The effect of fluid resuscitation on the effective circulating volume in patients undergoing liver surgery: a post-hoc analysis of a randomized controlled trial
To assess the significance of an analogue of the mean systemic filling pressure (Pmsa) and its derived variables, in providing a physiology based discrimination between responders and non-responders to fluid resuscitation during liver surgery. A post-hoc analysis of data from 30 patients undergoing...
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| Veröffentlicht in: | Journal of clinical monitoring and computing 2018-02, Vol.32 (1), p.73-80 |
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| creator | Vos, Jaap Jan Kalmar, A. F. Hendriks, H. G. D. Bakker, J. Scheeren, T. W. L. |
| description | To assess the significance of an analogue of the mean systemic filling pressure (Pmsa) and its derived variables, in providing a physiology based discrimination between responders and non-responders to fluid resuscitation during liver surgery. A post-hoc analysis of data from 30 patients undergoing major hepatic surgery was performed. Patients received 15 ml kg
−1
fluid in 30 min. Fluid responsiveness (FR) was defined as an increase of 20% or greater in cardiac index, measured by FloTrac-Vigileo
®
. Dynamic preload variables (pulse pressure variation and stroke volume variation: PPV, SVV) were recorded additionally. Pvr, the driving pressure for venous return (=Pmsa–central venous pressure) and heart performance (E
H
; Pvr/Pmsa) were calculated according to standard formula. Pmsa increased following fluid administration in responders (n = 18; from 13 ± 3 to 17 ± 4 mmHg, p |
| doi_str_mv | 10.1007/s10877-017-9990-5 |
| format | Article |
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−1
fluid in 30 min. Fluid responsiveness (FR) was defined as an increase of 20% or greater in cardiac index, measured by FloTrac-Vigileo
®
. Dynamic preload variables (pulse pressure variation and stroke volume variation: PPV, SVV) were recorded additionally. Pvr, the driving pressure for venous return (=Pmsa–central venous pressure) and heart performance (E
H
; Pvr/Pmsa) were calculated according to standard formula. Pmsa increased following fluid administration in responders (n = 18; from 13 ± 3 to 17 ± 4 mmHg, p < 0.01) and in non-responders (n = 12; from 14 ± 4 to 17 ± 4 mmHg, p < 0.01). Pvr, which was lower in responders before fluid administration (6 ± 1 vs. 7 ± 1 mmHg; p = 0.02), increased after fluid administration only in responders (from 6 ± 1 to 8 ± 1 mmHg; p < 0.01). E
H
only decreased in non-responders (from 0.56 ± 0.17 to 0.45 ± 0.12; p < 0.05). The area under the receiver operating characteristics curve of Pvr, PPV and SVV for predicting FR was 0.75, 0.73 and 0.72, respectively. Changes in Pmsa, Pvr and E
H
reflect changes in effective circulating volume and heart performance following fluid resuscitation, providing a physiologic discrimination between responders and non-responders. Also, Pvr predicts FR equivalently compared to PPV and SVV, and might therefore aid in predicting FR in case dynamic preload variables cannot be used.</description><identifier>ISSN: 1387-1307</identifier><identifier>EISSN: 1573-2614</identifier><identifier>DOI: 10.1007/s10877-017-9990-5</identifier><identifier>PMID: 28210935</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Adult ; Aged ; Anesthesia, General ; Anesthesiology ; Anesthetics - therapeutic use ; Blood Pressure - physiology ; Cardiac Output ; Central Venous Pressure ; Critical Care Medicine ; Critical Illness ; Data Interpretation, Statistical ; Discrimination ; Female ; Fluid Therapy - methods ; Health Sciences ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Intensive ; Liver ; Liver - surgery ; Male ; Mathematical analysis ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Research ; Patients ; Reproducibility of Results ; Resuscitation ; ROC Curve ; Signal Processing, Computer-Assisted ; Statistics for Life Sciences ; Stroke volume ; Stroke Volume - physiology ; Surgery ; Treatment Outcome</subject><ispartof>Journal of clinical monitoring and computing, 2018-02, Vol.32 (1), p.73-80</ispartof><rights>The Author(s) 2017</rights><rights>Journal of Clinical Monitoring and Computing is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-808bb077a2ebc7235a111ccdbe24e3de543014d699868abca41e9aaf4c078ac03</citedby><cites>FETCH-LOGICAL-c470t-808bb077a2ebc7235a111ccdbe24e3de543014d699868abca41e9aaf4c078ac03</cites><orcidid>0000-0002-0597-6462</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10877-017-9990-5$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10877-017-9990-5$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28210935$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vos, Jaap Jan</creatorcontrib><creatorcontrib>Kalmar, A. F.</creatorcontrib><creatorcontrib>Hendriks, H. G. D.</creatorcontrib><creatorcontrib>Bakker, J.</creatorcontrib><creatorcontrib>Scheeren, T. W. L.</creatorcontrib><title>The effect of fluid resuscitation on the effective circulating volume in patients undergoing liver surgery: a post-hoc analysis of a randomized controlled trial</title><title>Journal of clinical monitoring and computing</title><addtitle>J Clin Monit Comput</addtitle><addtitle>J Clin Monit Comput</addtitle><description>To assess the significance of an analogue of the mean systemic filling pressure (Pmsa) and its derived variables, in providing a physiology based discrimination between responders and non-responders to fluid resuscitation during liver surgery. A post-hoc analysis of data from 30 patients undergoing major hepatic surgery was performed. Patients received 15 ml kg
−1
fluid in 30 min. Fluid responsiveness (FR) was defined as an increase of 20% or greater in cardiac index, measured by FloTrac-Vigileo
®
. Dynamic preload variables (pulse pressure variation and stroke volume variation: PPV, SVV) were recorded additionally. Pvr, the driving pressure for venous return (=Pmsa–central venous pressure) and heart performance (E
H
; Pvr/Pmsa) were calculated according to standard formula. Pmsa increased following fluid administration in responders (n = 18; from 13 ± 3 to 17 ± 4 mmHg, p < 0.01) and in non-responders (n = 12; from 14 ± 4 to 17 ± 4 mmHg, p < 0.01). Pvr, which was lower in responders before fluid administration (6 ± 1 vs. 7 ± 1 mmHg; p = 0.02), increased after fluid administration only in responders (from 6 ± 1 to 8 ± 1 mmHg; p < 0.01). E
H
only decreased in non-responders (from 0.56 ± 0.17 to 0.45 ± 0.12; p < 0.05). The area under the receiver operating characteristics curve of Pvr, PPV and SVV for predicting FR was 0.75, 0.73 and 0.72, respectively. Changes in Pmsa, Pvr and E
H
reflect changes in effective circulating volume and heart performance following fluid resuscitation, providing a physiologic discrimination between responders and non-responders. Also, Pvr predicts FR equivalently compared to PPV and SVV, and might therefore aid in predicting FR in case dynamic preload variables cannot be used.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia, General</subject><subject>Anesthesiology</subject><subject>Anesthetics - therapeutic use</subject><subject>Blood Pressure - physiology</subject><subject>Cardiac Output</subject><subject>Central Venous Pressure</subject><subject>Critical Care Medicine</subject><subject>Critical Illness</subject><subject>Data Interpretation, Statistical</subject><subject>Discrimination</subject><subject>Female</subject><subject>Fluid Therapy - methods</subject><subject>Health Sciences</subject><subject>Heart</subject><subject>Heart Rate</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Intensive</subject><subject>Liver</subject><subject>Liver - surgery</subject><subject>Male</subject><subject>Mathematical analysis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Research</subject><subject>Patients</subject><subject>Reproducibility of Results</subject><subject>Resuscitation</subject><subject>ROC Curve</subject><subject>Signal Processing, Computer-Assisted</subject><subject>Statistics for Life Sciences</subject><subject>Stroke volume</subject><subject>Stroke Volume - physiology</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>1387-1307</issn><issn>1573-2614</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1kc2KFDEUhQtRnB99ADcScOOm9KZSVUm5EIbBUWHAzbgOqdSt7gyppM1PQ_s0PqopemxGQQjkkvPlntycqnpF4R0F4O8jBcF5DZTXwzBA3T2pzmnHWd30tH1aaiZ4TRnws-oixnsAGASjz6uzRjQUBtadV7_utkhwnlEn4mcy22wmEjDmqE1SyXhHykonyOyRaBN0tkV0G7L3Ni9IjCO7coAuRZLdhGHjV9UWPJCYwwbD4QNRZOdjqrdeE-WUPUQTV1NFgnKTX8xPnIj2LgVvbSlTMMq-qJ7NykZ8-bBfVt9vPt1df6lvv33-en11W-uWQ6oFiHEEzlWDo-YN6xSlVOtpxKZFNmHXMqDt1A-D6IUatWopDkrNrQYulAZ2WX089t3lccFJl1GCsnIXzKLCQXpl5N-KM1u58XvZ8Q5Yw0uDtw8Ngv-RMSa5mKjRWuXQ5yipKOY9F7B6vfkHvfc5lB8pVEmob2Dou0LRI6WDjzHgfHoMBbnmL4_5y5K_XPOX653Xj6c43fgTeAGaIxCL5Eosj6z_2_U3ZqXAMw</recordid><startdate>20180201</startdate><enddate>20180201</enddate><creator>Vos, Jaap Jan</creator><creator>Kalmar, A. 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F.</au><au>Hendriks, H. G. D.</au><au>Bakker, J.</au><au>Scheeren, T. W. L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of fluid resuscitation on the effective circulating volume in patients undergoing liver surgery: a post-hoc analysis of a randomized controlled trial</atitle><jtitle>Journal of clinical monitoring and computing</jtitle><stitle>J Clin Monit Comput</stitle><addtitle>J Clin Monit Comput</addtitle><date>2018-02-01</date><risdate>2018</risdate><volume>32</volume><issue>1</issue><spage>73</spage><epage>80</epage><pages>73-80</pages><issn>1387-1307</issn><eissn>1573-2614</eissn><abstract>To assess the significance of an analogue of the mean systemic filling pressure (Pmsa) and its derived variables, in providing a physiology based discrimination between responders and non-responders to fluid resuscitation during liver surgery. A post-hoc analysis of data from 30 patients undergoing major hepatic surgery was performed. Patients received 15 ml kg
−1
fluid in 30 min. Fluid responsiveness (FR) was defined as an increase of 20% or greater in cardiac index, measured by FloTrac-Vigileo
®
. Dynamic preload variables (pulse pressure variation and stroke volume variation: PPV, SVV) were recorded additionally. Pvr, the driving pressure for venous return (=Pmsa–central venous pressure) and heart performance (E
H
; Pvr/Pmsa) were calculated according to standard formula. Pmsa increased following fluid administration in responders (n = 18; from 13 ± 3 to 17 ± 4 mmHg, p < 0.01) and in non-responders (n = 12; from 14 ± 4 to 17 ± 4 mmHg, p < 0.01). Pvr, which was lower in responders before fluid administration (6 ± 1 vs. 7 ± 1 mmHg; p = 0.02), increased after fluid administration only in responders (from 6 ± 1 to 8 ± 1 mmHg; p < 0.01). E
H
only decreased in non-responders (from 0.56 ± 0.17 to 0.45 ± 0.12; p < 0.05). The area under the receiver operating characteristics curve of Pvr, PPV and SVV for predicting FR was 0.75, 0.73 and 0.72, respectively. Changes in Pmsa, Pvr and E
H
reflect changes in effective circulating volume and heart performance following fluid resuscitation, providing a physiologic discrimination between responders and non-responders. Also, Pvr predicts FR equivalently compared to PPV and SVV, and might therefore aid in predicting FR in case dynamic preload variables cannot be used.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>28210935</pmid><doi>10.1007/s10877-017-9990-5</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-0597-6462</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of clinical monitoring and computing, 2018-02, Vol.32 (1), p.73-80 |
| issn | 1387-1307 1573-2614 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5750327 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Adult Aged Anesthesia, General Anesthesiology Anesthetics - therapeutic use Blood Pressure - physiology Cardiac Output Central Venous Pressure Critical Care Medicine Critical Illness Data Interpretation, Statistical Discrimination Female Fluid Therapy - methods Health Sciences Heart Heart Rate Hemodynamics Humans Intensive Liver Liver - surgery Male Mathematical analysis Medicine Medicine & Public Health Middle Aged Original Research Patients Reproducibility of Results Resuscitation ROC Curve Signal Processing, Computer-Assisted Statistics for Life Sciences Stroke volume Stroke Volume - physiology Surgery Treatment Outcome |
| title | The effect of fluid resuscitation on the effective circulating volume in patients undergoing liver surgery: a post-hoc analysis of a randomized controlled trial |
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