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4 results

  • 13 - Fluid Responsiveness Assessment

  • from Section 3 - Practical Use
    • By
  • Edited by Alexandre Joosten, University of California, Los Angeles, Maxime Cannesson, University of California, Los Angeles, Robert G. Hahn, Karolinska Institutet, Stockholm
  • Book:
    Hemodynamic Monitoring and Fluid Therapy during Surgery
    Published online:
    11 April 2024
    Print publication:
    02 May 2024, pp 136-148

  • Summary

    Fluid administration in the operating room is a cornerstone of perioperative hemodynamic optimization Functional assessment of fluid response aims at evaluating the hemodynamic changes associated with the interplay between heart and lungs on flow and pressure parameters, with the purpose of tailoring fluid administration to predefined physiological targets and specific patient needs. In patients under mechanical ventilation, the fixed and repetitive inspiratory and expiratory pressure changes affect right ventricle’s preload, afterload and, hence, stroke volume, finally determining the changes on the dynamic indices of fluid responsiveness, such as pulse pressure variation and stroke volume variation. These changes may even be enhanced by the application of maneuvers that may potentiate heart–lung interactions, the so-called functional hemodynamic tests. This chapter analyzes methods and variables to assess fluid responsiveness in the perioperative setting, how to perform functional hemodynamic tests and how to interpret them considering potential confounding factors and limitations.

  • Comparison of End-Tidal Carbon Dioxide (ETCO2) Gradient and Vena Cava Collapsibility Index (VCCI) in Response to Intravenous Fluid Therapy in Patients with Moderate and Severe Dehydration and Acute Gastroenteritis

  • Gülin İnan, Pınar Hanife Kara Çetіnbіlek, Hayriye Gönüllü
  • Journal:
    Prehospital and Disaster Medicine / Volume 37 / Issue 4 / August 2022
    Published online by Cambridge University Press:
    25 May 2022, pp. 474-479
    Print publication:
    August 2022
  • Introduction and Objective:

    Acute gastroenteritis (AGE) is one of the most common clinical diagnoses globally, and dehydration in severe AGE cases can cause severe morbidity and mortality. Depending on the metabolic acidosis that occurs in dehydration, the respiratory rate per minute is increased, and the carbon dioxide pressure in the arterial blood is decreased. This condition correlates with end-tidal carbon dioxide (ETCO2). Therefore, this study primarily aims to evaluate whether ETCO2 measurement has a role in detecting metabolic fluid deficit, dehydration level, and regression in dehydration level after fluid replacement and its correlation with Vena Cava Collapsibility Index (VCCI).

    Material and Method:

    This study included spontaneously breathing patients admitted to the emergency department of a tertiary training and research hospital with symptoms of AGE and were thought to be moderately (6.0%-9.0%) and severely (>10.0%) dehydrated according to the Primary Options of Acute Care (POAC) Clinical Dehydration Scale. After the first evaluation, the patients’ vital signs, ETCO2 values, diameters of the inferior vena cava (IVC) in inspiration and expiration, and VCCI were measured and recorded. These measurements were repeated after intravenous (IV) fluid replacement, and finally, a comparison was made between the measurements.

    Results:

    A total of 49 patients, as 16 male (32.7%) and 33 female (67.3%), were included in the study. The mean fluid replacement value was calculated as 664.29 (SD = 259.41) ml. The mean increase in ETCO2 was 3.653 (SD = 2.554) mmHg (P <.001). The mean increase in inferior vena cava expirium (IVCexp) was calculated as 0.402 (SD = 0.280) cm (P <.001) and the mean increase in inferior vena cava inspirium (IVCinsp) as 0.476 (SD = 0.306) cm (P <.001). The VCCI (%) decreased by 12.556 (SD = 13.683) (P <.001). Post-replacement vital signs, ETCO2, and VCCI correlations of the patients were examined and no significant correlation was found between ETCO2 and VCCI (%). As a result of this study, a receiver operating characteristic (ROC) curve was established for the ETCO2 values predicting the level of dehydration and fluid response, and the area under the curve was calculated as 0.748. However, to classify the patient as moderately dehydrated, the ETCO2 cutoff value was determined as 28.5mmHg.

    Conclusion:

    The sensitivity and specificity of ETCO2 levels were 71.43% and 74.29% in evaluating the level of dehydration, and no correlation was found with VCCI, which is known to have high sensitivity and specificity in previous studies in determining the level of dehydration and fluid response. Hence, VCCI measurement made through ultrasonography (USG) is a method that should be preferred more in determining the level of dehydration. Nevertheless, as per the results of this study, swift ETCO2 measurements may be helpful in monitoring the change in the degree of dehydration with treatment in patients who were admitted to the emergency department with dehydration findings and were administered IV fluid replacement therapy.

  • Chapter 8 - Point-of-Care Ultrasound: Determination of Fluid Responsiveness

  • Edited by Andrew B. Leibowitz, Suzan Uysal
  • Book:
    Modern Monitoring in Anesthesiology and Perioperative Care
    Published online:
    28 April 2020
    Print publication:
    07 May 2020, pp 80-91

  • Summary

    Hypotension and shock in the perioperative setting may arise from a variety of etiologies. A common initial intervention is administration of a fluid bolus to increase the cardiac stroke volume and mean arterial blood pressure; however, up to 50% of all hypotensive patients do not have the desired hemodynamic response, and excessive fluid administration may be harmful. There is a clinical need to determine the likelihood that an individual patient will respond to fluid administration, and use of dynamic parameters is becoming routine. The respiratory variation of stroke volume associated with positive pressure ventilation (heart–lung interaction model) and the passive leg raise (endogenous fluid challenge model) are the two best-validated means to quickly augment stroke volume. This chapter will review ultrasound-based parameters such as inferior vena cava diameter change and velocity time integral variation utilizing these two methods of stroke volume augmentation to predict fluid responsiveness.

  • Chapter 11 - Assessing Intravascular Volume Status and Fluid Responsiveness: A Non-Ultrasound Approach

  • Edited by Andrew B. Leibowitz, Suzan Uysal
  • Book:
    Modern Monitoring in Anesthesiology and Perioperative Care
    Published online:
    28 April 2020
    Print publication:
    07 May 2020, pp 109-116

  • Summary

    Estimation of intravascular volume status by clinical examination and static measurements such as central venous pressure and pulmonary capillary wedge pressure do not predict fluid responsiveness. Current evidence indicates that dynamic monitoring of arterial pressure and derived indices are the most sensitive and specific means of determining fluid responsiveness, especially in mechanically ventilated patients. Several monitors that automate and embellish this approach, a few of which are noninvasive, are now commercially available and they are gradually being incorporated into intensive and perioperative care practice. This chapter reviews the physiologic underpinnings of how and why the arterial pressure waveform can be used to determine fluid responsiveness and gives an overview of the devices incorporating these principles.