Dynamic indices do not predict volume responsiveness in routine clinical practice

Lansdorp, Benno; Lemson, Joris; Putten, Michel Johannes Antonius Maria van; Keijzer, Ander de; Hoeven, Johannes G. van der; Pickkers, Peter

doi:10.1093/bja/aer411

Cited by 125 publications

(92 citation statements)

References 38 publications

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“…Pulse pressure variation and SVV require a constant R-R interval (i.e., normal sinus rhythm) and ''normal'' pressures in the chest and abdomen; otherwise, their predictive value is decreased. 48 The dynamic variables arise from heart-lung interactions during positive pressure variation; therefore, any change in tidal volume and /or intrathoracic pressure will affect the interaction. 49 A tidal volume \ 8 mLÁkg -1 decreases this interaction and, thus, decreases the negative predictive value of PPV, SVV, or SPV.…”

Section: Maintenance Fluid Therapymentioning

confidence: 99%

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Miller

Roche

Mythen

2014

Can J Anesth/J Can Anesth

230

137

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Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a ''zero-balance'' approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and ''permissive oliguria'' could be tolerated.Résumé La gestion périopératoire optimale des liquides est un élément important des programmes de récupération rapide après la chirurgie (RRAC). La gestion des liquides dans le cadre de la RRAC doit être vue comme un continuum au travers des phases pré-, per-et postopératoires. Chaque phase est importante pour améliorer la condition du patient et des soins sous-optimaux au cours d'une de ces phases peuvent miner les meilleures pratiques déployées tout au long de la RRAC. L'objectif de la gestion préopératoire des liquides est de faire en sorte que le patient entre en salle d'opération correctement hydraté et dans un état euvolémique. Pour y parvenir, un jeûne prolongé n'est pas recommandé et le nettoyage mécanique de l'intestin est à éviter. Les patients doivent être encouragés à absorber une boisson claire riche en hydrates de carbone, deux à trois heures avant la chirurgie. Les buts de la gestion peropératoire des liquides sont de maintenir une euvolémie centrale et d'éviter un excès de sel et d'eau. Pour y parvenir, les patients subissant une intervention chirurgicale dans le cadre d'un protocole de récupération rapide devraient avoir un programme personnalisé de gestion des liquides. Dans le cadre de ce plan, l'excès de cristalloïdes doit être évité chez tous les patients. Pour des patients à faible risque subissant une intervention c...

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Section: Maintenance Fluid Therapymentioning

confidence: 99%

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Miller

Roche

Mythen

2014

Can J Anesth/J Can Anesth

230

137

View full text Add to dashboard Cite

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“…PPV and SVV require a constant ReR interval (i.e., normal sinus rhythm) and "adequate" pressures in the chest and abdomen, otherwise their predictive value is decreased [24]. The technique relies on cardiopulmonary interactions, and therefore any change in tidal volume and/or intrathoracic pressure will affect the interaction.…”

Section: Individualized Gdftmentioning

confidence: 99%

State-of-the-art fluid management in the operating room

Miller

Raghunathan

Gan

2014

Best Practice & Research Clinical Anaesthesiology

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The underlying principles guiding fluid management in any setting are very simple: maintain central euvolemia, and avoid salt and water excess. However, these principles are frequently easier to state than to achieve. Evidence from recent literature suggests that avoidance of fluid excess is important, with excessive crystalloid use leading to perioperative weight gain and an increase in complications. A zero-balance approach aimed at avoiding fluid excess is recommended for all patients. For major surgery, there is a sizeable body of evidence that an individualized goal-directed fluid therapy (GDFT) improves outcomes. However, within an Enhanced Recovery program only a few studies have been published, yet so far GDFT has not achieved the same benefit. Balanced crystalloids are recommended for most patients. The use of colloids remains controversial; however, current evidence suggests they can be beneficial in intraoperative patients with objective evidence of hypovolemia.

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“…In particular, the predictive value of SVV was reportedly poor in patients ventilated with a tidal volume of less than 8 ml/kg [19][20][21]. This indicates that SVV measurements could have several such limitations, as with other parameters.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous peripheral and central venous pressure monitoring for evaluating cardiac preload in critically ill patients

Yanagisawa¹,

Takazawa²,

Kanamoto³

et al. 2017

Biomed Res Clin Prac

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Purpose: Arterial waveform-derived dynamic variables, such as stroke volume variation (SVV), are useful for predicting fluid responsiveness in perioperative patients. Since specific catheters and machines must be used for measuring SVV, we tried to find a novel indicator that correlates with SVV values and can be calculated using usual monitoring equipment. Methods:A total of 50 patients admitted to the ICU, both intubated (n=25) and non-intubated (n=25), were enrolled in this prospective observational study. Intubated patients received mechanical ventilation under pressure controlled ventilation (PCV) or continuous positive airway pressure /pressure support ventilation (CPAP/PSV) modes. SVV values were used for assessment of cardiac preload. Besides SVV, central venous pressure (CVP) and peripheral venous pressure (PVP) were simultaneously recorded. In each patient, 10 data pairs were randomly acquired at 1 hour or longer intervals.Results: Regression analysis showed a slightly weaker but substantial association between PVP and CVP (Pearson's correlation coefficient r=0.91, p<0.0001). However, we found that PVP-CVP difference values correlated with SVV (r=0.64, p<0.0001). Moreover, we were able to predict whether SVV was normal (≤ 10%) or high (>10%) from PVP-CVP difference values with high accuracy. This prediction was not affected by the respiratory mode. Conclusion:The difference between PVP and CVP might serve as a novel indicator of the adequacy of cardiac preload that does not require specific equipment, such as the FloTrac/Vigileo Monitor®.

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Dynamic indices do not predict volume responsiveness in routine clinical practice

Abstract: PPV, SPV, and SVV are the only reliable predictors of fluid responsiveness under strict conditions. In routine clinical practice, factors including low TV, cardiac arrhythmias, and the calculation method can substantially reduce their predictive value.

Cited by 125 publications

References 38 publications

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

State-of-the-art fluid management in the operating room

Simultaneous peripheral and central venous pressure monitoring for evaluating cardiac preload in critically ill patients

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