Influence of increased intra-abdominal pressure on fluid responsiveness predicted by pulse pressure variation and stroke volume variation in a porcine model*

Renner, Jochen; Gruenewald, Matthias; Quaden, René; Hanß, R.; Meybohm, Patrick; Steinfath, Markus; Scholz, Jens; Bein, Berthold

doi:10.1097/ccm.0b013e3181959864

Cited by 109 publications

(80 citation statements)

References 39 publications

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“…71 Consequently, PP can increase SVV, PPV, and SPV independently of changes in blood volume. 50,72 Does this mean, however, that the dynamic variables are less useful or that we can keep the indices but raise the threshold?…”

Section: Fluid Management In Laparoscopic Surgerymentioning

confidence: 99%

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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: Fluid Management In Laparoscopic Surgerymentioning

confidence: 99%

“…72 The ability of SVV to measure fluid responsiveness remained until the IAP was raised above 25 mmHg when it was abolished.…”

Section: Fluid Management In Laparoscopic Surgerymentioning

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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“…As these dynamic indices predict respondents with more accuracy than CVP and as no CVP threshold value is reliable to diagnose fluid responsiveness, there is less need for invasive lines merely for the purpose of monitoring [19,22]. In several studies comparing PPV and SVV, PPV appears to be the most sensitive and specific variable [19,20,23].…”

Section: Individualized Gdftmentioning

confidence: 99%

“…The technique relies on cardiopulmonary interactions, and therefore any change in tidal volume and/or intrathoracic pressure will affect the interaction. Raised intra-abdominal pressure will cause higher intrathoracic pressures and an exaggerated cardiopulmonary interaction that will raise the threshold for volume responsiveness independent of preload [23]. Only PPV has been validated in this situation, and the clinician needs to understand the physiology and look for the response to a fluid challenge to individualize the threshold for fluid responsiveness [23].…”

Section: Individualized Gdftmentioning

confidence: 99%

“…Raised intra-abdominal pressure will cause higher intrathoracic pressures and an exaggerated cardiopulmonary interaction that will raise the threshold for volume responsiveness independent of preload [23]. Only PPV has been validated in this situation, and the clinician needs to understand the physiology and look for the response to a fluid challenge to individualize the threshold for fluid responsiveness [23]. For example, with a pneumoperitoneum, a patient may have a PPV of 15% when euvolemic, and only respond to a fluid challenge with a 10% increase in SV when PPV > 20%.…”

Section: Individualized Gdftmentioning

confidence: 99%

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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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Péritonite et syndrome du compartiment abdominal chez l’enfant

Durand¹,

Baujard

Devictor³

2013

Réanimation Pédiatrique

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Influence of increased intra-abdominal pressure on fluid responsiveness predicted by pulse pressure variation and stroke volume variation in a porcine model*

Abstract: : In this animal model PPV and GEDV proved to be sensitive and specific predictors of fluid responsiveness even during increased IAP.

Cited by 109 publications

References 39 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

Péritonite et syndrome du compartiment abdominal chez l’enfant

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