Cardiac index and stroke volume variation as parameters to guide fluid therapy and hemodynamic management in renal transplantation in comparison to conventional management

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.

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Stroke volume variation to guide fluid therapy: is it suitable for high-risk surgical patients? A terminated randomized controlled trial

Perioperative Medicine ◽

10.1186/s13741-015-0016-x ◽

2015 ◽

Vol 4 (1) ◽

Cited By ~ 15

Author(s):

Ib Jammer ◽

Mari Tuovila ◽

Atle Ulvik

Keyword(s):

Randomized Controlled Trial ◽

High Risk ◽

Stroke Volume ◽

Fluid Therapy ◽

Stroke Volume Variation ◽

Controlled Trial ◽

Surgical Patients ◽

Randomized Controlled ◽

Volume Variation

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Evaluation of least significant changes of pulse contour analysis-derived parameters

Annals of Intensive Care ◽

10.1186/s13613-019-0590-z ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 4

Author(s):

Hugues de Courson ◽

Loic Ferrer ◽

Grégoire Cane ◽

Eric Verchère ◽

Musa Sesay ◽

...

Keyword(s):

Cardiac Index ◽

Stroke Volume ◽

Pulse Pressure ◽

Pulse Pressure Variation ◽

Stroke Volume Variation ◽

Pressure Variation ◽

Volume Index ◽

Index Stroke Volume ◽

Volume Variation ◽

Index Stroke

Abstract Background Many maneuvers assessing fluid responsiveness (minifluid challenge, lung recruitment maneuver, end-expiratory occlusion test, passive leg raising) are considered as positive when small variations in cardiac index, stroke volume index, stroke volume variation or pulse pressure variation occur. Pulse contour analysis allows continuous and real-time cardiac index, stroke volume, stroke volume variation and pulse pressure variation estimations. To use these maneuvers with pulse contour analysis, the knowledge of the minimal change that needs to be measured by a device to recognize a real change (least significant change) has to be studied. The aim of this study was to evaluate the least significant change of cardiac index, stroke volume index, stroke volume variation and pulse pressure variation obtained using pulse contour analysis (ProAQT®, Pulsion Medical System, Germany). Methods In this observational study, we included 50 mechanically ventilated patients undergoing neurosurgery in the operating room. Cardiac index, stroke volume index, pulse pressure variation and stroke volume variation obtained using ProAQT® (Pulsion Medical System, Germany) were recorded every 12 s during 15-min steady-state periods. Least significant changes were calculated every minute. Results Least significant changes statistically differed over time for cardiac index, stroke volume index, pulse pressure variation and stroke volume variation (p < 0.001). Least significant changes ranged from 1.3 to 0.7% for cardiac index, from 1.3 to 0.8% for stroke volume index, from 10 to 4.9% for pulse pressure variation and from 10.8 to 4.3% for stroke volume variation. Conclusion To conclude, the present study suggests that pulse contour analysis is able to detect rapid and small changes in cardiac index and stroke volume index, but the interpretation of rapid and small changes of pulse pressure variation and stroke volume variation must be done with caution.

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