Respiratory stroke volume variation assessed by oesophageal Doppler monitoring predicts fluid responsiveness during laparoscopy

Guinot, Pierre-Grégoire; Broca, B. de; Bernard, E.; Abou-Arab, Osama; Lorne, Emmanuel; Dupont, Hervé

doi:10.1093/bja/aet430

Cited by 42 publications

(22 citation statements)

References 23 publications

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“…Since laparoscopic procedures are more and more frequently performed and since severe intra-abdominal hypertension (such as abdominal compartment syndrome) reduces the reliability of PPV and SVV, Zlicar and colleagues [21] set out to investigate the influence of pneumoperitoneum on SVV’s and PPV’s predictive values, because of the moderately increased abdominal pressure. In the analysis of 56 patients, the authors found that SVV was a reasonably reliable fluid responsiveness predictor (AUC ROC : 0.80), but PPV less so (AUC ROC : 0.67), which was in accordance with the limited data published in the field [22, 23]. The optimal SVV threshold was 12.5% with a grey zone of 7.5–13%.…”

Section: Monitoring Of Fluid Responsivenesssupporting

confidence: 75%

Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management

Saugel

Flick

Bendjelid

et al. 2019

J Clin Monit Comput

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Hemodynamic management is a mainstay of patient care in the operating room and intensive care unit (ICU). In order to optimize patient treatment, researchers investigate monitoring technologies, cardiovascular (patho-) physiology, and hemodynamic treatment strategies. The Journal of Clinical Monitoring and Computing (JCMC) is a well-established and recognized platform for publishing research in this field. In this review, we highlight recent advancements and summarize selected papers published in the JCMC in 2018 related to hemodynamic monitoring and management.

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Section: Monitoring Of Fluid Responsivenesssupporting

confidence: 75%

Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management

Saugel

Flick

Bendjelid

et al. 2019

J Clin Monit Comput

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“…Guinot et al found that SVV measured by esophageal Doppler was reliable and predicted fluid responsiveness with PP \ 15 mmHg with an area under the curve = 0.92 (95% CI 0.82 to 0.98) and no change in the threshold for fluid responsiveness. 73 Conversely, Hoiseth et al also found no difference in the threshold for fluid responsiveness with PP \ 15 mmHg but showed that both PPV and SVV were relatively poor at predicting fluid responsiveness. 74 Despite these conflicting results in practice, consideration should be given to the limitations of each dynamic index and the dynamic variables used in combination with changes in SV to ensure that fluid boluses are given at the appropriate time to improve hemodynamics without any increase in risk.…”

Section: Fluid Management In Laparoscopic Surgerymentioning

confidence: 96%

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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“…However, pneumoperitoneum and head‐down positions make goal‐directed fluid therapy indices difficult to interpret. Increased intra‐abdominal pressure decreases ventilatory compliance, which increases the ventilatory pressure required to deliver a given tidal volume , in turn increasing the variation in haemodynamic indices during volume‐controlled ventilation without the blood volume changing . For instance, Høiseth et al.…”

Section: Common Clinical Challengesmentioning

confidence: 99%

Peri‐operative fluid management to enhance recovery

Gupta

Gan

2015

Anaesthesia

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Summary'Enhanced recovery after surgery' protocols implement a series of peri-operative interventions intended to improve recovery after major operations, one aspect of which is fluid management. The pre-operative goal is to prepare a hydrated, euvolaemic patient by avoiding routine mechanical bowel preparation and by encouraging patients to drink clear liquids up to two hours before induction of anaesthesia. The intra-operative goal is to achieve a 'zero' fluid balance at the end of uncomplicated surgery: goal-directed fluid therapy is recommended for poorly prepared or sick patients or those undergoing more complex surgery. The postoperative goal is eating and drinking without intravenous fluid infusions. Postoperative oliguria should be expected and accepted, as urine output does not indicate overall fluid status.

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Respiratory stroke volume variation assessed by oesophageal Doppler monitoring predicts fluid responsiveness during laparoscopy

Abstract: ΔrespSV and ΔrespPV predicted fluid responsiveness during laparoscopy under strict physiological conditions. FTc was not predictive of fluid responsiveness during laparoscopy.

Cited by 42 publications

References 23 publications

Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management

Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Peri‐operative fluid management to enhance recovery

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