Less invasive methods of advanced hemodynamic monitoring: principles, devices, and their role in the perioperative hemodynamic optimization

Chamos, Christos; Vele, Liana; Hamilton, Mark A.; Cecconi, Maurizio

doi:10.1186/2047-0525-2-19

Cited by 45 publications

(40 citation statements)

References 61 publications

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“…Multiple studies have shown that the CVP measurement is a very poor predictor of left ventricular function . Goal‐directed fluid therapy (GDFT) using dynamic measures of cardiac function has been shown to be effective in treating shock . GDFT in organ donors is associated with increased lung yield without sacrificing kidney yield .…”

Section: Introductionmentioning

confidence: 99%

“…19 Goal-directed fluid therapy (GDFT) using dynamic measures of cardiac function has been shown to be effective in treating shock. [20][21][22][23][24] GDFT in organ donors is associated with increased lung yield without sacrificing kidney yield. 13,25,26 Multiple studies have demonstrated that fluid resuscitation based on stroke volume (SV) optimization improves patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A stroke volume‐based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain‐dead donors

Marklin¹,

Klinkenberg²,

Helmers³

et al. 2020

Clinical Transplantation

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Brain‐dead donors are frequently hypovolemic and hypotensive requiring vasopressor support. We studied a stroke volume‐based fluid resuscitation and vasopressor weaning protocol prospectively on 64 hypotensive donors, with a recent control cohort of 30 hypotensive donors treated without a protocol. Stroke volume was measured every 30 minutes for 4 hours by pulse contour analysis or esophageal Doppler. A 500 mL saline fluid bolus was infused over 30 minutes and repeated if the stroke volume increased by 10%. No fluid was infused if the stroke volume did not increase by 10%. Vasopressors were weaned every 10 minutes if the mean arterial pressure was greater than 65 mm Hg. The protocol group received 1937 ± 906 mL fluid compared to 1323 ± 919 mL in the control group (P = .003). Mean time on vasopressors was decreased from 957.6 ± 586.2 to 176.3 ± 82.2 minutes (P<.001). Donors in the protocol group were more likely to donate four or more organs than donors in the control group (OR = 4.114, 95% Confidence Interval (CI) = 1.003‐16.876). While more organs were transplanted per donor in the protocol group (3.39 ± 1.52) than in the control group (2.93 ± 1.44) (P = .268), the difference did not reach statistical significance. A goal‐directed fluid resuscitation protocol decreased organ ischemia and may increase organs transplanted.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A stroke volume‐based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain‐dead donors

Marklin¹,

Klinkenberg²,

Helmers³

et al. 2020

Clinical Transplantation

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“…Unfortunately, the invasive nature of this method means that it is not applicable during the initial phase in the ED [9,10]. Thus, thermodilution often cannot be used early in the evaluation of trauma patients.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive hemodynamic monitoring in trauma patients

2015

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BackgroundThe assessment of hemodynamic status is a crucial task in the initial evaluation of trauma patients. However, blood pressure and heart rate are often misleading, as multiple variables may impact these conventional parameters. More reliable methods such as pulmonary artery thermodilution for cardiac output measuring would be necessary, but its applicability in the Emergency Department is questionable due to their invasive nature. Non-invasive cardiac output monitoring devices may be a feasible alternative.MethodsA systematic literature review was conducted. Only studies that explicitly investigated non-invasive hemodynamic monitoring devices in trauma patients were considered.ResultsA total of 7 studies were identified as suitable and were included into this review. These studies evaluated in a total of 1,197 trauma patients the accuracy of non-invasive hemodynamic monitoring devices by comparing measurements to pulmonary artery thermodilution, which is the gold standard for cardiac output measuring. The correlation coefficients r between the two methods ranged from 0.79 to 0.92. Bias and precision analysis ranged from -0.02 +/- 0.78 l/min/m2 to -0.14 +/- 0.73 l/min/m2. Additionally, data on practicality, limitations and clinical impact of the devices were collected.ConclusionThe accuracy of non-invasive cardiac output monitoring devices in trauma patients is broadly satisfactory. As the devices can be applied very early in the shock room or even preclinically, hemodynamic shock may be recognized much earlier and therapeutic interventions could be applied more rapidly and more adequately. The devices can be used in the daily routine of a busy ED, as they are non-invasive and easy to master.

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“…The preload (Stroke Volume Variation -SVV), contractility (Cardiac Output CO) and afterload (Systolic Blood Pressure) are the main parameters used to guide fluid administration and hemodynamic management. The arterial pressure based cardiac output (APCO) is a CO monitoring system based on the analysis of the systemic arterial pressure wave form and back calculate the stroke volume (SV) (17). Adequate volume replacement to achieve optimal cardiac performance is critical in hemodynamic management in order to prevent any deleterious consequence of under-resuscitation or fluid overload.…”

Section: Surgical Techniquementioning

confidence: 99%

Laparoscopic HIPEC for Peritoneal Carcinomatosis from Gastric Cancer - Technique and Early Outcomes of Our First Cases

Bălescu¹,

Godoroja²,

Gongu³

et al. 2017

chr

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RezumatCancerul gastric rămâne una din cele mai agresive malignităţi, fiind asociat cu rezultate terapeutice nesatisfăcătoare, în special la pacienţii cu boală avansată. Din cauza acestui aspect atenţia comunităţii medicale actuale este concentrată în a identifica un tratament mai bun, un control mai eficient al bolii şi în a îmbunătăţi ratele de supravieţuire. Odată ce beneficiile chirurgiei citoreductive în asociere cu hipertermia intraperitoneală (HIPEC) au fost demonstrate pe scală largă la pacienţii diagnosticaţi cu carcinomatoză peritoneală din origine colorectală sau ovariană, atenţia a fost axată pe posibila utilizare a acestei metode la pacienţii diagnosticaţi cu carcinomatoză peritoneală de origine gastrică. Mai mult decât atât, prin utilizarea laparoscopiei pentru efectuarea chirurgiei citoreductive (L-CRS) în asociere cu chimioterapia hipertermică intraperitoneală (L-HIPEC), se aşteaptă ca beneficiile intervenţiei chirurgicale minimal invazive (MIS) să contribuie la îmbunătăţirea rezultatelor postoperatorii. În acest mod, pacienţii beneficiază de o administrare mai rapidă a tratamentului chimioterapeutic adjuvant ori de câte ori este necesar. Scop: de a prezenta tehnica L-CRS + L-HIPEC şi rezultatele obţinute într-o serie de cazuri de doi pacienţi diagnosticaţi cu carcinomatoză peritoneală din cancerul gastric. Metodă: În toate cazurile, a fost efectuată o procedură completă de investigare, incluzând laparoscopia exploratorie pentru evaluarea Indexului de Carcinomatoză Peritoneală (PCI). Consiliul Surgical TechniqueChirurgia (2017) AbstractGastric cancer remains one of the most aggressive malignancies, being associated with very poor therapeutic outcomes, especially in the advanced disease patients. Due to this evidence, finding a better treatment, a better control and higher survival rates is the current scientific focus of the medical community. Once the benefits of cytoreductive surgery in association with intraperitoneal hyperthermy (HIPEC) have been widely demonstrated in patients presenting peritoneal carcinomatosis from colorectal or ovarian origin,attention was focused on the possible benefit of this method in patients diagnosed with peritoneal carcinomatosis with gastric origin. Moreover, using laparoscopy for the cytoreductive surgery (L-CRS) and hyperthermic intraperitoneal chemotherapy (L-HIPEC), the advantages of minimal invasive surgery (MIS) are expected to contribute to improved postoperative outcomes. In this way, the patients benefit from a faster administration of the adjuvant chemotherapeutic treatment, whenever is necessary. Aim: to present the technique of L-CRS + L-HIPEC and the early therapeutic outcomes in a case series of two patients diagnosed with peritoneal carcinomatosis from gastric cancer. Method: A complete investigational work-up including diagnostic laparoscopy to evaluate the Peritoneal Carcinomatosis Index (PCI) was fulfilled in all the cases. The institutional Tumor Board decided the therapeutic strategy: laparoscopic radical resection and HIPEC (L-CRS +L-HIPEC)...

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Less invasive methods of advanced hemodynamic monitoring: principles, devices, and their role in the perioperative hemodynamic optimization

Cited by 45 publications

References 61 publications

A stroke volume‐based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain‐dead donors

A stroke volume‐based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain‐dead donors

Non-invasive hemodynamic monitoring in trauma patients

Laparoscopic HIPEC for Peritoneal Carcinomatosis from Gastric Cancer - Technique and Early Outcomes of Our First Cases

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