Ability of mini-fluid challenge to predict fluid responsiveness in obese patients undergoing surgery in the prone position

Ali, Achmet; Dorman, Yeser; Abdullah, Taner; Yasa, Ceren; Orhan-Sungur, Mukadder; Akıncı, İbrahim Özkan; Ozcan, Perihan Ergin

doi:10.23736/s0375-9393.19.13276-2

Cited by 11 publications

(9 citation statements)

References 35 publications

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“…Most fluid responsiveness studies performed under operating room conditions are conducted under general anesthesia and within the first minutes of mechanical ventilation, i.e., before its effects on lung mechanics appear [9][10][11]. Positive pressure ventilation inevitably causes atelectasis, fluid sequestration, surfactant dysfunction, and impaired capillary and lymphatic flow, all of which reduce respiratory system compliance [12].…”

Section: Introductionmentioning

confidence: 99%

Ability of short-time low peep challenge to predict fluid responsiveness in mechanically ventilated patients in the intensive care

Abdullah

Ali

Saka

et al. 2021

J Clin Monit Comput

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Short-time low PEEP challenge (SLPC, application of additional 5 cmH 2 O PEEP to patients for 30 s) is a novel functional hemodynamic test presented in the literature. We hypothesized that SLPC could predict fluid responsiveness better than stroke volume variation (SVV) in mechanically ventilated intensive care patients. Heart rate, mean arterial pressure, stroke volume index (SVI) and SVV were recorded before SLPC, during SLPC and before and after 500 mL fluid loading. Patients whose SVI increased more than 15% after the fluid loading were defined as fluid responders. Reciever operating characteristics (ROC) curves were generated to evaluate the abilities of the methods to predict fluid responsiveness. Fifty-five patients completed the study. Twenty-five (46%) of them were responders. Decrease percentage in SVI during SLPC (SVIΔ%-SLPC) was 11.6 ± 5.2% and 4.3 ± 2.2% in responders and non-responders, respectively (p < 0.001). A good correlation was found between SVIΔ%-SLPC and percentage change in SVI after fluid loading (r = 0.728, P < 0.001). Areas under the ROC curves (ROC-AUC) of SVIΔ%-SLPC and SVV were 0.951 (95% CI 0.857-0.991) and 0.747 (95% CI 0.611-0.854), respectively. The ROC-AUC of SVIΔ%-SLPC was significantly higher than that of SVV (p = 0.0045). The best cut-off value of SVIΔ%-SLPC was 7.5% with 90% sensitivity and 96% specificity. The percentage change in SVI during SLPC predicts fluid responsiveness in intensive care patients who are ventilated with low tidal volumes; the sensitivity and specificity values are higher than those of SVV.

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Section: Introductionmentioning

confidence: 99%

Ability of short-time low peep challenge to predict fluid responsiveness in mechanically ventilated patients in the intensive care

Abdullah

Ali

Saka

et al. 2021

J Clin Monit Comput

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“…10 Since the systematic review, more MFC studies have been published, all pointing to the same compelling conclusion: that the method is accurate in predicting fluid responsiveness. [11][12][13][14][15] In 2018, we published a correspondence debating the way MFC studies were designed. 16 The correspondence raised clinical and statistical issues with the most adopted methodology.…”

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confidence: 99%

Existing fluid responsiveness studies using the mini‐fluid challenge may be misleading: Methodological considerations and simulations

Enevoldsen

Scheeren

Berg

et al. 2021

Acta Anaesthesiol Scand

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The term mini-fluid challenge (MFC) was coined by Muller et al about a decade ago 1 as a new way to predict fluid responsiveness. At the time, common fluid infusion practice consisted of 'let's give some fluid and see what happens' as highlighted by the accompanying editorial. 2 That 'some fluid' was a fluid challenge of around 500 ml as identified by the FENICE study. 3 Motivated by the finding that fluid

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“…The majority of studies retrieved concerned the cardiovascular (n = 14) [9][10][11][12][13][14][15][16][17][18][19][20][21][22], respiratory (n = 7) [23][24][25][26][27][28][29], and neurological (n = 9) [30][31][32][33][34][35][36][37] systems. Two pertained to point-of-care testing [38,39].…”

Section: Resultsmentioning

confidence: 99%

“…The results in this population were somewhat equivocal. In one study, mini fluid challenge was superior to either SVV or PPV in predicting fluid responsiveness (AUC 0.967 vs. 0.709 and 0.689 respectively) [ 18 ]. Another found no additional benefit to using semi-invasive cardiac output monitoring regarding intraoperative fluid administered, postoperative complications, or length of stay [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

et al. 2021

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With the increasing prevalence of obesity in the population, anaesthetists must confidently manage both the pathophysiological and technical challenges presented in bariatric and non-bariatric surgery. The intraoperative period represents an important opportunity to optimise and mitigate risk. However, there is little formal guidance on what intraoperative monitoring techniques should be used in this population. This narrative review collates the existing evidence for intraoperative monitoring devices in the obese patients. Although a number of non-invasive blood pressure monitors have been tested, an invasive arterial line remains the most reliable monitor if accurate, continuous monitoring is required. Goal-directed fluid therapy is recommended by clinical practice guidelines, but the methods tested to assess this had guarded applicability to the obese population. Transcutaneous carbon dioxide (CO 2 ) monitoring may offer additional benefit to standard capnography in this population. Individually titrated positive end expiratory pressure (PEEP) and recruitment manoeuvres improved intraoperative mechanics but yielded no benefit in the immediate postoperative period. Depth of anaesthesia monitoring appears to be beneficial in the perioperative period regarding recovery times and complications. Objective confirmation of reversal of neuromuscular blockade continues to be a central tenet of anaesthesia practice, particularly relevant to this group who have been characterised as an “at risk” extubation group. Where deep neuromuscular blockade is used, continuous neuromuscular blockade is suggested. Both obesity and the intraoperative context represent somewhat unstable search terms, as the clinical implications of the obesity phenotype are not uniform, and the type and urgency of surgery have significant impact on the intraoperative setting. This renders the generation of summary conclusions around what intraoperative monitoring techniques are suitable in this population highly challenging.

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Ability of mini-fluid challenge to predict fluid responsiveness in obese patients undergoing surgery in the prone position

Cited by 11 publications

References 35 publications

Ability of short-time low peep challenge to predict fluid responsiveness in mechanically ventilated patients in the intensive care

Ability of short-time low peep challenge to predict fluid responsiveness in mechanically ventilated patients in the intensive care

Existing fluid responsiveness studies using the mini‐fluid challenge may be misleading: Methodological considerations and simulations

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

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