Maintenance of cardiac index within normal range is associated with mortality reduction in patients undergoing major urological surgery

Szturz, P; Maca, J; Tichy, J; Sukenik, P; Chylek, VC; Sklienka, P; Jahoda, J; Kula, R

doi:10.1186/cc8355

Cited by 4 publications

(8 citation statements)

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“…Effectiveness data were calculated from meta-analyses of several rigorously selected RCTs according to the Mantel-Haenszel method with a fixed-effect model, which provides robustness to this study. These meta-analyses took into consideration recent studies [10][11][12][13]15] that were not evaluated in previous meta-analyses [1,2,5,7,28]. Some unpublished studies have also been collected to obtain comprehensive data [13,15,22].…”

Section: Discussionmentioning

confidence: 99%

“…A comprehensive literature search identified a total of 13 RCTs: 10 RCTs comparing CCA with ED þ CCA [10][11][12][13]15,[21][22][23][24][25], including three unpublished studies [13,15,22] and three RCTs comparing CCA with APPWA þ CCA in high-risk abdominal surgery [6,26,27]. None has been deemed to be of inadequate methodological quality (Table 1).…”

Section: Clinical Effectivenessmentioning

confidence: 99%

“…The probability of mortality and major complications with CCA calculated from pooled data from 13 (N ¼ 653) [6,[10][11][12][13]15,[21][22][23][24][25][26][27] and 7 (N ¼ 366) studies [6,[10][11][12]21,22,24] was 0.04 (95% CI 0.02-0.07) and 0.16 (95% CI 0.10-0.24), respectively.…”

Section: Clinical Effectivenessmentioning

confidence: 99%

“…ED was associated with a significant decrease in perioperative mortality when compared with CCA with a fixed-effect model based on data from 10 studies (N ¼ 1 078) [10][11][12][13]15,[21][22][23][24][25] (RR ¼ 0.47; 95% CI 0.24-0.91). The RR of major complications, calculated from six studies (N ¼ 603) [10][11][12]21,22,24], showed a trend toward better results with ED (RR ¼ 0.69; 95% CI 0.44-1.09) (Fig.…”

Section: Clinical Effectivenessmentioning

confidence: 99%

“…These recommendations, however, have been discussed because they were based on a small number of RCTs with quite small and heterogeneous populations: Interventions studied were as diverse as cardiac, orthopedic, and abdominal surgery, in operative rooms or in HDUs [9]. More recently, other RCTs have been published focusing on abdominal surgery [10][11][12][13][14][15], but their results remain to be synthetized.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Goal-Directed Fluid Therapy Guided by Cardiac Monitoring During High-Risk Abdominal Surgery in Adult Patients: Cost-Effectiveness Analysis of Esophageal Doppler and Arterial Pulse Pressure Waveform Analysis

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Effectivenessmentioning

confidence: 99%

Section: Clinical Effectivenessmentioning

confidence: 99%

Section: Clinical Effectivenessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Goal-Directed Fluid Therapy Guided by Cardiac Monitoring During High-Risk Abdominal Surgery in Adult Patients: Cost-Effectiveness Analysis of Esophageal Doppler and Arterial Pulse Pressure Waveform Analysis

et al. 2015

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Goal-directed hemodynamic therapy in patients with colorectal cancer undergoing laparoscopic surgery

PАNАFIDINА

Шлык

2020

Vestn. anesteziol. reanimatol.

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Introduction. The conductance of goal-directed hemodynamic therapy is controversial due to the difficulty in its implementation in routine practice despite the signiﬁcant number of studies and meta-analyses.Objective. To estimate the efficacy of a modiﬁed algorithm of goal-directed hemodynamic management in patients with colorectal cancer who undergo laparoscopic surgery based on non-invasive monitoring of cardiac output.Subjects and methods. A single-centered, randomized trial was conducted. The control group included 75 patients, while the goal-directed therapy (GDT) group included 72 patients. In the control group, hemodynamic management was based on mean arterial pressure and intraabdominal perfusion pressure. In addition, results of ﬂuid responsiveness tests were considered in the GDT group. The suggested protocol efficacy was evaluated on the basis of frequency of critical incidents, shifts in acid-base balance and lactate concentration, infusion volume, vasopressor doses, the incidence of acute kidney injury, and other complications.Results. After anesthesia induction and according to the results of a modiﬁed, passive leg raising test, 67.1% of patients were considered responders and received 1250 (1000; 1500) ml of balanced crystalloids before carboxyperitoneum. The infusion differentiation test of hypotension cause was performed in 47 patients of the GDT group, 37% were considered responders, and others received vasopressors and/or inotropes. The use of the GDT protocol led to a decrease in total infusion volume and vasopressor doses. A lower frequency of critical incidents was recorded when the GDT protocol was used. In the GDT group, there were no signs of ischemia and increased frequency of complications (including acute kidney injury).Conclusions. Testing of ﬂuid responsiveness and non-invasive cardiac output monitoring allows for the correction of hemodynamics during surgery. Goal-directed therapy in the intraoperative period allows different approaches to maintaining systemic and intraabdominal perfusion pressure, thus decreasing the total volume of infusion without increasing hypoperfusion risk.

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Correlation between cardiac index(CI) and cardio ankle vascular index(CAVI) at different degrees of head up tilt table

Zwain,

Abood

2021

KMJ

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Background: Cardio Ankle Vascular Index (CAVI), a new index for arterial stiffness that can be measured by VaSera VS-1000 CAVI device. This is a new method for estimating the level of arteriosclerosis, which is relatively uninfluenced by changes of blood pressure. An association between some arterial fitness indices and cardiac function has been recently demonstrated. CI: is Cardiodynamic measure based on the Cardiac output (CO)which is normalized according to body size ,this is gained by dividing CO on body surface area. Aim: To establish if any significant interrelationship exists between indexed cardiac output (CI) and Cardio ankle vascular Index (CAVI). Further, to introduce a new index as a haemodynemic parameter, notably CI/CAVI. . Method: This study was carried out at Dr.Akeel Zwain private clinic, on 20 healthy male volunteers of a mean age of 30±5 year and BMI of 23.1±1.1 Kg/m². Measurement of cardiac output (CO) is accomplished by estimation of aortic diameter (D) and calculating the velocity time integral (VTI) of aortic flow by Doppler echocardiography, then utilizing the equation: CO=(VTI*D2 *0.785)*heart rate. Measurement of arterial stiffness index (CAVI) can be generated by VaSeraVS-1000 device. A motorized tilting table of incremental degrees; at 0º, 30º and 60º of head up tilt (HUT), was used to bring about peripheral sympathetic outflow modifications, together with postural changes in stroke volume, hence CO and CI. Results: This study demonstrated that there was a statistical significant negative correlation between CI and the degree of head up tilt. CI is significantly decreased relative to increase of HUT degree, in a stepwise manner; CI is significantly lower at 30 and 60 degrees than that at zero degree, (Pearson's correlation coefficient: r=0.63 for 0ºand 30º; r=0.81 for 0ºand 60º, p<0.001 for both; r= 0.71for 30ºand 60º; p<0.05 ). On the other hand, CAVI showed a statistical significant positive correlation relative to the degree of HUT. CAVI was significantly increased, in a stepwise fashion, at 30 and 60 degrees, than that at supine zero degree (Pearson's correlation coefficient: r =0.88 for 0º and 30º; r=0.83 for 0ºand 60º; r=0.81 for 30º and 60º ; p<0.001 for all). Correlation between CI and CAVI at different degrees of HUT was studied, the results demonstrated a significant negative correlation exists between CI and CAVI (r = - 0.47; p<0.05). The result of dividing the two indexes, by each other, CI/CAVI, yielded significant inverse inter relationship with respect to degree of HUT; being lower at 30ºand 60º than that obtained at 0ºtilt. It was significantly lower, in a slope wise pattern, at 60º than that at 30º of tilt (r =0.65 for 0º and 30º; r =0.78, for 0º and 60º; r =0.68, for 30º and 60º; p<0.001 for all). Conclusion: the present investigation reveals an inverse interrelationship between CI and CAVI; a decrease of CI is consistently associated with an increase of CAVI. A new index CI/CAVI may be proposed; it can be employed to early detect subclinical atherosclerosis impact on cardiac muscle pump function. This new integrated parameter could possibly serve for fitness assessment, and for cardiovascular risk stratification. Abbreviations: CAVI, cardio ankle vascular index; HUT: head up tilt; CI: cardiac index; CO: cardiac output; VTI: velocity time integral ; D: aortic diameter; SV ,stroke volume; HR, heart rate; Dd :change of diameter ; PS, systolic pressure ; Pd, diastolic pressure

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Maintenance of cardiac index within normal range is associated with mortality reduction in patients undergoing major urological surgery

Cited by 4 publications

References 0 publications

Goal-Directed Fluid Therapy Guided by Cardiac Monitoring During High-Risk Abdominal Surgery in Adult Patients: Cost-Effectiveness Analysis of Esophageal Doppler and Arterial Pulse Pressure Waveform Analysis

Goal-Directed Fluid Therapy Guided by Cardiac Monitoring During High-Risk Abdominal Surgery in Adult Patients: Cost-Effectiveness Analysis of Esophageal Doppler and Arterial Pulse Pressure Waveform Analysis

Goal-directed hemodynamic therapy in patients with colorectal cancer undergoing laparoscopic surgery

Correlation between cardiac index(CI) and cardio ankle vascular index(CAVI) at different degrees of head up tilt table

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