Noninvasive Beat-to-Beat Stroke Volume Measurements to Determine Preload Responsiveness during Mini-Fluid Challenge in a Swine Model

Shock ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ryoung Eun Ko ◽  
Geuk Young Jang ◽  
Chi Ryang Chung ◽  
Jin Young Lee ◽  
Tong In Oh ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Fluid Challenge ◽  
Swine Model ◽  
Preload Responsiveness ◽  
Volume Measurements

Pleth variability index may predict preload responsiveness in patients treated with nasal high flow: a physiological study

2021 ◽  
Author(s):  
Marina García de Acilu ◽  
Andrés Pacheco ◽  
Manel Santafé ◽  
Francisco-Javier Ramos ◽  
Juan C. Ruiz-Rodríguez ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Diagnostic Accuracy ◽  
Fluid Challenge ◽  
High Flow ◽  
Passive Leg Raising ◽  
Strongly Correlated ◽  
Pleth Variability Index ◽  
Preload Responsiveness ◽  
Variability Index ◽  
Plethysmographic Variability Index

The purpose of this study was to determine whether the plethysmographic variability index (PVi) can predict preload responsiveness in nasal high flow (NHF) patients (≥30 L/min) with any sign of hypoperfusion. Preload responsiveness was defined as a ≥10% increase in stroke volume (SV), measured by transthoracic echocardiography, after passive leg raising. SV and PVi were reassessed in preload responders after receiving a 250-mL fluid challenge. Twenty patients were included, and 12 patients (60%) were preload responders. Responders showed higher baseline mean PVi (24% vs. 13%; p=0.001) and higher mean PVi variation (∆PVi) after passive leg raising (6.8% vs. -1.7%; p<0.001). No differences between mean ∆PVi after passive leg raising and mean ∆PVi after fluid challenge were observed (6.8 % vs. 7.4%; p=0.24), and both values were strongly correlated (r=0.84; p<0.001). Baseline PVi and ∆PVi after passive leg raising showed excellent diagnostic accuracy identifying preload responders (AUROC 0.92 and 1.00, respectively). Baseline PVi ≥16% had a sensitivity of 91.7% and a specificity of 87.5% for detecting preload responders. Similarly, ∆PVi after passive leg raising ≥2%, had a 100% of both sensitivity and specificity. Thus, PVi might predict preload responsiveness in patients treated with NHF, suggesting that it may guide fluid administration in these patients.

Mini-fluid Challenge of 100 ml of Crystalloid Predicts Fluid Responsiveness in the Operating Room

2017 ◽  
Vol 127 (3) ◽  
pp. 450-456 ◽  
Author(s):  
Matthieu Biais ◽  
Hugues de Courson ◽  
Romain Lanchon ◽  
Bruno Pereira ◽  
Guillaume Bardonneau ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Operating Room ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Fluid Challenge ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Abstract Background Mini-fluid challenge of 100 ml colloids is thought to predict the effects of larger amounts of fluid (500 ml) in intensive care units. This study sought to determine whether a low quantity of crystalloid (50 and 100 ml) could predict the effects of 250 ml crystalloid in mechanically ventilated patients in the operating room. Methods A total of 44 mechanically ventilated patients undergoing neurosurgery were included. Volume expansion (250 ml saline 0.9%) was given to maximize cardiac output during surgery. Stroke volume index (monitored using pulse contour analysis) and pulse pressure variations were recorded before and after 50 ml infusion (given for 1 min), after another 50 ml infusion (given for 1 min), and finally after 150 ml infusion (total = 250 ml). Changes in stroke volume index induced by 50, 100, and 250 ml were recorded. Positive fluid challenges were defined as an increase in stroke volume index of 10% or more from baseline after 250 ml. Results A total of 88 fluid challenges were performed (32% of positive fluid challenges). Changes in stroke volume index induced by 100 ml greater than 6% (gray zone between 4 and 7%, including 19% of patients) predicted fluid responsiveness with a sensitivity of 93% (95% CI, 77 to 99%) and a specificity of 85% (95% CI, 73 to 93%). The area under the receiver operating curve of changes in stroke volume index induced by 100 ml was 0.95 (95% CI, 0.90 to 0.99) and was higher than those of changes in stroke volume index induced by 50 ml (0.83 [95% CI, 0.75 to 0.92]; P = 0.01) and pulse pressure variations (0.65 [95% CI, 0.53 to 0.78]; P &lt; 0.005). Conclusions Changes in stroke volume index induced by rapid infusion of 100 ml crystalloid predicted the effects of 250 ml crystalloid in patients ventilated mechanically in the operating room.

scholarly journals Stroke volume variation is a good predictor of fluid responsiveness in cardiac surgery patients with implanted intra-arortic balloon pump

2021 ◽  
Author(s):  
Rostislav Enev ◽  
Filip Abedinov ◽  
Neda Bakalova
Keyword(s):  
Cardiac Surgery ◽  
Stroke Volume ◽  
Fluid Responsiveness ◽  
Fluid Therapy ◽  
Good Predictor ◽  
Stroke Volume Variation ◽  
Fluid Challenge ◽  
Pulse Contour ◽  
Important Variable ◽  
Volume Variation

Abstract There is a vast body of evidence in favor of individualising fluid therapy using dynamic hemodynamic indices like stroke volume variation (SVV). Patients with implanted intra-aortic balloon pump (IABP) are excluded from this approach because of pulse contour artifacts caused by the pump. The aim of this work is to test whether SVV can be used for fluid responsiveness prediction in these patients. Materials and methods: Patients after cardiac surgery with implanted IABP were included in this study. SVV was measured after placing the IABP on standy mode for one minute. Cardiac output (CO) measurement was obtained via Swan-Ganz catheter before and after a 6 ml/kg fluid challenge. Fluid responsiveness was defined as increase of CO by at least 10%. Results: SVV above 8.5% showed a good correlation with fuid responsiveness. Sensitivity was 95 (95% CI 85 to 100) and specificity 82 (95% CI 72 to 92). SVV had an area under the ROC curve 0.91 (95% CI 0.81 to 1.0) Conclusion: SVV is a good predictor of fluid responsiveness in patients with IABP. SVV should not be excluded as a fluid therapy guide for these patients. Placing the pump on standby for one minute allows obtaining an accurate measurement of this important variable.

Hemodynamic effects of cardiac cycle-specific increases in intrathoracic pressure

1986 ◽  
Vol 60 (2) ◽  
pp. 604-612 ◽  
Author(s):  
M. R. Pinsky ◽  
G. M. Matuschak ◽  
L. Bernardi ◽  
M. Klain
Keyword(s):  
Stroke Volume ◽  
Cardiac Cycle ◽  
Intrathoracic Pressure ◽  
Canine Model ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Cardiac Performance ◽  
Hemodynamic Effects ◽  
Volume Measurements ◽  
Systemic Venous Return

Changes in intrathoracic pressure (ITP) can influence cardiac performance by affecting ventricular loading conditions. Because both systemic venous return and factors determining left ventricular (LV) ejection may vary over the cardiac cycle, phasic increases in ITP may differentially affect preload or afterload if delivered at specific points within the cardiac cycle. We studied the hemodynamic effects of cardiac cycle-specific increases in ITP (pulses) delivered by a high-frequency jet ventilator in an acute closed-chested canine model (n = 11), using electromagnetic flow probes to measure biventricular stroke volume. Measurements were taken during a control condition after the induction of acute ventricular failure (AVF) by propranolol hydrochloride and volume infusion. ITP was independently varied without changing lung volume by the inflation of thoracoabdominal binders. Although synchronous pulses had minimal hemodynamic effects in unbound controls, binding pulses timed to occur in early diastole resulted in decreases in LV filling pressure and left ventricular stroke volume (SVlv) (P less than 0.05). In the AVF condition, pulses increased LV performance, evidenced by increases in SVlv (P less than 0.01), despite decreases in LV filling pressure (P less than 0.05). This effect is maximized by binding and by timing the pulses to occur in systole. We conclude that cardiac cycle-specific increases in ITP can significantly affect cardiac performance. These effects appear to be related to the ability of such timed pulses to selectively affect LV preload and afterload.

Comparison of volume and hemodynamic effects of crystalloid, hydroxyethyl starch, and albumin in patients undergoing major abdominal surgery: a prospective observational study

2020 ◽  
Author(s):  
Daisuke Toyoda ◽  
Yuichi Maki ◽  
Yasumasa Sakamoto ◽  
Junki Kinoshita ◽  
Risa Abe ◽  
...  
Keyword(s):  
Observational Study ◽  
Abdominal Surgery ◽  
Stroke Volume ◽  
Hydroxyethyl Starch ◽  
Fluid Challenge ◽  
Stroke Volume Index ◽  
Ringer Solution ◽  
Colloid Osmotic Pressure ◽  
Volume Index ◽  
Hemodynamic Effects

Abstract Background The volume effect of iso-oncotic colloid is supposedly larger than crystalloid, but such differences are dependent on clinical context. The purpose of this study was to compare the volume and hemodynamic effects of crystalloid and colloid during surgical manipulation in patients undergoing major abdominal surgery. Methods Subjects undergoing intraabdominal surgery for malignancies with intraoperative goal-directed fluid management enrolled in this observational study. Fluid challenges consisted with 250 ml of either bicarbonate Ringer solution, 6% hydroxyethyl starch or 5% albumin were provided to maintain optimal stroke volume index. Hematocrit derived-plasma volume and colloid osmotic pressure was determined immediately before and 30 min after the fluid challenge. Data were expressed as median (IQR) and statistically compared with Kruskal-Wallis test. Results One hundred thirty-nine fluid challenges in 65 patients were analyzed. bicarbonate Ringer solution, 6% hydroxyethyl starch and 5% albumin were administered in 42, 49 and 48 instances, respectively. Plasma volume increased 7.3 (3.6–10.0) % and 6.3 (1.4–8.8) % 30 min after the fluid challenge with 6% hydroxyethyl starch and 5% albumin and these values are significantly larger than the value with bicarbonate Ringer solution (1.0 (-2.7-2.3) %) Colloid osmotic pressure increased 0.6 (0.2–1.2) mmHg after the fluid challenge with 6% hydroxyethyl starch and 0.7(0.2–1.3) mmHg with 5% albumin but decreased 0.6 (0.2–1.2) mmHg after the fluid challenge with bicarbonate Ringer solution. The area under the curve of stroke volume index after fluid challenge was significantly larger after 6% hydroxyethyl starch or 5% albumin compared to bicarbonate Ringer solution. Conclusions Fluid challenge with 6% hydroxyethyl starch and 5% albumin showed significantly larger volume and hemodynamic effects compared to bicarbonate Ringer solution during gastrointestinal surgery. Trial registration: UMIN Clinical Trial Registry UMIN000017964. Registered July 01, 2015

Non-invasive continuous arterial pressure, heart rate and stroke volume measurements during graded head-up tilt in normal man

1997 ◽  
Vol 7 (2) ◽  
pp. 97-101 ◽  
Author(s):  
L. A. H. Critchley ◽  
F. Conway ◽  
P. J. Anderson ◽  
B. Tomlinson ◽  
J. A. J. H. Critchley
Keyword(s):  
Heart Rate ◽  
Arterial Pressure ◽  
Stroke Volume ◽  
Non Invasive ◽  
Volume Measurements ◽  
Head Up Tilt ◽  
Normal Man
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