Fluid responsiveness raises many questions—echocardiography may be the answer

Lazzeri, Chiara; Peris, Adriano

doi:10.21037/jtd.2017.03.146

Cited by 2 publications

(2 citation statements)

References 17 publications

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“…Pulsed-wave Doppler provides an estimation of SV on the basis of calculation of the VTI and the diameter of the LVOT. Because the area of the LVOT does not change over time, changes in the VTI allow the changes in SV to be assessed (16)(17)(18). In this study, we found that an increase in VTI greater than 5% during an EEO test predicted fluid responsiveness with a receiver operating characteristic area of 0.90 as well as satisfactory positive and negative predictive values.…”

Section: Discussionmentioning

confidence: 56%

End-expiratory occlusion test predicts fluid responsiveness in cardiac surgical patients in the operating theatre

Cang

et al. 2019

Ann. Transl. Med.

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Background: The aim of this study was to evaluate whether a 20-second end-expiratory occlusion (EEO) test can predict fluid responsiveness in cardiac surgery patients in the operating theatre. Methods: This prospective study enrolled 75 mechanically ventilated patients undergoing elective coronary artery bypass grafting surgery. Hemodynamic data coupled with transesophageal echocardiography monitoring of the velocity time integral (VTI) and the peak velocity (Vmax) at the left ventricular outflow tract were collected at each step (baseline 1, EEO, baseline 2 and fluid challenge). Patients were divided into fluid responders (increase in VTI ≥15%) and non-responders (increase in VTI <15%) after a fluid challenge (6 mL 0.9% saline per kg, given in 10 minutes). Results: Fluid challenge significantly increased the VTI by more than 15% in 36 (48%) patients (responders). An increase in VTI greater than 5% during the EEO test predicted fluid responsiveness with a sensitivity of 81% and a specificity of 93%. The area under the receiver-operating characteristic curve (AUROC) of ΔVTI-EEO was 0.90 [95% confidence interval (CI): 0.83-0.97]. ΔVmax-EEO was poorly predictive of fluid responsiveness, with an AUC of 0.75 (95% CI: 0.63-0.86). Conclusions: Changes in VTI induced by a 20-second EEO can reliably predict fluid responsiveness in cardiac surgical patients in the operating theatre, whereas the changes in Vmax cannot.

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Section: Discussionmentioning

confidence: 56%

End-expiratory occlusion test predicts fluid responsiveness in cardiac surgical patients in the operating theatre

Cang

et al. 2019

Ann. Transl. Med.

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“…In lieu of the static hemodynamic markers used in the available studies, future analyses could instead use functional dynamic measures of stroke volume, such as pulse pressure variation, stroke volume variation, and systolic pressure variation to more reliably quantify fluid responsiveness [60,81,83]. In addition to this, echocardiography could be used to guide clinical practice by evaluating biventricular function and volume assessment, an imaging modality that would more reliably quantify fluid responsiveness [84]. Finally, the passive leg raise (PLR) could be of use to aid clinicians in determining the need for FBT in future studies on HS and hyperoncotic albumin in post-CABG patients [81,85].…”

Section: Discussionmentioning

confidence: 99%

Fluid Resuscitation after Cardiac surgery: Is Hypertonic Saline or Hyperoncotic Albumin the Future?

Otero

Aljure

2020

Preprint

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Background: Over-resuscitation in post-cardiac patients is associated with significant morbidity and mortality. Accordingly, there is a growing interest in concentrated human albumin and hypertonic saline for resuscitation in cardiac patients following revascularization surgery. In this article, we will review the use of hyperosmolar fluid therapies for resuscitation in post-cardiac surgical patients from the current literature. Methods: A literature search was conducted in MEDLINE (PubMed) utilizing keywords, narrowing publications to 2010-2019. Results: Patients receiving concentrated albumin after cardiac surgery required less fluid bolus therapy, less time on vasopressors and were found to have a less positive fluid balance compared to patients receiving crystalloids. The impact on cardiac output and mean arterial pressure in those given concentrated albumin compared to crystalloid boluses was inconsistent. There was no difference in mortality in those given 20% albumin compared to crystalloids post-revascularization. Hypertonic saline showed some positive immunomodulatory effects in patients post-revascularization. Studies identifying the impact of hypertonic saline on fluid balance and mortality compared to normal saline in patients following revascularization surgery are on-going. Conclusions: In this analysis, publications on resuscitation with hyperoncotic albumin and hypertonic saline in patients post-revascularization surgery were reviewed. While there is data in support of using these alternative fluid therapies in other critically ill patient populations, the limited literature in support of using concentrated albumin and hypertonic saline for resuscitation in following cardiac surgery is equivocal.

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Fluid responsiveness raises many questions—echocardiography may be the answer

Cited by 2 publications

References 17 publications

End-expiratory occlusion test predicts fluid responsiveness in cardiac surgical patients in the operating theatre

End-expiratory occlusion test predicts fluid responsiveness in cardiac surgical patients in the operating theatre

Fluid Resuscitation after Cardiac surgery: Is Hypertonic Saline or Hyperoncotic Albumin the Future?

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