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

Published online by Cambridge University Press:  28 April 2020

By
David S. Beebe
Edited by
Andrew B. Leibowitz  and
Suzan Uysal
Andrew B. Leibowitz
Affiliation:
Icahn School of Medicine at Mount Sinai
Suzan Uysal
Affiliation:
Icahn School of Medicine at Mount Sinai
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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.

Keywords

Intravascular volumefluid responsivenesspulse pressure variationstroke volume variationperfusion indexplethysmographypleth variability indexgoal-directed therapy
Type
Chapter
Information
Modern Monitoring in Anesthesiology and Perioperative Care , pp. 109 - 116
Publisher: Cambridge University Press
Print publication year: 2020

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References

Rick, J, Burke, S. Respirator paradox. South Med J 1978;71:1376–8.Google Scholar
Michard, F. Changes in arterial pressure during mechanical ventilation. Anesthesiology 2005;103:419–28.Google Scholar
Yang, X, Du, B. Does pulse pressure variation predict fluid responsiveness in critically ill patients? A systematic review and meta-analysis. Crit Care 2014;18:650–63.CrossRefGoogle ScholarPubMed
Marik, P, Cavallazzi, R, Vasu, T, Hirani, A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med 2009;37:2642–7.CrossRefGoogle ScholarPubMed
Forget, P, Lois, F, de Kock, M. Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management. Anesth Analg 2010;111:910–4.CrossRefGoogle ScholarPubMed
Carsetti, A, Cecconi, M, Rhodes, A. Fluid bolus therapy: monitoring and predicting fluid responsiveness. Curr Opin Crit Care 2015;21:388–94.Google Scholar
Porhomayon, J, Zadell, G, Congello, S, Nader, N. Applications of minimally invasive cardiac output monitors. Intl J Emerg Med 2012;5:18.CrossRefGoogle ScholarPubMed
LiDCO product information retrieved at www.lidco.com on January 24, 2019.Google Scholar
Raggi, E, Sakai, T. Update on finger-application-type noninvasive continuous hemodynamic monitors (CNAP and ccNexfin): physical principles, validation, and clinical use. Semin Cardiothorac Vasc Anesth 2017;21:321–9.Google Scholar
Waldron, N, Miller, T, Thacker, J, et al. A prospective comparison of a noninvasive cardiac output monitor versus esophageal Doppler monitor for goal-directed fluid therapy in colorectal surgery patients. Anesth Analg 2014;118:966–75.Google Scholar
Conway, D, Hussain, A, Gall, I. A comparison of noninvasive bioreactance with oesophageal Doppler estimation of stroke volume during open abdominal surgery: an observational study. Eur J Anaesthesiol 2013;30:501–8.CrossRefGoogle ScholarPubMed
Chandler, J, Cook, E, Petersen, C, et al. Pulse oximeter plethysmograph variation and its relationship to the arterial waveform in mechanically ventilated children. J Clin Monit Comput 2012;26:145–51.CrossRefGoogle Scholar
Guerin, L, Monnet, X, Teboul, J. Monitoring volume and fluid responsiveness: from static to dynamic indicators. Best Pract Res Clin Anaesthesiol 2013;27:177–85.Google Scholar
Rivers, E, Nguyen, B, Havstad, S, et al. Early goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368–77.Google Scholar
Pearse, R, Harrison, D, MacDonald, N, et al. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA 2014;311:2181–90.Google Scholar
Pestana, D, Espinosa, E, Eden, A, et al. Perioperative goal-directed hemodynamic optimization using noninvasive cardiac output monitoring in major abdominal surgery: a prospective, randomized, multicenter, pragmatic trial: POEMAS Study (PerOperative goal-directed thErapy in Major Abdominal Surgery). Anesth Analg 2014;119:579–87.CrossRefGoogle Scholar
Chau, E, Slinger, P. Perioperative fluid management for pulmonary resection surgery and esophagectomy. Semin Cardiothorac Vasc Anesth 2014;18:36–44.CrossRefGoogle ScholarPubMed
Bacchin, M, Ceria, C, Giannone, S, et al. Goal-directed fluid therapy based on stroke volume variation in patients undergoing major spine surgery in the prone position: a cohort study. Spine 2016;41:E1131–E1137.CrossRefGoogle ScholarPubMed
Mair, S, Tschirdewahn, J, Gotz, S, et al. Applicability of stroke volume variation in patients of a general intensive care unit: a longitudinal observational study. J Clin Monit Comput 2017;31:1177–87.Google Scholar
Rowan, K, Angus, D, Baily, M, et al. Early goal directed therapy for septic shock-a patient level meta-analysis. N Engl J Med 2017;376:2223–34.Google ScholarPubMed
Jeong, D, Ahn, H, Park, H, et al. Stroke volume variation and pulse pressure variation are not useful for predicting fluid responsiveness in thoracic surgery. Anesth Analg 2017;125:1158–65.CrossRefGoogle Scholar
Liu, F, Zhu, S, Ji, Q, et al. The impact of intra-abdominal pressure on the stroke volume variation and plethysmographic variability index in patients undergoing laparoscopic cholecystectomy. Biosci Trends 2015;9:129–33.CrossRefGoogle ScholarPubMed
Gan, H, Cannesson, M, Chandler, J, Ansermino, J. Predicting fluid responsiveness in children: a systematic review. Anesth Analg 2013;117:1380–92.Google Scholar

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