Perioperative haemodynamic therapy

Kirov, Mikhail Y.; Kuzkov, Vsevolod V.; Molnár, Zsolt

doi:10.1097/mcc.0b013e32833ab81e

Cited by 56 publications

(37 citation statements)

References 55 publications

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“…'Sources of error', i.e., influencing factors related to individual patients impairing measurement by the tested CO monitoring method [8,[13][14][15], should be identified. And last, in order to justify usage of a monitoring method, a potential 'clinical benefit' of the measured parameters for the examined patient group should be assessed [16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Effect of patent ductus arteriosus and patent foramen ovale on left ventricular stroke volume measurement by electrical velocimetry in comparison to transthoracic echocardiography in neonates

Blohm

Hartwich

Obrecht

et al. 2016

J Clin Monit Comput

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This prospective single-center observational study compared impedance cardiography [electrical velocimetry (EV)] with transthoracic echocardiography (TTE, based on trans-aortic flow) and analyzed the influence of physiological shunts, such as patent ductus arteriosus (PDA) or patent foramen ovale (PFO), on measurement accuracy. Two hundred and ninety-one triplicate simultaneous paired left ventricular stroke volume (LVSV) measurements by EV (LVSV) and TTE (LVSV) in 99 spontaneously breathing neonates (mean weight 3270 g; range 1227-4600 g) were included. For the whole cohort, the mean absolute LVSV was 5.5 mL, mean LVSV was 4.9 mL, resulting in an absolute Bland-Altman bias of -0.7 mL (limits of agreement LOA -3.0 to 1.7 mL), relative bias -12.8 %; mean percentage error MPE 44.9 %; true precision TP 33.4 % (n = 99 aggregated data points). In neonates without shunts (n = 32): mean LVSV 5.0 mL, mean LVSV 4.6 mL, Bland-Altman bias -0.4 mL (LOA -2.8 to 2.0 mL), relative bias -8.2 %; MPE 50.7 %; TP 40.9 %. In neonates with shunts (PDA and/or PFO; n = 67): mean LVSV 5.8 mL, mean LVSV 5.0 mL, bias -0.8 mL (LOA -3.1 to 1.5 mL), relative bias -14.8 %, MPE 41.9 %, TP 29.3 %. Accuracy was affected by PDA and/or PFO, with a significant increase in the relative difference in LVSV versus LVSV: Subjects without shunts -2.9 % (n = 91), PFO alone -9.6 % (n = 125), PDA alone -14.0 % (n = 12), and PDA and PFO -18.5 % (n = 63). Physiological shunts (PDA and/or PFO) in neonates affect measurement accuracy and cause overestimation of LVSV compared with LVSV.

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Section: Introductionmentioning

confidence: 99%

Effect of patent ductus arteriosus and patent foramen ovale on left ventricular stroke volume measurement by electrical velocimetry in comparison to transthoracic echocardiography in neonates

Blohm

Hartwich

Obrecht

et al. 2016

J Clin Monit Comput

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“…As the prediction of feeding intolerance is rather diffucult, the increased amount of gastric residuals in the patients with compromised tonometric parameters suggest that normalization of these parameters may positively affect the motility of the stomach. The concept of improving cardiovascular performance to reduce gastrointestinal complications in the perioperative period has already been justified in several studies [43][44][45][46][47]. In an examination performed in neonates decreased Doppler sonographic blood flow in the superior mesenteric artery has been linked to intestinal dysmotility and feeding intolerance [48].…”

Section: Discussionmentioning

confidence: 99%

Recent Advances Of Mucosal Capnometry And The Perspectives Of Gastrointestinal Monitoring In The Critically Ill. A Pilot Study

Palágyi

Barna

Csábi

et al. 2016

The Journal of Critical Care Medicine

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Mucosal capnometry involves the monitoring of partial pressure of carbon dioxide (PCO2) in mucous membranes. Different techniques have been developed and applied for this purpose, including sublingual or buccal sensors, or special gastrointestinal tonometric devices. The primary use of these procedures is to detect compensated shock in critically ill patients or patients undergoing major surgery. Compensatory mechanisms, in the early phases of shock, lead to the redistribution of blood flow towards the vital organs, within ostensibly typical macro-haemodynamic parameters. Unfortunately, this may result in microcirculatory disturbances, which can play a pivotal role in the development of organ failure. In such circumstances mucosal capnometry monitoring, at different gastrointestinal sites, can provide a sensitive method for the early diagnosis of shock. The special PCO2 monitoring methods assess the severity of ischaemia and help to define the necessary therapeutic interventions and testing of these monitors have justified their prognostic value. Gastrointestinal mucosal capnometry monitoring also helps in determining the severity of ischaemia and is a useful adjunctive in the diagnosis of occlusive splanchnic arterial diseases. The supplementary functional information increases the diagnostic accuracy of radiological techniques, assists in creating individualized treatment plans, and helps in follow-up the results of interventions. The results of a pilot study focusing on the interrelation of splanchnic perfusion and gastrointestinal function are given and discussed concerning recent advances in mucosal capnometry.

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“…Although the concept of GDFT was first suggested more than 30 years ago (18), there remains no consensus about the most effective goals for fluid therapy or the most appropriate monitoring methods. As such, despite evidence demonstrating the potential benefit of this technique in several disease states (19), GDFT remains a well-accepted concept that has yet to translate into an established standard of care (20). One of the many reasons that explain this incongruity is the fact that GDFT is based on fluid challenges and the patient's response to them.…”

Section: First Drs Della Rocca and Vetrugno State That Dynamic Indimentioning

confidence: 99%

Goal-Directed Fluid Therapy: What the Mind Does Not Know, the Eye Cannot See

Bloomstone¹,

Dull²,

Navarro³

2017

Turk J Anaesth Reanim

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Dear Editor, Y our recent first (1, 2) and second (3, 4) round fluid debates were enjoyable and interesting. The editor and authors are to be congratulated for an excellent distillation of the key elements of this important discussion. We have a few comments relative to key points that were made.First, Drs. Della Rocca and Vetrugno state that dynamic indices cannot be used as indicators of fluid responsiveness (FR) during open chest conditions. Respectfully, we disagree. The authors provide us with two "supporting" references, one by Wyffels (5), and the other by Lansdorp (6). The first of these two papers included 15 patients, 10 of whom exhibited dynamic indices (DynI) that were less than 10% or were within the gray zone (7,8). DynI within these ranges are unlikely to be associated with FR. Of note, all patients demonstrated physiologic concordance with the passive leg raising (PLR) maneuver: Stroke volume variation (SVV) and pulse pressure variation (PPV) decreased and the cardiac index (CI) rose, even during open chest conditions, though the rise in CI was not statistically significant in this small sample. The second paper by Lansdorp investigated FR in post-cardiac surgical patients within the Intensive Care Unit (ICU) and does not address the use of dynamic indices during open chest conditions. The idea that DynI lose their predictive ability during open chest surgery is also supported by de Waal who demonstrated that DynI were no more useful than static indicators for predicting FR during open chest conditions (9). Contrary to these findings, Reuter (10), Suehiro (11), Lee (12), Kang (13), and Rex (14) have all demonstrated that DynI can be used to predict FR during cardiothoracic surgery. How is the practicing anesthesiologist to reconcile these contradictory conclusions? This question was best answered by Jean Louis Teboul, who not only described a plausible physiologic mechanism based on transpulmonary pressure changes generating meaningful DynI during open chest conditions, but also provides us with a solid understanding of how DynI should be interpreted during open chest conditions. Assuming that appropriate clinical conditions are met for using DynI (15), Teboul states "the presence of high PPV (or SVV) is indicative of fluid responsiveness under both closed and open chest conditions. However, under open conditions, other tools are still required to diagnose the origin of hemodynamic instability because the presence of low PPV and SVV cannot preclude a positive hemodynamic response to fluid." (16). As with any hemodynamic parameter, the clinician must be aware of its underlying physiologic mechanism, its clinical meaning, and the pitfalls that may derail its interpretation.

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Perioperative haemodynamic therapy

Cited by 56 publications

References 55 publications

Effect of patent ductus arteriosus and patent foramen ovale on left ventricular stroke volume measurement by electrical velocimetry in comparison to transthoracic echocardiography in neonates

Effect of patent ductus arteriosus and patent foramen ovale on left ventricular stroke volume measurement by electrical velocimetry in comparison to transthoracic echocardiography in neonates

Recent Advances Of Mucosal Capnometry And The Perspectives Of Gastrointestinal Monitoring In The Critically Ill. A Pilot Study

Goal-Directed Fluid Therapy: What the Mind Does Not Know, the Eye Cannot See

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