiac Output - Can We Use It in Clinical Practice? Front Physiol 2021; 12:704425. [PMID: 34413788 PMCID: PMC8369501 DOI: 10.3389/fphys.2021.704425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022] Open
Abstract
While invasive thermodilution techniques remain the reference methods for cardiac output (CO) measurement, there is a currently unmet need for non-invasive techniques to simplify CO determination, reduce complications related to invasive procedures required for indicator dilution CO measurement, and expand the application field toward emergency room, non-intensive care, or outpatient settings. We evaluated the performance of a non-invasive oscillometry-based CO estimation method compared to transpulmonary thermodilution. To assess agreement between the devices, we used Bland–Altman analysis. Four-quadrant plot analysis was used to visualize the ability of Mobil-O-Graph (MG) to track CO changes after a fluid challenge. Trending analysis of CO trajectories was used to compare MG and PiCCO® calibrated pulse wave analysis over time (6 h). We included 40 patients from the medical intensive care unit at the Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin between November 2019 and June 2020. The median age was 73 years. Forty percent of the study population was male; 98% was ventilator-dependent and 75% vasopressor-dependent at study entry. The mean of the observed differences for the cardiac output index (COI) was 0.7 l∗min–1*m–2 and the lower, and upper 95% limits of agreement (LOA) were -1.9 and 3.3 l∗min–1*m–2, respectively. The 95% confidence interval for the LOA was ± 0.26 l∗min–1*m–2, the percentage error 83.6%. We observed concordant changes in CO with MG and PiCCO® in 50% of the measurements after a fluid challenge and over the course of 6 h. Cardiac output calculation with a novel oscillometry-based pulse wave analysis method is feasible and replicable in critically ill patients. However, we did not find clinically applicable agreement between MG and thermodilution or calibrated pulse wave analysis, respectively, assessed with established evaluation routine using the Bland–Altman approach and with trending analysis methods. In summary, we do not recommend the use of this method in critically ill patients at this time. As the basic approach is promising and the CO determination with MG very simple to perform, further studies should be undertaken both in hemodynamically stable patients, and in the critical care setting to allow additional adjustments of the underlying algorithm for CO estimation with MG.
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Affiliation(s)
- Alexander Reshetnik
- Department of Nephrology and Intensive Care Medicine, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jonida Gjolli
- Department of Nephrology and Intensive Care Medicine, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus van der Giet
- Department of Nephrology and Intensive Care Medicine, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Friederike Compton
- Department of Nephrology and Intensive Care Medicine, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Szabo C, Betances-Fernandez M, Navas-Blanco JR, Modak RK. PRO: The pulmonary artery catheter has a paramount role in current clinical practice. Ann Card Anaesth 2021; 24:4-7. [PMID: 33938823 PMCID: PMC8081135 DOI: 10.4103/aca.aca_125_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ever since its clinical introduction, the utilization of the pulmonary artery catheter (PAC) has been surrounded by multiple controversies, mostly related to imprecise clinical indications and the complications derived from its placement. Currently, one of the most important criticisms of the PAC is the ambiguity in the interpretation of its hemodynamic measurements and therefore, in the translation of this data into specific therapeutic interventions. The popularity of the PAC stems from the fact that it provides hemodynamic data that cannot be obtained from clinical examination. The assumption is that this information would allow better understanding of the individual's hemodynamic profile which would trigger therapeutic interventions that improve patient outcomes. Nevertheless, even with the current diversity of hemodynamic devices available, the PAC remains a valuable tool in a wide variety of clinical settings. The authors present a review exposing the benefits of the PAC, current clinical recommendations for its use, mortality and survival profile, its role in goal-directed therapy, and other applications of the PAC beyond cardiac surgery and the intensive care unit.
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Affiliation(s)
- Christian Szabo
- Department of Anesthesia, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Maria Betances-Fernandez
- Department of Anesthesia, Pain Management and Perioperative Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jose R Navas-Blanco
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Raj K Modak
- Department of Anesthesia, Pain Management and Perioperative Medicine, Divisions of Cardiothoracic Anesthesia and Critical Care Anesthesiology, Henry Ford Hospital, Detroit, Michigan, USA
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Technological Assessment and Objective Evaluation of Minimally Invasive and Noninvasive Cardiac Output Monitoring Systems. Anesthesiology 2020; 133:921-928. [PMID: 32773696 DOI: 10.1097/aln.0000000000003483] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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10
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Effects of dobutamine and phenylephrine on cerebral perfusion in patients undergoing cerebral bypass surgery: a randomised crossover trial. Br J Anaesth 2020; 125:539-547. [PMID: 32718724 PMCID: PMC7565906 DOI: 10.1016/j.bja.2020.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/20/2020] [Accepted: 05/13/2020] [Indexed: 01/22/2023] Open
Abstract
Background Patients undergoing cerebral bypass surgery are prone to cerebral hypoperfusion. Currently, arterial blood pressure is often increased with vasopressors to prevent cerebral ischaemia. However, this might cause vasoconstriction of the graft and cerebral vasculature and decrease perfusion. We hypothesised that cardiac output, rather than arterial blood pressure, is essential for adequate perfusion and aimed to determine whether dobutamine administration resulted in greater graft perfusion than phenylephrine administration. Methods This randomised crossover study included 10 adult patients undergoing cerebral bypass surgery. Intraoperatively, patients randomly and sequentially received dobutamine to increase cardiac index or phenylephrine to increase mean arterial pressure (MAP). An increase of >10% in cardiac index or >10% in MAP was targeted, respectively. Before both interventions, a reference phase was implemented. The primary outcome was the absolute difference in graft flow between the reference and intervention phase. We compared the absolute flow difference between each intervention and constructed a random-effect linear regression model to explore treatment and carry-over effects. Results Graft flow increased with a median of 4.1 (inter-quartile range [IQR], 1.7–12.0] ml min−1) after dobutamine administration and 3.6 [IQR, 1.3–7.8] ml min−1 after phenylephrine administration (difference –0.6 ml min−1; 95% confidence interval [CI], –14.5 to 5.3; P=0.441). There was no treatment effect (0.9 ml min−1; 95% CI, 0.0–20.1; P=0.944) and no carry-over effect. Conclusions Both dobutamine and phenylephrine increased graft flow during cerebral bypass surgery, without a preference for one method over the other. Clinical trial registration Netherlands Trial Register, NL7077 (https://www.trialregister.nl/trial/7077).
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Su Y, Liu K, Zheng JL, Li X, Zhu DM, Zhang Y, Zhang YJ, Wang CS, SHI TT, Luo Z, Tu GW. Hemodynamic monitoring in patients with venoarterial extracorporeal membrane oxygenation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:792. [PMID: 32647717 PMCID: PMC7333156 DOI: 10.21037/atm.2020.03.186] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an effective mechanical circulatory support modality that rapidly restores systemic perfusion for circulatory failure in patients. Given the huge increase in VA-ECMO use, its optimal management depends on continuous and discrete hemodynamic monitoring. This article provides an overview of VA-ECMO pathophysiology, and the current state of the art in hemodynamic monitoring in patients with VA-ECMO.
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Affiliation(s)
- Ying Su
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Kai Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ji-Li Zheng
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xin Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Du-Ming Zhu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ying Zhang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yi-Jie Zhang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chun-Sheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Tian-Tian SHI
- Department of medicine, Yale New Haven Health/Bridgeport Hospital, Bridgeport, USA
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Bubenek-Turconi ŞI, Văleanu L, Popescu M, Panaitescu E, Tomescu D, Cacoveanu MC, Perel A. Continuous Noninvasive Hemoglobin Monitoring Reflects the Development of Acute Hemodilution After Consecutive Fluid Challenges. Anesth Analg 2020; 130:696-703. [PMID: 31306244 DOI: 10.1213/ane.0000000000004323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Consecutive fluid challenges (FCs) are frequently administered to maximize the stroke volume (SV) as part of a goal-directed therapy (GDT) strategy. However, fluid administration may also cause acute hemodilution that might lead to an actual paradoxical decrease in oxygen delivery (DO2). The aim of this study was to examine whether continuous noninvasive hemoglobin (SpHb) monitoring can be used to detect the development of acute hemodilution after graded fluid administration. METHODS In 40 patients who underwent major vascular or gastrointestinal surgery, an FC, consisting of 250 mL colloid solution, was administered. When the SV increased by ≥10%, the FC was repeated up to a maximum of 3 times. Laboratory-measured hemoglobin concentrations (BHb), SpHb, SV, cardiac output (CO), and DO2 values were recorded after each FC. RESULTS All 40 patients received the first FC, 32 patients received the second FC, and 20 patients received the third FC (total of 750 mL). Out of the 92 administered FCs, only 55 (60%) caused an increase in SV ≥10% ("responders"). The first and the second FCs were associated with a significant increase in the mean CO and DO2, while the mean SpHb and BHb decreased significantly. However, the third and last FC was associated with no statistical difference in CO and SV, a further significant decrease in mean SpHb and BHb, and a significant decrease in DO2 in these patients. Compared to their baseline values (T0), BHb and SpHb decreased by a mean of 5.3% ± 4.9% and 4.4% ± 5.2%, respectively, after the first FC (T1; n = 40), by 9.7% ± 8.4% and 7.9% ± 6.9% after the second FC (T2; n = 32), and by 14.5% ± 6.2% and 14.6% ± 5.7% after the third FC (T3; n = 20). Concordance rates between the changes in SpHb and in BHb after the administration of 250, 500, and 750 mL colloids were 83%, 90%, and 100%, respectively. CONCLUSIONS Fluid loading aimed at increasing the SV and the DO2 as part of GDT strategy is associated with acute significant decreases in both BHb and SpHb concentrations. When the administration of an FC is not followed by a significant increase (≥10%) in the SV, the DO2 decreases significantly due to the development of acute hemodilution. Continuous noninvasive monitoring of SpHb does not reflect accurately absolute BHb values, but may be reliably used to detect the development of acute hemodilution especially after the administration of at least 500 mL of colloids.
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Affiliation(s)
- Şerban Ion Bubenek-Turconi
- From the Department of Anesthesiology and Intensive Care, Fundeni Clinic, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,1st Department of Cardiovascular Anesthesiology and Intensive Care, Prof. C.C. Iliescu Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Liana Văleanu
- From the Department of Anesthesiology and Intensive Care, Fundeni Clinic, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,1st Department of Cardiovascular Anesthesiology and Intensive Care, Prof. C.C. Iliescu Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Mihai Popescu
- From the Department of Anesthesiology and Intensive Care, Fundeni Clinic, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Eugenia Panaitescu
- Department of Marketing, Technology and Medical Informatics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Dana Tomescu
- From the Department of Anesthesiology and Intensive Care, Fundeni Clinic, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai Cătălin Cacoveanu
- 1st Department of Cardiovascular Anesthesiology and Intensive Care, Prof. C.C. Iliescu Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Azriel Perel
- Department of Anesthesiology and Critical Care, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
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Ho AMH, Mizubuti GB. Co-induction with a vasopressor "chaser" to mitigate propofol-induced hypotension when intubating critically ill/frail patients-A questionable practice. J Crit Care 2019; 54:256-260. [PMID: 31630076 DOI: 10.1016/j.jcrc.2019.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/14/2019] [Accepted: 09/11/2019] [Indexed: 11/19/2022]
Abstract
Prophylactic administration of a vasopressor to mitigate the hypotensive effect of propofol (and/or other co-induction agents) during sedation/anesthesia immediately prior to tracheal intubation in frail patients in the intensive care unit and emergency and operating rooms appears to be not an uncommon practice. We submit that this practice is unnecessary and potentially harmful. Despite restoring the blood pressure, phenylephrine, for instance, may have an additive or synergistic effect with propofol in reducing the cardiac output and, ultimately, organ perfusion. Airway instrumentation often leads to sympathetic activation and hypertension (thereby increasing myocardial oxygen consumption) which may be exacerbated by an arbitrary prophylactic dose of phenylephrine. Finally, in spite of the well-recognized need to reduce dosages of propofol in frail patients, excessive doses are commonly given, leading to hypotension. We herein discuss each of these points and suggest alternative techniques to promote a stable induction in frail patients.
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Affiliation(s)
- Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada
| | - Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
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Bubenek-Turconi ŞI, Hendy A, Băilă S, Drăgan A, Chioncel O, Văleanu L, Moroșanu B, Iliescu VA. The value of a superior vena cava collapsibility index measured with a miniaturized transoesophageal monoplane continuous echocardiography probe to predict fluid responsiveness compared to stroke volume variations in open major vascular surgery: a prospective cohort study. J Clin Monit Comput 2019; 34:491-499. [PMID: 31278544 PMCID: PMC7223808 DOI: 10.1007/s10877-019-00346-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/27/2019] [Indexed: 11/28/2022]
Abstract
Superior vena cava collapsibility index (SVC-CI) and stroke volume variation (SVV) have been shown to predict fluid responsiveness. SVC-CI has been validated only with conventional transoesophageal echocardiography (TEE) in the SVC long axis, on the basis of SVC diameter variations, but not in the SVC short axis or by SVC area variations. SVV was not previously tested in vascular surgery patients. Forty consecutive adult patients undergoing open major vascular surgical procedures received 266 intraoperative volume loading tests (VLTs), with 500 ml of gelatine over 10 min. The hSVC-CI was measured using a miniaturized transoesophageal echocardiography probe (hTEE). The SVV and cardiac index (CI) were measured using Vigileo-FloTrac technology. VLTs were considered 'positive' (≥ 11% increase in CI) or 'negative' (< 11% increase in CI). We compared SVV and hSVC-CI measurements in the SVC short axis to predict fluid responsiveness. Areas under the receiver operating characteristic curves for hSVC-CI and SVV were not significantly different (P = 0.56), and both showed good predictivity at values of 0.92 (P < 0.001) and 0.89 (P < 0.001), respectively. The cutoff values for hSVC-CI and SVV were 37% (sensitivity 90%, specificity of 83%) and 15% (sensitivity 78%, specificity of 100%), respectively. Our study validated the value of the SVC-CI measured as area variations in the SVC short axis to predict fluid responsiveness in anesthetized patients. An hTEE probe was used to monitor and measure the hSVC-CI but conventional TEE may also offer this new dynamic parameter. In our cohort of significant preoperative hypovolemic patients undergoing major open vascular surgery, hSVC-CI and SVV cutoff values of 37% and 15%, respectively, predicted fluid responsiveness with good accuracy.
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Affiliation(s)
- Şerban-Ion Bubenek-Turconi
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bulevardul Eroii Sanitari Nr. 8, 050474, Bucharest, Romania. .,1-st Department of Cardiovascular Anaesthesiology and Intensive Care, "Prof. C. C. Iliescu" Emergency Institute for Cardiovascular Diseases, Șos. Fundeni Nr. 258, 022328, Bucharest, Romania.
| | - Adham Hendy
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bulevardul Eroii Sanitari Nr. 8, 050474, Bucharest, Romania
| | - Sorin Băilă
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bulevardul Eroii Sanitari Nr. 8, 050474, Bucharest, Romania.,Department of Cardiovascular Surgery, "Prof. C. C. Iliescu" Emergency Institute for Cardiovascular Diseases, Șos. Fundeni Nr. 258, 022328, Bucharest, Romania
| | - Anca Drăgan
- 1-st Department of Cardiovascular Anaesthesiology and Intensive Care, "Prof. C. C. Iliescu" Emergency Institute for Cardiovascular Diseases, Șos. Fundeni Nr. 258, 022328, Bucharest, Romania
| | - Ovidiu Chioncel
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bulevardul Eroii Sanitari Nr. 8, 050474, Bucharest, Romania.,1-st Department of Cardiology, "Prof. C. C. Iliescu" Emergency Institute for Cardiovascular Diseases, Șos. Fundeni Nr. 258, 022328, Bucharest, Romania
| | - Liana Văleanu
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bulevardul Eroii Sanitari Nr. 8, 050474, Bucharest, Romania.,1-st Department of Cardiovascular Anaesthesiology and Intensive Care, "Prof. C. C. Iliescu" Emergency Institute for Cardiovascular Diseases, Șos. Fundeni Nr. 258, 022328, Bucharest, Romania
| | - Bianca Moroșanu
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bulevardul Eroii Sanitari Nr. 8, 050474, Bucharest, Romania.,1-st Department of Cardiovascular Anaesthesiology and Intensive Care, "Prof. C. C. Iliescu" Emergency Institute for Cardiovascular Diseases, Șos. Fundeni Nr. 258, 022328, Bucharest, Romania
| | - Vlad-Anton Iliescu
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bulevardul Eroii Sanitari Nr. 8, 050474, Bucharest, Romania.,Department of Cardiovascular Surgery, "Prof. C. C. Iliescu" Emergency Institute for Cardiovascular Diseases, Șos. Fundeni Nr. 258, 022328, Bucharest, Romania
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Eisenried A, Klarwein R, Ihmsen H, Wehrfritz A, Tandler R, Heim C, Fechner J. Accuracy and Trending Ability of the Fourth-Generation FloTrac/EV1000 System in Patients With Severe Aortic Valve Stenosis Before and After Surgical Valve Replacement. J Cardiothorac Vasc Anesth 2019; 33:1230-1236. [DOI: 10.1053/j.jvca.2018.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Indexed: 11/11/2022]
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16
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Kusaka Y, Ohchi F, Minami T. Evaluation of the Fourth-Generation FloTrac/Vigileo System in Comparison With the Intermittent Bolus Thermodilution Method in Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:953-960. [DOI: 10.1053/j.jvca.2018.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Indexed: 11/11/2022]
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17
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Goal-directed therapy during transthoracic oesophageal resection does not improve outcome. Eur J Anaesthesiol 2019; 36:153-161. [DOI: 10.1097/eja.0000000000000908] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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18
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Evaluation of cardiac output variations with the peripheral pulse pressure to mean arterial pressure ratio. J Clin Monit Comput 2018; 33:581-587. [PMID: 30361823 DOI: 10.1007/s10877-018-0210-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
Cardiac output (CO) optimisation during surgery reduces post-operative morbidity. Various methods based on pulse pressure analysis have been developed to overcome difficulties to measure accurate CO variations in standard anaesthetic settings. Several of these methods include, among other parameters, the ratio of pulse pressure to mean arterial pressure (PP/MAP). The aim of this study was to evaluate whether the ratio of radial pulse pressure to mean arterial pressure (ΔPPrad/MAP) could track CO variations (ΔCO) induced by various therapeutic interventions such as fluid infusions and vasopressors boluses [phenylephrine (PE), norepinephrine (NA) or ephedrine (EP)] in the operating room. Trans-oesophageal Doppler signal and pressure waveforms were recorded in patients undergoing neurosurgery. CO and PPrad/MAP were recorded before and after fluid challenges, PE, NA and EP bolus infusions as medically required during their anaesthesia. One hundred and three patients (mean age: 52 ± 12 years old, 38 men) have been included with a total of 636 sets of measurement. During fluids challenges (n = 188), a positive correlation was found between ΔPPrad/MAP and ΔCO (r = 0.22, p = 0.003). After PE (n = 256) and NA (n = 121) boluses, ΔPPrad/MAP positively tracked ΔCO (r = 0.53 and 0.41 respectively, p < 0.001). By contrast, there was no relation between ΔPPrad/MAP and ΔCO after EP boluses (r = 0.10, p = 0.39). ΔPPrad/MAP tracked ΔCO variations during PE and NA vasopressor challenges. However, after positive fluid challenge or EP boluses, ΔPPrad/MAP was not as performant to track ΔCO which could make the use of this ratio difficult in current clinical practice.
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20
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Alternatives to the Swan–Ganz catheter. Intensive Care Med 2018; 44:730-741. [DOI: 10.1007/s00134-018-5187-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/18/2018] [Indexed: 12/12/2022]
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21
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Jalil B, Thompson P, Cavallazzi R, Marik P, Mann J, El-Kersh K, Guardiola J, Saad M. Comparing Changes in Carotid Flow Time and Stroke Volume Induced by Passive Leg Raising. Am J Med Sci 2018; 355:168-173. [DOI: 10.1016/j.amjms.2017.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 01/25/2023]
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22
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Preload dependency determines the effects of phenylephrine on cardiac output in anaesthetised patients: A prospective observational study. Eur J Anaesthesiol 2018; 33:638-44. [PMID: 27164015 DOI: 10.1097/eja.0000000000000470] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Although phenylephrine is widely used in the operating room to control arterial pressure, its haemodynamic effects remain controversial. OBJECTIVE We hypothesised that the effect of phenylephrine on cardiac output is affected by preload dependency. DESIGN A prospective observational study. SETTING Single-centre, University Hospital of Caen, France. PATIENTS Fifty ventilated patients undergoing surgery were studied during hypotension before and after administration of phenylephrine. MAIN OUTCOME MEASURES Cardiac index (CI), stroke volume (SV), corrected flow time, mean arterial pressure, pulse pressure variations (PPV) and systemic vascular resistance index were used to assess effects of changes in preload dependency. RESULTS Twenty seven (54%) patients were included in the preload-dependent group (PPV ≥ 13%) and 23 (46%) in the preload-independent group (PPV < 13%) before administration of phenylephrine. For the whole cohort, phenylephrine increased mean arterial pressure [58 (±8) mmHg vs. 79 (±13) mmHg; P < 0.0001] and calculated systemic vascular resistance index [2010 (1338; 2481) dyn s cm m vs. 2989 (2155; 3870) dyn s cm m; P < 0.0001]. However, CI and SV decreased in the preload-independent group [2.3 (1.9; 3.7) l min m vs. 1.8 (1.5; 2.7) l min m; P < 0.0001 and 65 (44; 81) ml vs. 56 (39; 66) ml; P < 0.0001 for both] but not in the preload-dependent group [respectively 2.1 (1.8; 3.5) l min m vs. 2.1 (1.8; 3.3) l min m; P = 0.168 and 49 (41; 67) ml vs. 53 (41; 69) ml; P = 0.191]. Corrected flow time increased [294 (47) ms vs. 306 (56) ms; P = 0.031], and PPV decreased [17 (15; 19) % vs.12 (14; 16) %; P < 0.0003] only in the PPV at least 13% group. CONCLUSION The effects of phenylephrine on CI and SV depend on preload. CI and SV decreased in preload-independent patients through increase in afterload, but were unchanged in those preload-dependent through increased venous return.
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Plurad DS, Chiu W, Raja AS, Galvagno SM, Khan U, Kim DY, Tisherman SA, Ward J, Hamill ME, Bennett V, Williams B, Robinson B. Monitoring modalities and assessment of fluid status: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2018; 84:37-49. [PMID: 29019796 DOI: 10.1097/ta.0000000000001719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fluid administration in critically ill surgical patients must be closely monitored to avoid complications. Resuscitation guided by invasive methods are not consistently associated with improved outcomes. As such, there has been increased use of focused ultrasound and Arterial Pulse Waveform Analysis (APWA) to monitor and aid resuscitation. An assessment of these methods using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework is presented. METHODS A subsection of the Surgical Critical Care Task Force of the Practice Management Guideline Committee of EAST conducted two systematic reviews to address the use of focused ultrasound and APWA in surgical patients being evaluated for shock. Six population, intervention, comparator, and outcome (PICO) questions were generated. Critical outcomes were prediction of fluid responsiveness, reductions in organ failures or complications and mortality. Forest plots were generated for summary data and GRADE methodology was used to assess for quality of the evidence. Reviews are registered in PROSPERO, the International Prospective Register of Systematic Reviews (42015032402 and 42015032530). RESULTS Twelve focused ultrasound studies and 20 APWA investigations met inclusion criteria. The appropriateness of focused ultrasound or APWA-based protocols to predict fluid responsiveness varied widely by study groups. Results were mixed in the one focused ultrasound study and 9 APWA studies addressing reductions in organ failures or complications. There was no mortality advantage of either modality versus standard care. Quality of the evidence was considered very low to low across all PICO questions. CONCLUSION Focused ultrasound and APWA compare favorably to standard methods of evaluation but only in specific clinical settings. Therefore, conditional recommendations are made for the use of these modalities in surgical patients being evaluated for shock. LEVEL OF EVIDENCE Systematic Review, level II.
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Affiliation(s)
- David S Plurad
- From the Department of Surgery (D.S.P., D.Y.K.), Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Torrance, California; Department of Surgery (W.C., S.A.T.), University of Maryland School of Medicine, Baltimore, Maryland; Department of Emergency Medicine (A.S.R.), Harvard School of Medicine, Boston, Massachusetts; Department of Anesthesiology (S.M.G.), University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery (U.K.), West Virginia University School of Medicine, Morgantown, West Virginia; Department of Surgery (J.W.), Baylor College of Medicine, Houston, Texas; Department of Surgery (M.A.H.), Carilion Clinic, Roanoke, Virginia; Banner Health (V.B.), Phoenix, Arizona; Department of Surgery (B.W.), University of Texas Southwestern, Dallas, Texas; and Department of Surgery (B.R.), University of Washington, Seattle, Washington
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The physiologic basis for goal-directed hemodynamic and fluid therapy: the pivotal role of the venous circulation. Can J Anaesth 2017; 65:294-308. [DOI: 10.1007/s12630-017-1045-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 02/05/2023] Open
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Lighthall GK, Singh S. Perioperative Maintenance of Tissue Perfusion and Cardiac Output in Cardiac Surgery Patients. Semin Cardiothorac Vasc Anesth 2017; 18:117-36. [PMID: 24876228 DOI: 10.1177/1089253214534781] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Sumit Singh
- University of California Los Angeles, CA, USA
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26
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Reply to: phenylephrine and cardiac output. Eur J Anaesthesiol 2017; 34:316. [PMID: 28375980 DOI: 10.1097/eja.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sørensen H, Thomsen JH, Meyer ASP, Terzic D, Hilsted L, Kjærgaard J, Goetze JP, Barbosa TC, Secher NH. Phenylephrine increases near-infrared spectroscopy determined muscle oxygenation in men. J Clin Monit Comput 2016; 31:1159-1166. [PMID: 27987104 DOI: 10.1007/s10877-016-9965-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/07/2016] [Indexed: 01/22/2023]
Abstract
Phenylephrine increases mean arterial pressure (MAP) by enhanced total peripheral resistance (TPR) but near-infrared spectroscopy (NIRS) determined muscle oxygenation (SmO2) increases. We addressed that apparent paradox during supine rest and head-up tilt (HUT). Variables were determined ± phenylephrine in males during supine rest (n = 17) and 40° HUT (n = 7). MAP, stroke volume (SV), heart rate (HR), and TPR were derived by Modelflow® and NIRS determined biceps SmO2 and (tibial) bone oxygenation (StibialO2). For ten subjects, cardiac filling and the diameter of the inferior caval vein (ICV collapsibility index: ((ICVexpiration - ICVinspiration)/ICVexpiration) × 100) were assessed by ultrasound. Pancreatic polypeptide (PP) and atrial natriuretic peptide (proANP) in plasma were determined by immunoassay. Brachial artery blood flow was assessed by ultrasound and skin oxygenation (SskinO2) monitored by white light spectroscopy. Phenylephrine increased MAP by 34% and TPR (62%; P < 0.001) during supine rest. The ICV collapsibility index decreased (24%; P < 0.001) indicating augmented cardiac preload although volume of the left atrium and ventricle did not change. SV increased (18%; P < 0.001) as HR decreased (24%; P < 0.001). ProANP increased by 9% (P = 0.002) with unaffected PP. Brachial artery blood flow tended to decrease while SskinO2 together with StibialO2 decreased by 11% (P = 0.026) and 20% (P < 0.001), respectively. Conversely, phenylephrine increased SmO2 (9%) and restored the HUT elicited decrease in SmO2 (by 19%) along with SV (P = 0.02). Phenylephrine reduces skin and bone oxygenation and tends to reduce arm blood flow, suggesting that the increase in SmO2 reflects veno-constriction with consequent centralization of the blood volume.
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Affiliation(s)
- H Sørensen
- Department of Anesthesia, The Copenhagen Muscle Research Centre, University of Copenhagen, Rigshospitalet 2043, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark.
| | - J H Thomsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A S P Meyer
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - D Terzic
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L Hilsted
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Kjærgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - T C Barbosa
- Laboratory of Exercise Sciences, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - N H Secher
- Department of Anesthesia, The Copenhagen Muscle Research Centre, University of Copenhagen, Rigshospitalet 2043, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
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Krige A, Bland M, Fanshawe T. Fluid responsiveness prediction using Vigileo FloTrac measured cardiac output changes during passive leg raise test. J Intensive Care 2016; 4:63. [PMID: 27721980 PMCID: PMC5052799 DOI: 10.1186/s40560-016-0188-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/27/2016] [Indexed: 12/16/2022] Open
Abstract
Background Passive leg raising (PLR) is a so called self-volume challenge used to test for fluid responsiveness. Changes in cardiac output (CO) or stroke volume (SV) measured during PLR are used to predict the need for subsequent fluid loading. This requires a device that can measure CO changes rapidly. The Vigileo™ monitor, using third-generation software, allows continuous CO monitoring. The aim of this study was to compare changes in CO (measured with the Vigileo device) during a PLR manoeuvre to calculate the accuracy for predicting fluid responsiveness. Methods This is a prospective study in a 20-bedded mixed general critical care unit in a large non-university regional referral hospital. Fluid responders were defined as having an increase in CO of greater than 15 % following a fluid challenge. Patients meeting the criteria for circulatory shock with a Vigileo™ monitor (Vigileo™; FloTrac; Edwards™; Lifesciences, Irvine, CA, USA) already in situ, and assessed as requiring volume expansion by the clinical team based on clinical criteria, were included. All patients underwent a PLR manoeuvre followed by a fluid challenge. Results Data was collected and analysed on stroke volume variation (SVV) at baseline and CO and SVV changes during the PLR manoeuvre and following a subsequent fluid challenge in 33 patients. The majority had septic shock. Patient characteristics, baseline haemodynamic variables and baseline vasoactive infusion requirements were similar between fluid responders (10 patients) and non-responders (23 patients). Peak increase in CO occurred within 120 s during the PLR in all cases. Using an optimal cut point of 9 % increase in CO during the PLR produced an area under the receiver operating characteristic curve of 0.85 (95 % CI 0.63 to 1.00) with a sensitivity of 80 % (95 % CI 44 to 96 %) and a specificity of 91 % (95 % CI 70 to 98 %). Conclusions CO changes measured by the Vigileo™ monitor using third-generation software during a PLR test predict fluid responsiveness in mixed medical and surgical patients with vasopressor-dependent circulatory shock. Electronic supplementary material The online version of this article (doi:10.1186/s40560-016-0188-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anton Krige
- Department of Anaesthesia and Critical Care, Royal Blackburn Hospital, Haslingden Road, Blackburn, UK
| | - Martin Bland
- Department of Anaesthesia and Critical Care, Royal Blackburn Hospital, Haslingden Road, Blackburn, UK
| | - Thomas Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Ripollés J, Espinosa A, Martínez‐Hurtado E, Abad‐Gurumeta A, Casans‐Francés R, Fernández‐Pérez C, López‐Timoneda F, Calvo‐Vecino JM. Terapia hemodinâmica alvo‐dirigida no intraoperatório de cirurgia não cardíaca: revisão sistemática e meta‐análise. Rev Bras Anestesiol 2016; 66:513-28. [DOI: 10.1016/j.bjan.2015.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/18/2015] [Indexed: 11/28/2022] Open
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Ripollés J, Espinosa A, Martínez-Hurtado E, Abad-Gurumeta A, Casans-Francés R, Fernández-Pérez C, López-Timoneda F, Calvo-Vecino JM. Intraoperative goal directed hemodynamic therapy in noncardiac surgery: a systematic review and meta-analysis. Braz J Anesthesiol 2016; 66:513-28. [DOI: 10.1016/j.bjane.2015.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/18/2015] [Indexed: 02/07/2023] Open
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Park JH, Hwang GS. Respiratory variation of systolic and diastolic time intervals within radial arterial waveform: a comparison with dynamic preload index. J Clin Anesth 2016; 32:75-81. [PMID: 27290951 DOI: 10.1016/j.jclinane.2015.12.022] [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: 08/20/2013] [Revised: 01/29/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND A blood pressure (BP) waveform contains various pieces of information related to respiratory variation. Systolic time interval (STI) reflects myocardial performance, and diastolic time interval (DTI) represents diastolic filling. This study examined whether respiratory variations of STI and DTI within radial arterial waveform are comparable to dynamic indices. METHODS During liver transplantation, digitally recorded BP waveform and stroke volume variation (SVV) were retrospectively analyzed. Beat-to-beat STI and DTI were extracted within each BP waveform, which were separated by dicrotic notch. Systolic time variation (STV) was calculated by the average of 3 consecutive respiratory cycles: [(STImax- STImin)/STImean]. Similar formula was used for diastolic time variation (DTV) and pulse pressure variation (PPV). Receiver operating characteristic analysis with area under the curve (AUC) was used to assess thresholds predictive of SVV ≥12% and PPV ≥12%. RESULTS STV and DTV showed significant correlations with SVV (r= 0.78 and r= 0.67, respectively) and PPV (r= 0.69 and r= 0.69, respectively). Receiver operating characteristic curves demonstrated that STV ≥11% identified to predict SVV ≥12% with 85.7% sensitivity and 89.3% specificity (AUC = 0.935; P< .001). DTV ≥11% identified to predict SVV ≥12% with 71.4% sensitivity and 85.7% specificity (AUC = 0.829; P< .001). STV ≥12% and DTV ≥11% identified to predict PPV ≥12% with an AUC of 0.881 and 0.885, respectively. CONCLUSION Respiratory variations of STI and DTI derived from radial arterial contour have a potential to predict hemodynamic response as a surrogate for SVV or PPV.
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Affiliation(s)
- Ji Hyun Park
- Department of Anesthesia and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gyu-Sam Hwang
- Department of Anesthesia and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Xia J, Sun Y, Yuan J, Lu X, Peng Z, Yin N. Hemodynamic effects of ephedrine and phenylephrine bolus injection in patients in the prone position under general anesthesia for lumbar spinal surgery. Exp Ther Med 2016; 12:1141-1146. [PMID: 27446334 DOI: 10.3892/etm.2016.3432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/14/2015] [Indexed: 11/05/2022] Open
Abstract
Ephedrine and phenylephrine (PE) are vasoconstrictors commonly used to restore the blood pressure (BP) to normal values. The aim of the present study was to investigate the effects of ephedrine and PE bolus administration on intra-arterial systolic BP (ISBP), intra-arterial diastolic BP (IDBP) and cardiac output (CO) in patients undergoing lumbar spine surgery in the prone position under general anesthesia (GA). In this prospective, randomized, and double-blind study, a total of 60 patients aged 20-60 years and undergoing elective lumbar spine surgery were administered either a single dose of ephedrine (0.1 mg/kg) or PE (1 µg/kg) through a central venous catheter as a bolus injection following the achievement of a stable hemodynamic status for ≥10 min. Following bolus injection of ephedrine or PE, a significant increase in ISBP was observed in the two experimental groups compared with pre-ephedrine and pre-PE values. The duration of the increment in ISBP however was significantly longer in the ephedrine group compared with the PE group. A similar response was observed in IDBP. A significant increase in CO began 1 min following ephedrine injection and lasted for the entire observation period, whereas the increase was only sustained for 3 min following bolus injection in the PE group. The results of the present study demonstrated that bolus ephedrine produces a more persistent pressor response and durable increase in CO and CI compared with PE when patients are in the prone position with GA for spine surgery.
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Affiliation(s)
- Jiangyan Xia
- Department of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Yongying Sun
- Department of Stomatology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Jing Yuan
- Department of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Xinjian Lu
- Department of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Zhendan Peng
- Department of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Ning Yin
- Department of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China
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Hodgson LE, Forni LG, Venn R, Samuels TL, Wakeling HG. A comparison of the non-invasive ultrasonic cardiac output monitor (USCOM) with the oesophageal Doppler monitor during major abdominal surgery. J Intensive Care Soc 2016; 17:103-110. [PMID: 28979473 DOI: 10.1177/1751143715610785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Perioperative interventions, targeted to increase global blood flow defined by explicit measured goals, reduce postoperative complications. Consequently, reliable non-invasive estimation of the cardiac output could have far-reaching benefit. METHODS This study compared a non-invasive Doppler device - the ultrasonic cardiac output monitor (USCOM) - with the oesophageal Doppler monitor (ODM), on 25 patients during major abdominal surgery. Stroke volume was determined by USCOM (SVUSCOM) and ODM (SVODM) pre and post fluid challenges. RESULTS A ≥ 10% change (Δ) SVUSCOM had a sensitivity of 94% and specificity of 88% to detect a ≥ 10% Δ SVODM; the area under the receiver operating curve was 0.94 (95% CI 0.90-0.99). Concordance was 98%, using an exclusion zone of <10% Δ SVODM. 135 measurements gave median SVUSCOM 80 ml (interquartile range 65-93 ml) and SVODM 86 ml (69-100 ml); mean bias was 5.9 ml (limits of agreement -20 to +30 ml) and percentage error 30%. CONCLUSIONS Following fluid challenges SVUSCOM showed good concordance and accurately discriminated a change ≥10% in SVODM.
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Affiliation(s)
- Luke E Hodgson
- Anaesthetics & Intensive Care Department, Western Sussex NHS Foundation Trust, Worthing, UK
| | - Lui G Forni
- Intensive Care Department, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Richard Venn
- Anaesthetics & Intensive Care Department, Western Sussex NHS Foundation Trust, Worthing, UK
| | - Theophilus L Samuels
- Intensive Care Department, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Howard G Wakeling
- Anaesthetics & Intensive Care Department, Western Sussex NHS Foundation Trust, Worthing, UK
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Phan TD, Kluger R, Wan C. Minimally Invasive Cardiac Output Monitoring: Agreement of Oesophageal Doppler, LiDCOrapid™ and Vigileo FloTrac™ Monitors in Non-Cardiac Surgery. Anaesth Intensive Care 2016; 44:382-90. [DOI: 10.1177/0310057x1604400313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is lack of data about the agreement of minimally invasive cardiac output monitors, which make it impossible to determine if they are interchangeable or differ objectively in tracking physiological trends. We studied three commonly used devices: the oesophageal Doppler and two arterial pressure–based devices, the Vigileo FloTrac™ and LiDCOrapid™. The aim of this study was to compare the agreement of these three monitors in adult patients undergoing elective non-cardiac surgery. Measurements were taken at baseline and after predefined clinical interventions of fluid, metaraminol or ephedrine bolus. From 24 patients, 131 events, averaging 5.2 events per patient, were analysed. The cardiac index of LiDCOrapid versus FloTrac had a mean bias of −6.0% (limits of agreement from −51% to 39%) and concordance of over 80% to the three clinical interventions. The cardiac index of Doppler versus LiDCOrapid and Doppler versus FloTrac, had an increasing negative bias at higher mean cardiac outputs and there was significantly poorer concordance to all interventions. Of the preload-responsive parameters, Doppler stroke volume index, Doppler systolic flow time and FloTrac stroke volume variation were fair at predicting fluid responsiveness while other parameters were poor. While there is reasonable agreement between the two arterial pressure–derived cardiac output devices (LiDCOrapid and Vigileo FloTrac), these two devices differ significantly to the oesophageal Doppler technology in response to common clinical intraoperative interventions, representing a limitation to how interchangeable these technologies are in measuring cardiac output.
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Affiliation(s)
- T. D. Phan
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria
| | - R. Kluger
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria
| | - C. Wan
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria
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Hendy A, Bubenek Ş. Pulse waveform hemodynamic monitoring devices: recent advances and the place in goal-directed therapy in cardiac surgical patients. Rom J Anaesth Intensive Care 2016; 23:55-65. [PMID: 28913477 DOI: 10.21454/rjaic.7518.231.wvf] [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] [Indexed: 11/27/2022] Open
Abstract
Hemodynamic monitoring has evolved and improved greatly during the past decades as the medical approach has shifted from a static to a functional approach. The technological advances have led to innovating calibrated or not, but minimally invasive and noninvasive devices based on arterial pressure waveform (APW) analysis. This systematic clinical review outlines the physiologic rationale behind these recent technologies. We describe the strengths and the limitations of each method in terms of accuracy and precision of measuring the flow parameters (stroke volume, cardiac output) and dynamic parameters which predict the fluid responsiveness. We also analyzed the place of the APW monitoring devices in goal-directed therapy (GDT) protocols in cardiac surgical patients. According to the data from the three GDT-randomized control trials performed in cardiac surgery (using two types of APW techniques PiCCO and FloTrac/Vigileo), these devices did not demonstrate that they played a role in decreasing mortality, but only decreasing the ventilation time and the ICU and hospital length of stay.
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Affiliation(s)
- Adham Hendy
- Carol Davila University of Medicine and Pharmacy, Bucharest, 1 Department of Cardiovascular Anaesthesia and Intensive Care, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Şerban Bubenek
- Carol Davila University of Medicine and Pharmacy, Bucharest, 1 Department of Cardiovascular Anaesthesia and Intensive Care, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
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Minimally invasive or noninvasive cardiac output measurement: an update. J Anesth 2016; 30:461-80. [DOI: 10.1007/s00540-016-2154-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 02/17/2016] [Indexed: 12/15/2022]
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Ha TN, van Renen RG, Ludbrook GL, Wormald PJ. The effect of blood pressure and cardiac output on the quality of the surgical field and middle cerebral artery blood flow during endoscopic sinus surgery. Int Forum Allergy Rhinol 2016; 6:701-9. [PMID: 26879693 DOI: 10.1002/alr.21728] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/03/2015] [Accepted: 12/10/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND A clear surgical field is critical during endoscopic sinus surgery (ESS). Hypotensive anesthesia and cardiac output (CO) may optimize the surgical field; however, evidence of their effect on bleeding and cerebral blood flow is conflicting. The aim of this study was to evaluate the effect of blood pressure (BP) and CO on intraoperative bleeding and middle cerebral artery blood flow velocity (Vmca ) during ESS. METHODS This was a prospective randomized controlled trial. Patients undergoing ESS for chronic rhinosinusitis at a tertiary institution in 2013 were randomized to receive BP manipulation using target-controlled noradrenaline infusion during surgery to either their left or right sinuses. The contralateral side in each patient served as control. Bleeding was scored using a 0 to 10 point bleeding assessment scale (BAS, 0-10) and Vmca was measured using transcranial Doppler ultrasonography every 10 minutes or when surgically opportune, and time-matched with BP and CO. Data was analyzed using Bland-Altman methods. RESULTS A total of 105 time points were collected across a mean arterial pressure (MAP) range of 32 to 118 mmHg. Significant correlations were demonstrated between MAP and Vmca (r = 0.7, p < 0.0001), MAP and BAS (r = 0.50, p < 0.0001), CO and Vmca (r = 0.57, p < 0.0001), and CO and BAS (r = 0.42, p < 0.0001). The best surgical fields were seen at 40 to 59 mmHg MAP. However, MAP below 60 mmHg produced >50% reduction in Vmca in more than 10% of time points. CONCLUSION Balancing surgical visibility with organ perfusion remains a challenge. The results of this study show that moderate hypotension significantly improves the surgical field; however reducing BP below 60 mmHg may risk cerebral hypoperfusion.
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Affiliation(s)
- Thanh Ngoc Ha
- Department of Surgery-Otolaryngology Head and Neck Surgery, The University of Adelaide, Australia
| | | | - Guy L Ludbrook
- Discipline of Acute Care Medicine, The University of Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery-Otolaryngology Head and Neck Surgery, The University of Adelaide, Australia
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The effect of head up tilting on bioreactance cardiac output and stroke volume readings using suprasternal transcutaneous Doppler as a control in healthy young adults. J Clin Monit Comput 2016; 30:519-26. [DOI: 10.1007/s10877-016-9835-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
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Johnson A, Mohajer-Esfahani M. Exploring hemodynamics: a review of current and emerging noninvasive monitoring techniques. Crit Care Nurs Clin North Am 2016; 26:357-75. [PMID: 25169689 DOI: 10.1016/j.ccell.2014.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The lack of randomized controlled trials suggesting improved outcomes with pulmonary artery catheter use and pressure-based hemodynamic monitoring has led to a decrease in pulmonary artery catheter use. However, an increasing amount of literature supporting stroke volume optimization (SVO) has caused a paradigm shift from pressure-based to flow-based techniques. This article discusses emerging flow-based techniques, supporting evidence, and considerations for use in critical care for methods such as Doppler, pulse contour, bioimpedance, bioreactance, and exhaled carbon dioxide. Regardless of the device chosen, the SVO algorithm approach should be considered, and volume challenges should be guided by dynamic assessments of fluid responsiveness.
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Affiliation(s)
- Alexander Johnson
- Critical Care, Central DuPage Hospital, Cadence Health, 25 North Winfield Road, Winfield, IL 60190, USA.
| | - Mehr Mohajer-Esfahani
- Critical Care, Central DuPage Hospital, Cadence Health, 25 North Winfield Road, Winfield, IL 60190, USA
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Choi JW, Joo Ahn H, Yang M, Kim JA, Lee SM, Ahn JH. Comparison Between Phenylephrine and Dopamine in Maintaining Cerebral Oxygen Saturation in Thoracic Surgery: A Randomized Controlled Trial. Medicine (Baltimore) 2015; 94:e2212. [PMID: 26656357 PMCID: PMC5008502 DOI: 10.1097/md.0000000000002212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Fluid is usually restricted during thoracic surgery, and vasoactive agents are often administered to maintain blood pressure. One-lung ventilation (OLV) decreases arterial oxygenation; thus oxygen delivery to the brain can be decreased. In this study, we compared phenylephrine and dopamine with respect to maintaining cerebral oxygenation during OLV in major thoracic surgery.Sixty-three patients undergoing lobectomies were randomly assigned to the dopamine (D) or phenylephrine (P) group. The patients' mean arterial pressure was maintained within 20% of baseline by a continuous infusion of dopamine or phenylephrine. Maintenance fluid was kept at 5 mL/kg/h. The depth of anesthesia was maintained with desflurane 1MAC and remifentanil infusion under bispectral index guidance. Regional cerebral oxygen saturation (rScO2) and hemodynamic variables were recorded using near-infrared spectroscopy and esophageal cardiac Doppler.The rScO2 was higher in the D group than the P group during OLV (OLV 60 min: 71 ± 6% vs 63 ± 12%; P = 0.03). The number of patients whose rScO2 dropped more than 20% from baseline was 0 and 6 in the D and P groups, respectively (P = 0.02). The D group showed higher cardiac output, but lower mean arterial pressure than the P group (4.7 ± 1.0 vs 3.9 ± 1.2 L/min; 76.7 ± 8.1 vs 84.5 ± 7.5 mm Hg; P = 0.02, P = 0.02). Among the variables, age, hemoglobin concentration, and cardiac output were associated with rScO2 by correlation analysis.Dopamine was superior to phenylephrine in maintaining cerebral oxygenation during OLV in thoracic surgery.
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Affiliation(s)
- Ji Won Choi
- From the Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, Republic of Korea
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Chin JH, Kim WJ, Choi JH, Han YA, Kim SO, Choi WJ. Unreliable Tracking Ability of the Third-Generation FloTrac/Vigileo™ System for Changes in Stroke Volume after Fluid Administration in Patients with High Systemic Vascular Resistance during Laparoscopic Surgery. PLoS One 2015; 10:e0142125. [PMID: 26529592 PMCID: PMC4631474 DOI: 10.1371/journal.pone.0142125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/16/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The FloTrac/Vigileo™ system does not thoroughly reflect variable arterial tones, due to a lack of external calibration. The ability of this system to measure stroke volume and track its changes after fluid administration has not been fully evaluated in patients with the high systemic vascular resistance that can develop during laparoscopic surgery. METHODS In 42 patients undergoing laparoscopic prostatectomy, the stroke volume derived by the third-generation FloTrac/Vigileo™ system (SV-Vigileo), the stroke volume measured using transesophageal echocardiography (SV-TEE) as a reference method, and total systemic vascular resistance were evaluated before and after 500 ml fluid administration during pneumoperitoneum combined with the Trendelenburg position. RESULTS Total systemic vascular resistance was 2159.4 ± 523.5 dyn·s/cm5 before fluid administration. The SV-Vigileo was significantly higher than the SV-TEE both before (68.8 ± 15.9 vs. 57.0 ± 11.0 ml, P < 0.001) and after (73.0 ± 14.8 vs. 64.9 ± 12.2 ml, P = 0.003) fluid administration. During pneumoperitoneum combined with the Trendelenburg position, Bland-Altman analysis for repeated measures showed a 53.8% of percentage error between the SV-Vigileo and the SV-TEE. Four-quadrant plot (69.2% of a concordance rate) and polar plot analysis (20.6° of a mean polar angle, 16.4° of the SD of a polar angle, and ±51.5° of a radial sector containing 95% of the data points) did not indicate a good trending ability of the FloTrac/Vigileo™ system. CONCLUSIONS The third-generation FloTrac/Vigileo™ system may not be useful in patients undergoing laparoscopic surgery, based on unreliable performance in measuring the stroke volume and in tracking changes in the stroke volume after fluid administration during pneumoperitoneum combined with the Trendelenburg position.
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Affiliation(s)
- Ji-Hyun Chin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wook-Jong Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Hyun Choi
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Yun A. Han
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Jong Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- * E-mail:
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Kanda H, Hirasaki Y, Iida T, Kanao M, Toyama Y, Kunisawa T, Iwasaki H. Effect of fluid loading with normal saline and 6% hydroxyethyl starch on stroke volume variability and left ventricular volume. Int J Gen Med 2015; 8:319-24. [PMID: 26491368 PMCID: PMC4598218 DOI: 10.2147/ijgm.s89939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose The aim of this clinical trial was to investigate changes in stroke volume variability (SVV) and left ventricular end-diastolic volume (LVEDV) after a fluid bolus of crystalloid or colloid using real-time three-dimensional transesophageal echocardiography (3D-TEE) and the Vigileo-FloTrac™ system. Materials and methods After obtaining Institutional Review Board approval, and informed consent from the research participants, 22 patients undergoing scheduled peripheral vascular bypass surgery were enrolled in the study. The patients were randomly assigned to receive 500 mL of hydroxyethyl starch (HES; HES group, n=11) or normal saline (Saline group, n=11) for fluid replacement therapy. SVV was measured using the Vigileo-FloTrac system. LVEDV, stroke volume, and cardiac output were measured by 3D-TEE. The measurements were performed over 30 minutes before and after the fluid bolus in both groups. Results SVV significantly decreased after fluid bolus in both groups (HES group, 14.7%±2.6% to 6.9%±2.7%, P<0.001; Saline group, 14.3%±3.9% to 8.8%±3.1%, P<0.001). LVEDV significantly increased after fluid loading in the HES group (87.1±24.0 mL to 99.9±27.2 mL, P<0.001), whereas no significant change was detected in the Saline group (88.8±17.3 mL to 91.4±17.6 mL, P>0.05). Stroke volume significantly increased after infusion in the HES group (50.6±12.5 mL to 61.6±19.1 mL, P<0.01) but not in the Saline group (51.6±13.4 mL to 54.1±12.8 mL, P>0.05). Cardiac output measured by 3D-TEE significantly increased in the HES group (3.5±1.1 L/min to 3.9±1.3 L/min, P<0.05), whereas no significant change was seen in the Saline group (3.4±1.1 L/min to 3.3±1.0 L/min, P>0.05). Conclusion Administration of colloid and crystalloid induced similar responses in SVV. A higher plasma-expanding effect of HES compared to normal saline was demonstrated by the significant increase in LVEDV.
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Affiliation(s)
- Hirotsugu Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yuji Hirasaki
- Department of Anatomy, The Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Takafumi Iida
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Megumi Kanao
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yuki Toyama
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Takayuki Kunisawa
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroshi Iwasaki
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
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Perioperative fluid guidance with transthoracic echocardiography and pulse-contour device in morbidly obese patients. Obes Surg 2015; 24:2117-25. [PMID: 24902655 DOI: 10.1007/s11695-014-1329-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In bariatric surgery, non- or mini-invasive modalities for cardiovascular monitoring are addressed to meet individual variability in hydration needs. The aim of the study was to compare conventional monitoring to an individualized goal-directed therapy (IGDT) regarding the need of perioperative fluids and cardiovascular stability. METHODS Fifty morbidly obese patients were consecutively scheduled for laparoscopic bariatric surgery (ClinicalTrials.gov Identifier: NCT01873183). The intervention group (IG, n=30) was investigated preoperatively with transthoracic echocardiography (TTE) and rehydrated with colloid fluids if a low level of venous return was detected. During surgery, IGDT was continued with a pulse-contour device (FloTrac™). In the control group (CG, n=20), conventional monitoring was conducted. The type and amount of perioperative fluids infused, vasoactive/inotropic drugs administered, and blood pressure levels were registered. RESULTS In the IG, 213 ± 204 mL colloid fluids were administered as preoperative rehydration vs. no preoperative fluids in the CG (p<0.001). During surgery, there was no difference in the fluids administered between the groups. Mean arterial blood pressures were higher in the IG vs. the CG both after induction of anesthesia and during surgery (p=0.001 and p=0.001). CONCLUSIONS In morbidly obese patients suspected of being hypovolemic, increased cardiovascular stability may be reached by preoperative rehydration. The management of rehydration should be individualized. Additional invasive monitoring does not appear to have any effect on outcomes in obesity surgery.
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Scully CG, Gomatam S, Forrest S, Strauss DG. Importance of re-calibration time on pulse contour analysis agreement with thermodilution measurements of cardiac output: a retrospective analysis of intensive care unit patients. J Clin Monit Comput 2015; 30:577-86. [PMID: 26285740 DOI: 10.1007/s10877-015-9749-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
We assessed the effect of re-calibration time on cardiac output estimation and trending performance in a retrospective analysis of an intensive care unit patient population using error grid analyses. Paired thermodilution and arterial blood pressure waveform measurements (N = 2141) from 222 patient records were extracted from the Multiparameter Intelligent Monitoring in Intensive Care II database. Pulse contour analysis was performed by implementing a previously reported algorithm at calibration times of 1, 2, 8 and 24 h. Cardiac output estimation agreement was assessed using Bland-Altman and error grid analyses. Trending was assessed by concordance and a 4-Quadrant error grid analysis. Error between pulse contour and thermodilution increased with longer calibration times. Limits of agreement were -1.85 to 1.66 L/min for 1 h maximum calibration time compared to -2.70 to 2.41 L/min for 24 h. Error grid analysis resulted in 74.2 % of points bounded by 20 % error limits of thermodilution measurements for 1 h calibration time compared to 65 % for 24 h. 4-Quadrant error grid analysis showed <75 % of changes in pulse contour estimates to be within ±80 % of the change in the thermodilution measurement at any calibration time. Shorter calibration times improved the agreement of cardiac output pulse contour estimates with thermodilution. Use of minimally invasive pulse contour methods in intensive care monitoring could benefit from prospective studies evaluating calibration protocols. The applied pulse contour analysis method and thermodilution showed poor agreement to monitor changes in cardiac output.
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Affiliation(s)
- Christopher G Scully
- Office of Science and Engineering Laboratories, Division of Biomedical Physics, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA.
| | - Shanti Gomatam
- Office of Surveillance and Biometrics, Division of Biostatistics, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Shawn Forrest
- Office of Device Evaluation, Division of Cardiovascular Devices, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - David G Strauss
- Office of Science and Engineering Laboratories, Division of Biomedical Physics, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
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Zhang J, Critchley LAH, Huang L. Five algorithms that calculate cardiac output from the arterial waveform: a comparison with Doppler ultrasound. Br J Anaesth 2015; 115:392-402. [PMID: 26243646 DOI: 10.1093/bja/aev254] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Different mathematical approaches are used to calculate arterial pulse pressure wave analysis (PPWA) cardiac output. The CardioQ-Combi is a research oesophageal Doppler (COODM) monitor that includes these five fundamental PPWA algorithms. We compared these PPWA cardiac output readings to COODM and suprasternal USCOM Doppler (COUS) over a range of cardiac output values induced by dopamine infusion in patients undergoing major surgery. USCOM acted as a control. METHODS Serial sets of cardiac output data were recorded at regular intervals as cardiac output increased. Formulae included: cardiac output calculated form systemic vascular resistance (COMAP), pulse pressure (COPP), Liljestrand-Zander formula (COLZ), alternating current power (COAC) and systolic area with Kouchoukos correction (COSA). The reference method for comparisons was COODM. Statistical methods included: Scatter plots (correlation), Bland-Altman (agreement) and concordance (trending) and polar (trending). RESULTS From 20 patients 255 sets of cardiac output comparative data were collected. Mean cardiac output for each method ranged between 5.0 and 5.5 litre min(-1). For comparisons between COUS and the five PPWA algorithms with COODM: Correlation was best with COUS (R(2)=0.81) followed by COLZ (R(2)=0.72). Bias ranged between 0.1 and 0.5 litre min(-1). Percentage error was lowest with COUS (26.4%) followed by COLZ (35.2%), others (40.7 to 56.3%). Concordance was best with COUS (92%), followed by COLZ (71%), others (64 to 66%). Polar analysis (mean(standard deviation)) were best with COUS (-2.7 (21.1)), followed by COLZ (+4.7 (26.6). CONCLUSIONS The Liljestrand-Zander PPWA formula was most reliable compared with oesophageal Doppler in major surgical patients under general anaesthesia, but not better than USCOM.
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Affiliation(s)
- J Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - L A H Critchley
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - L Huang
- Department of Anesthesia and Surgical Intensive Care, Peking University First Hospital, Beijing, China
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Comparison of an advanced minimally invasive cardiac output monitoring with a continuous invasive cardiac output monitoring during lung transplantation. J Clin Monit Comput 2015. [PMID: 26223864 DOI: 10.1007/s10877-015-9741-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to compare a continuous non-calibrated left heart cardiac index (CI) measurement by arterial waveform analysis (FloTrac(®)/Vigileo(®)) with a continuous calibrated right heart CI measurement by pulmonary artery thermodilution (CCOmbo-PAC(®)/Vigilance II(®)) for hemodynamic monitoring during lung transplantation. CI was measured simultaneously by both techniques in 13 consecutive lung transplants (n = 4 single-lung transplants, n = 9 sequential double-lung transplants) at distinct time points perioperatively. Linear regression analysis and Bland-Altman analysis with percentage error calculation were used for statistical comparison of CI measurements by both techniques. In this study the FloTrac(®) system underestimated the CI in comparison with the continuous pulmonary arterial thermodilution (p < 0.000). For all measurement pairs we calculated a bias of -0.55 l/min/m(2) with limits of agreement between -2.31 and 1.21 l/min/m(2) and a percentage error of 55 %. The overall correlations before clamping a branch oft the pulmonary artery (percentage error 41 %) and during the clamping periods of a branch oft the pulmonary artery (percentage error 66 %) failed to reached the required percentage error of less than 30 %. We found good agreement of both CI measurements techniques only during the measurement point "15 min after starting the second one-lung ventilation period" (percentage error 30 %). No agreement was found during all other measurement points. This pilot study shows for the first time that the CI of the FloTrac(®) system is not comparable with the continuous pulmonary-artery thermodilution during lung transplantation including the time periods without clamping a branch of the pulmonary artery. Arterial waveform and continuous pulmonary artery thermodilution are, therefore, not interchangeable during these complex operations.
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Abstract
Although use of the classic pulmonary artery catheter has declined, several techniques have emerged to estimate cardiac output. Arterial pressure waveform analysis computes cardiac output from the arterial pressure curve. The method of estimating cardiac output for these devices depends on whether they need to be calibrated by an independent measure of cardiac output. Some newer devices have been developed to estimate cardiac output from an arterial curve obtained noninvasively with photoplethysmography, allowing a noninvasive beat-by-beat estimation of cardiac output. This article describes the different devices that perform pressure waveform analysis.
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Affiliation(s)
- Xavier Monnet
- Medical Intensive Care Unit, Bicêtre Hospital, Paris-Sud University Hospitals, 78, rue du Général Leclerc, F-94270 Le Kremlin-Bicêtre, France; EA4533, Paris-Sud University, 63 rue Gabriel Péri, F-94270 Le Kremlin-Bicêtre, France.
| | - Jean-Louis Teboul
- Medical Intensive Care Unit, Bicêtre Hospital, Paris-Sud University Hospitals, 78, rue du Général Leclerc, F-94270 Le Kremlin-Bicêtre, France; EA4533, Paris-Sud University, 63 rue Gabriel Péri, F-94270 Le Kremlin-Bicêtre, France
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Suehiro K, Tanaka K, Mikawa M, Uchihara Y, Matsuyama T, Matsuura T, Funao T, Yamada T, Mori T, Nishikawa K. Improved Performance of the Fourth-Generation FloTrac/Vigileo System for Tracking Cardiac Output Changes. J Cardiothorac Vasc Anesth 2015; 29:656-62. [DOI: 10.1053/j.jvca.2014.07.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Indexed: 11/11/2022]
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Hamzaoui O, Monnet X, Teboul JL. Evolving concepts of hemodynamic monitoring for critically ill patients. Indian J Crit Care Med 2015; 19:220-6. [PMID: 25878430 PMCID: PMC4397629 DOI: 10.4103/0972-5229.154556] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The last decades have been characterized by a continuous evolution of hemodynamic monitoring techniques from intermittent toward continuous and real-time measurements and from an invasive towards a less invasive approach. The latter approach uses ultrasounds and pulse contour analysis techniques that have been developed over the last 15 years. During the same period, the concept of prediction of fluid responsiveness has also been developed and dynamic indices such as pulse pressure variation, stroke volume variation, and the real-time response of cardiac output to passive leg raising or to end-expiration occlusion, can be easily obtained and displayed with the minimally invasive techniques. In this article, we review the main hemodynamic monitoring devices currently available with their respective advantages and drawbacks. We also present the current viewpoint on how to choose a hemodynamic monitoring device in the most severely ill patients and especially in patients with circulatory shock.
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Affiliation(s)
- Olfa Hamzaoui
- Intensive Care Unit, Antoine Beclere Hospital, Clamart, France
| | - Xavier Monnet
- Medical Intensive Care Unit, Bicetre Hospital, Le Kremlin-Bicetre, France ; Paris-South University, Inserm U999, Le Kremlin-Bicetre, France
| | - Jean-Louis Teboul
- Medical Intensive Care Unit, Bicetre Hospital, Le Kremlin-Bicetre, France ; Paris-South University, Inserm U999, Le Kremlin-Bicetre, France
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