Plasma pro-atrial natriuretic peptide to estimate fluid balance during open and robot-assisted esophagectomy: a prospective observational study

Strandby, Rune Broni; Ambrus, Rikard; Secher, Niels H.; Goetze, Jens P.; Achiam, Michael Patrick; Svendsen, Lars Bo

doi:10.1186/s12871-017-0314-6

Cited by 8 publications

(13 citation statements)

References 34 publications

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“…8,27 In an experimental model, both molecules released syndecan-1 and increased capillary leakage. 28 However, a recent study shows that the plasma concentration of the stable pro-form of ANP decreases by 10%-20% during upper abdominal surgery despite fluid administration, 29 which supports our view that anesthesia-induced vasodilatation alleviates the natriuretic peptide response to fluid loading.…”

Section: M Itati O N Ssupporting

confidence: 62%

Hypervolemia does not cause degradation of the endothelial glycocalyx layer during open hysterectomy performed under sevoflurane or propofol anesthesia

Nemme

Krizhanovskii

Ntika

et al. 2019

Acta Anaesthesiol Scand

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Background: Fluid-induced hypervolemia may stimulate the release of natriuretic peptides and cause degradation (shedding) of the endothelial glycocalyx layer. Sevoflurane is believed to protect the glycocalyx, but the importance of using sevoflurane to prevent shedding during routine surgery is unclear. Methods: The plasma concentrations of brain natriuretic peptide and two biomarkers of glycocalyx shedding, syndecan-1, and heparan sulfate, were measured in 26 patients randomized to receive general anesthesia with sevoflurane or propofol during open abdominal hysterectomy. The fluid therapy consisted of 25 mL/kg (approximately 2 L) of Ringer´s lactate over 30 minutes. Blood hemoglobin and plasma albumin were used to indicate plasma volume expansion and capillary leakage. Results: The plasma concentrations of brain natriuretic peptide and shedding products showed low levels throughout the surgery (median brain natriuretic peptide, 21 ng/L; syndecan-1, 12.9 ng/mL; and heparan sulfate, 6.5 µg/mL), but the heparan sulfate concentration increased 2 hours post-operatively (to 17.3 µg/mL, P < .005). No differences were noted between the propofol and sevoflurane groups in any of the measured parameters. Albumin was apparently recruited to the bloodstream during the first 20 minutes, when the intravascular retention of infused fluid was almost 100%. The urine flow was <1 mL/min, despite the vigorous volume loading. Conclusions: No relevant elevations of brain natriuretic peptide or degradation products of the glycocalyx layer were observed when hypervolemia was induced during open abdominal hysterectomy performed with sevoflurane or propofol anesthesia. Plasma volume expansion from Ringer´s lactate was pronounced. How to cite this article: Nemme J, Krizhanovskii C, Ntika S, Sabelnikovs O, Vanags I, Hahn RG. Hypervolemia does not cause degradation of the endothelial glycocalyx layer during open hysterectomy performed under sevoflurane or propofol anesthesia.

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Section: M Itati O N Ssupporting

confidence: 62%

Hypervolemia does not cause degradation of the endothelial glycocalyx layer during open hysterectomy performed under sevoflurane or propofol anesthesia

Nemme

Krizhanovskii

Ntika

et al. 2019

Acta Anaesthesiol Scand

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“…For the fasting surgical patient, both plasma proANP 19,20 and TI 21 are sensitive to fluid balance, and these methods might therefor not be ideally suited for detecting minor blood loss in surgical patients. In contrast, deviations in stroke volume were sensitive to a reduced total blood volume and could therefore be an appropriate trigger for the administration of fluids to these patients 22 …”

Section: Discussionmentioning

confidence: 99%

The central blood volume as measured by thoracic electrical impedance and plasma proANP is not compromised by donation of 900 mL of blood in men

Gybel-Brask

Nordsborg

Goetze

et al. 2020

Transfusion Medicine

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Objectives: To evaluate whether the donation of 900 mL of blood reduces the central blood volume (CBV) assessed by thoracic electrical impedance (TI) and plasma pro-atrial natriuretic peptide (proANP). Background: Donation of 450 mL of blood carries a 1% risk of a vasovagal reaction. Withdrawal of 900 mL of blood decreases cardiac output; however, the effect on CBV remains unknown. Methods/Materials: A randomised, single-blinded, placebo-controlled, crossover design was used, where 21 healthy semi-recumbent men donated 2 × 450 mL blood or were sham-phlebotomised. Changes in CBV were estimated by proANP and TI at 1.5 (TI 1.5) and 100 (TI 100) kHz, reflecting extracellular volume and (regional) total body water, respectively, and the index value (IDX; 1/T 1.5-1/TI 100) was used to estimate changes in intracellular (red cell) volume. Systolic, diastolic and mean arterial blood pressure; heart rate; stroke volume; cardiac output; and systemic vascular resistance were monitored. After completion of the study, 1000 mL of isotonic saline was infused. Results: Changes (mean% ± SD) in TI 1.5 , TI 100 and IDX were similar after 450 mL (−0.2 ± 1.6%, 0.0 ± 1.1%, −0.4 ± 10.1%) and 900 mL (0.1 ± 1.6%, 0.2 ± 1.5% and −2.0 ± 15.8%) of blood donation compared to after a sham donation of 450 mL (−0.9 ± 1.2%, −0.5 ± 1.5% and −0.1 ± 6.1%) and 900 mL (−1.2 ± 1.5%, −0.6 ± 1.3% and 0.5 ± 9.9%). In addition, changes in plasma proANP were similar after 450 and 900 mL of blood donation (−0.8 ± 6.7% and −7.6 ± 7.9%) as after sham donations (1.3 ± 7.3% and −4.5 ± 5.6%). Monitoring haemodynamic variables revealed that stroke volume decreased after the donation of 900 mL of blood (−12 ± 12 mL) compared to sham donations. Conclusion: During a 900-mL blood loss in semi-recumbent men, CBV measured by TI and plasma proANP is not affected.

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“…Thus, a stable plasma MR‐proANP from start to end of surgery indicates a maintained CBV, which is likely important for avoiding complications associated with hypovolemia 9,10 or fluid excess 11 . Furthermore, a correlation between plasma MR‐proANP and perioperative fluid balance is reported during both cystectomy 12 and robot‐assisted 5 as well as open esophagectomy 5,13 . Thus, a decrease in plasma MR‐proANP may indicate a reduced CBV and the fluid deficit estimated by relating changes in plasma MR‐proANP and the perioperative fluid balance 5,12,13 …”

Section: Introductionmentioning

confidence: 99%

Mid‐regional plasma pro‐atrial natriuretic peptide and stroke volume responsiveness for detecting deviations in central blood volume following major abdominal surgery

Strandby

Secher

Ambrus

et al. 2022

Acta Anaesthesiol Scand

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Background: A reduced central blood volume is reflected by a decrease in midregional plasma pro-atrial natriuretic peptide (MR-proANP), a stable precursor of ANP, and a volume deficit may also be assessed by the stroke volume (SV) response to head-down tilt (HDT). We determined plasma MR-proANP during major abdominal procedures and evaluated whether the patients were volume responsive by the end of the surgery, taking the fluid balance and the crystalloid/colloid ratio into account.Methods: Patients undergoing pancreatic (n = 25), liver (n = 25), or gastroesophageal (n = 38) surgery were included prospectively. Plasma MR-proANP was determined before and after surgery, and the fluid response was assessed by the SV response to 10HDT after the procedure. The fluid strategy was based mainly on lactated Ringer's solution for gastroesophageal procedures, while for pancreas and liver surgery, more human albumin 5% was administered.Results: Plasma MR-proANP decreased for patients undergoing gastroesophageal surgery (À9% [95% CI À3.2 to À15.3], p = .004) and 10 patients were fluid responsive by the end of surgery (ΔSV > 10% during HDT) with an administered crystalloid/ colloid ratio of 3.3 (fluid balance +1389 ± 452 ml). Furthermore, plasma MR-proANP and fluid balance were correlated (r = .352 [95% CI 0.031-0.674], p < .001). In contrast, plasma MR-proANP did not change significantly during pancreatic and liver surgery during which the crystalloid/colloid ratio was 1.0 (fluid balance +385 ± 478 ml) and 1.9 (fluid balance +513 ± 381 ml), respectively. For these patients, there was no correlation between plasma MR-proANP and fluid balance, and no patient was fluid responsive. Conclusion:Plasma MR-proANP was reduced in fluid responsive patients by the end of surgery for the patients for whom the fluid strategy was based on more lactated Ringer's solution than human albumin 5%.

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Plasma pro-atrial natriuretic peptide to estimate fluid balance during open and robot-assisted esophagectomy: a prospective observational study

Cited by 8 publications

References 34 publications

Hypervolemia does not cause degradation of the endothelial glycocalyx layer during open hysterectomy performed under sevoflurane or propofol anesthesia

Hypervolemia does not cause degradation of the endothelial glycocalyx layer during open hysterectomy performed under sevoflurane or propofol anesthesia

The central blood volume as measured by thoracic electrical impedance and plasma proANP is not compromised by donation of 900 mL of blood in men

Mid‐regional plasma pro‐atrial natriuretic peptide and stroke volume responsiveness for detecting deviations in central blood volume following major abdominal surgery

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