Transesophageal Echocardiographic Monitoring of Preoperative Acute Hypervolemic Hemodilution

Daele, M. E. R. M. van; Trouwborst, A.; Woerkens, Liesbeth C. S. M. van; Tenbrinck, R.; Fraser, Alan G.; Roelandt, Jos R.T.C.

doi:10.1097/00000542-199409000-00012

Cited by 50 publications

(15 citation statements)

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“…With respect to HHD, hypervolaemia of 1,000 ml is assumed to be tolerated by otherwise healthy patients. However, this degree of hypervolaemia is far below of that in the model given by Smetannikov et al [20] or as reported by van Daele et al [21] from animal experiments. Thus, we consider our model of HHD model very close to clinical routine and reality.…”

Section: Discussionmentioning

confidence: 50%

“…Besides one clinical study on a small number of patients comparing HHD versus ANH [16], those data mainly refer to case reports [17,18]. The very few MM on HHD versus no-HHD published differ from each other in both mathematical description of the model itself [13,19] and the degree of hypervolaemia assumed [13,20,21]. Nevertheless, HHD per se is less effective in avoiding HPRBC than ANH [13].…”

Section: Introductionmentioning

confidence: 99%

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Cost-Minimising Analysis of Acute Normovolaemic Haemodilution and Hypervolaemic Haemodilution in Saving Red Blood Cells as Compared to Transfusion of Allogeneic Blood

Singbartl¹,

Singbartl²,

Schleinzer³

et al. 2000

Transfus Med Hemother

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Background: Analysing cost data with respect to savings of red blood cells (rbc) by acute normovolaemic haemodilution (ANH) / hypervolaemic haemodilution (HHD) versus purchasing homologous packed rbc (HPRBC). Methods: Using our previously published model for ANH/HHD we calculated saving of rbc mass for various initial (45 and 40%) and minimal (haematocrit) hct levels (27, 24, 21 and 18%). ANH was performed by isovolaemic exchange of 4 units of blood (each 500 ml) versus colloid with an intravascular volume effect of 1.0. Intra-operative loss of colloid was only due to surgical blood loss. ANH units were re-transfused in reverse order; thereby maintaining isovolaemia and minimal hct level with ongoing blood loss by additional infusion of colloid. HHD was performed by pre-operative infusion of 1,000 ml colloid; assumed intravascular volume effect is 1.0. Hypervolaemia during surgical blood loss was maintained by infusion of colloid until reaching minimal hct. Elimination of the excessive colloid from the intravascular space lead to rise in hct (from minimal to final hct). This difference between final and minimal hct results in saving of rbc mass. Cost data refer to both hospital variable/acquisition cost and data given in DKG-NT (variable/acquisition cost (‘Sachkosten’) and total cost (‘Gesamtkosten’)). Results: ANH at best allows for rbc mass savings of approximately 2 units (each 190 ml of rbc). Under less ideal conditions (initial hct ≤ 40%, minimal hct ≥ 21%), rbc savings amount to approximately 1 unit. With HHD, the corresponding rbc mass saved amounts up to 1 unit at best. Our cost-minimising analysis (CMA) shows that these rbc savings by ANH/HHD are less expensive than purchasing equal amounts of allogeneic rbc mass. With respect to the underlying cost base, these 2 units are between 25% (total cost according to DKG-NT: ANH EUR 166.5 versus HPRBC EUR 221.1) and 60% (hospital variable cost: ANH EUR 61.7 versus HPRBC EUR 157.2) cheaper than corresponding units of HPRBC. rbc mass saved by HHD is even less expensive (total cost according to DKG-NT: HHD EUR 63.8 versus HPRBC EUR 135.1; hospital variable cost EUR 32.1 versus HPRBC EUR 95.2). Thus, they are approximately 53% (total cost according to DKG-NT) to 62% (hospital variable cost) less expensive than HPRBC. Conclusions: Both ANH and HHD – under ideal conditions and within their limited extent – are more cost-effective in saving rbc than transfusion of allogeneic blood. However, both the efficacy of these measures and the resulting financial savings are limited at best to 2 units of rbc for ANH and 1 unit for HHD.

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Section: Discussionmentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Cost-Minimising Analysis of Acute Normovolaemic Haemodilution and Hypervolaemic Haemodilution in Saving Red Blood Cells as Compared to Transfusion of Allogeneic Blood

Singbartl¹,

Singbartl²,

Schleinzer³

et al. 2000

Transfus Med Hemother

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“…Neither a low filling state nor hypervolaemia will result in an optimal cardiac output cordant with stabilization of cardiac output [10,11]. PAOP, however, will rise further, concomitant with further filling.…”

Section: Static Variables Of Preloadmentioning

confidence: 99%

Assessment of loading conditions with cardiac ultrasound. A comprehensive review

Poelaert¹

2015

Anaesthesiol Intensive Ther

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Optimization of the preloading conditions and concomitant determination of endpoints of fluid administration are the most frequent therapeutic actions in critically ill patients. Besides a clinical appraisal, reproducible data should be acquired at the bedside to estimate the adequacy of fluid resuscitation. The dynamic assessment and determination of fluid responsiveness plays a major role in this respect. Right-sided cardiac variables, such as inferior and superior caval vein diameter variation during mechanical ventilation, are easily obtained with cardiac ultrasound. Moreover, left sided variables, including aortic flow variation, with intermittent swings of intrathoracic pressure during mechanical ventilation, may be achieved non-invasively with Doppler-echocardiography. Both in terms of resuscitation, as well as correct interpretation of various two-dimensional and Doppler variables, it is essential to acquire a clear understanding of the filling status of a patient. Doppler-echocardiography plays herein a pivotal role.

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“…Using transesophageal echocardiographic monitoring in cardiovascularly healthy patients undergoing preoperative hypervolemic hemodilution, van Daele et al 90 observed that an infusion of 1500 mL Dextran ® 40 and 1500 mL Ringer ® solution resulted in a 36% increase in hematocrit. The increase in CO was due to an increase in stroke volume from 48 to 72 mL, while heart rate remained constant.…”

Section: Iso-or Hypervolemic Hemodilution In Acute Stroke ?mentioning

confidence: 99%

Volume Therapy in Patients with Acute Stroke

Woessner

Haaß

et al. 1999

Transfus Alt Transfus Med

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Transesophageal Echocardiographic Monitoring of Preoperative Acute Hypervolemic Hemodilution

Cited by 50 publications

References 0 publications

Cost-Minimising Analysis of Acute Normovolaemic Haemodilution and Hypervolaemic Haemodilution in Saving Red Blood Cells as Compared to Transfusion of Allogeneic Blood

Cost-Minimising Analysis of Acute Normovolaemic Haemodilution and Hypervolaemic Haemodilution in Saving Red Blood Cells as Compared to Transfusion of Allogeneic Blood

Assessment of loading conditions with cardiac ultrasound. A comprehensive review

Volume Therapy in Patients with Acute Stroke

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