ROLES OF SO2 INDEX FOR PREDICTING OF FLUID RESPONSIVENESS IN HIGH RISK CARDIAC SURGICAL PATIENTS

Purpose: (1) Study the change in SO2 value in fluid therapy in patients after cardiac surgery; (2) Evaluate the role of SO2 monitoring in serving as an indicator of fluid responsiveness in patients after cardiac surgery. Methods: This was a prospective study reported earlier on critically ill patients with clinical hypovolemia after cardiac surgery. Fluid therapy was guided by changes in pulmonary artery wedge pressure or central venous pressure. Fluid responsiveness was defined as ≥15% increase in cardiac index. Hemodynamics, including left ventricular ejection fraction, cardiac index, and oxygen delivery were measured when SO2 blood samples taken. Results: There was 110 patients receiving fluid therapy in postoperative period. The SO2 increased in 104 patients responding to fluid loading (≥15% in cardiac index in n=107) versus those not responding (n=6). The increase in ejection fraction, cardiac index and oxygen delivery was also greater in responders (p=0.005). The area under the receiver operating characteristic curve for fluid responsiveness of changes in SO2 was 0.78 (p=0.05), with an optimal cutoff of 2%. The value of SO2 increased to reflect cardiac index increases with fluid loading was in 66.7% of patients. Conclusions: An increase in SO2 ≥ 2% can thus be used as an indicator of fluid responsiveness in clinically hypovolemic patients after cardiac surgery, particularly in those with systolic cardiac dysfunction. Fluid responsiveness concurs with increased tissue oxygen delivery. Key words: mixed venous oxygen saturation (SO2); oxygen delivery (DO2); oxygen consumption (VO2); central venous pressure (CVP), pulmonary artery wedge pressure (PAWP); cardiac index (CI); hypovolemia; fluid therapy.

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Fluid Responsiveness Predictability in Immediate Postoperative Pediatric Cardiac Surgery. Is the Old Slandered Central Venous Pressure Back Again?

Shock ◽

10.1097/shk.0000000000001786 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Eran Shostak ◽

Tzippy Shochat ◽

Orit Manor ◽

Ovadia Dagan ◽

Ofer Schiller

Keyword(s):

Cardiac Surgery ◽

Central Venous Pressure ◽

Fluid Responsiveness ◽

Venous Pressure ◽

Pediatric Cardiac Surgery ◽

Central Venous

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Uppermost Blood Levels of the Right and Left Atria in the Supine Position

Anesthesiology ◽

10.1097/01.anes.0000270720.67307.fa ◽

2007 ◽

Vol 107 (2) ◽

pp. 260-263 ◽

Cited By ~ 10

Author(s):

Jeong-Hwa Seo ◽

Chul-Woo Jung ◽

Jae-Hyon Bahk

Keyword(s):

Pulmonary Artery ◽

Central Venous Pressure ◽

Supine Position ◽

Pressure Transducer ◽

Venous Pressure ◽

Blood Levels ◽

Pulmonary Artery Wedge Pressure ◽

Central Venous ◽

Significant Difference ◽

Wedge Pressure

Background To eliminate the influence of hydrostatic pressure, proper transducer positions for central venous pressure and pulmonary artery wedge pressure are at the uppermost blood levels of right atrium (RA) and left atrium (LA). This study was performed to investigate accurate reference levels of central venous pressure and pulmonary artery wedge pressure in the supine position. Methods Chest computed tomography images of 96 patients without history of cardiothoracic surgery, heart disease, or cardiothoracic anatomical abnormality were retrospectively reviewed. The anteroposterior (AP) diameter of the thorax and the vertical distances from the skin on the back to the most anterior portion of RA (RA height) and LA (LA height) were measured. Their ratios were abbreviated, respectively, as RA height/AP diameter and LA height/AP diameter. Data are expressed as mean +/- SD (range). Results There was a significant difference [4.6 +/- 1.0 (1.6-6.4) cm; P < 0.001] between RA and LA heights. AP diameter was positively correlated with RA and LA heights (R = 0.839 and 0.700, respectively; P < 0.001). There was also a significant difference between RA height/AP diameter [0.83 +/- 0.03 (0.71-0.91)] and LA height/AP diameter [0.62 +/- 0.04 (0.52-0.72)] (P < 0.001). Conclusion In the supine position, a central venous pressure transducer should be positioned approximately 4.6 cm higher than a pulmonary artery wedge pressure transducer. The external reference level for central venous pressure seems to be at approximately four fifths of the AP diameter of the thorax from the back, and that for pulmonary artery wedge pressure seems to be at approximately three fifths of the AP diameter.

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Predictability of left heart dysfunction from right heart performance. Cardiac index-venous pressure plots and cardiac index-mean pulmonary artery wedge pressure plots at rest and their shift during dynamic exercise.

Japanese Circulation Journal ◽

10.1253/jcj.53.219 ◽

1989 ◽

Vol 53 (3) ◽

pp. 219-228 ◽

Cited By ~ 1

Author(s):

KAZUKO HORIE ◽

KOSHI GOTOH ◽

TAKAHIKO SUZUKI ◽

YO YASUDA ◽

HIDEKI FUJIWARA ◽

...

Keyword(s):

Cardiac Index ◽

Pulmonary Artery ◽

Venous Pressure ◽

Dynamic Exercise ◽

Left Heart ◽

Pulmonary Artery Wedge Pressure ◽

Right Heart ◽

Heart Dysfunction ◽

Heart Performance ◽

Wedge Pressure

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A comparative study of pulse pressure variation, stroke volume variation and central venous pressure in patients undergoing kidney transplantation

Singapore Medical Journal ◽

10.11622/smedj.2021221 ◽

2021 ◽

Author(s):

KM Kim ◽

GS Kim ◽

M Han

Keyword(s):

Kidney Transplantation ◽

Stroke Volume ◽

Fluid Responsiveness ◽

Pulse Pressure ◽

Stroke Volume Variation ◽

Venous Pressure ◽

Fluid Management ◽

Pressure Variation ◽

Fluid Loading ◽

Central Venous

Introduction: Optimal intraoperative fluid management guided by central venous pressure (CVP), a traditional intravascular volume status indicator, has improved transplanted graft function during kidney transplantation (KT). Pulse pressure variation (PPV) and stroke volume variation (SVV) – dynamic preload indexes – are robust predictors of fluid responsiveness. This study aimed to compare the accuracy of PPV and CVP against SVV in predicting fluid responsiveness in terms of cost-effectiveness after a standardised empiric volume challenge in KT patients. Methods: 36 patients undergoing living-donor KT were analysed. PPV, SVV, CVP and cardiac index (CI) were measured before and after fluid loading with a hydroxyethyl starch solution (7 mL/kg of ideal body weight). Patients were classified as responders (n = 12) or non-responders (n = 24) to fluid loading when CI increases were ≥ 10% or < 10%, respectively. The ability of PPV, SVV and CVP to predict fluid responsiveness was assessed using receiver operating characteristic (ROC) curves. Results: SVV and CVP measured before fluid loading were correlated with changes in CI caused by fluid expansion (ρ = 0.33, p = 0.049 and ρ = −0.37, p = 0.026) in contrast to PPV (ρ = 0.14, p = 0.429). The ROC analysis showed that SVV and CVP predicted response to volume loading (area under the ROC curve = 0.781 and 0.727, respectively; p < 0.05). Conclusion: Under the conditions of our study, SVV and CVP exhibited similar performance in predicting fluid responsiveness and could inform fluid management during KT as compared with PPV.

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Prediction of fluid responsiveness in the immediate post-operative period of cardiac surgery

Journal of Anesthesia & Critical Care Open Access ◽

10.15406/jaccoa.2021.13.00467 ◽

2021 ◽

Vol 13 (1) ◽

pp. 35-45

Author(s):

Bernard Benjamin P. Albano ◽

Luis Martin I. Habana

Keyword(s):

Cardiac Surgery ◽

Fluid Responsiveness ◽

Predictive Accuracy ◽

Venous Pressure ◽

Fluid Challenge ◽

Pulmonary Artery Occlusion Pressure ◽

Artery Occlusion ◽

Hemodynamic Parameters ◽

Fluid Loading ◽

Post Cardiac Surgery

Background: Prediction of fluid responsiveness can identify patients who will benefit from fluid loading in the immediate postoperative period of cardiac surgery. Several hemodynamic parameters may help identify those who will benefit from hydration. This study aimed to identify and compare the parameters that predict fluid responsiveness in post-cardiac surgery patients. Methodology: This prospective cohort study included 101 post-cardiac surgery patients. Hemodynamic parameters were recorded at baseline and after an 8 mL/kg IV fluid challenge. Fluid responders are those with an increase in stroke volume of ≥15%. Multivariate analysis was used to identify independent predictors of fluid responder status. Sensitivity and specificity analyses were done to determine the predictive accuracy of each parameter. Results: The rate of fluid responsiveness was 54.5%. Independent predictors were: central venous pressure (CVP) ≤6 mmHg (p=0.001), pulmonary artery occlusion pressure (PAOP) ≤12 mmHg (p=0.016), PAOP increase by ≥7 mmHg (p=0.002), pulse pressure variability (PPV) >12% (p<0.001), PPV decrease by >5% (p=0.049) and weight (p=0.04). PPV was the most sensitive (92%) and specific (74%); while PAOP was the least sensitive (70%) and CVP the least specific (51%). PPV had the highest ability to discriminate fluid responders (AUC 0.83) compared to PAOP (AUC 0.21) and CVP (AUC 0.40) (p<0.0001). Conclusion: PPV (a dynamic index) is superior to CVP and PAOP (static indices) in discriminating fluid responders in adult patients who underwent cardiac surgery. PPV is the favored tool to guide initiation of fluid therapy in this clinical setting.

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