Background: Fluid resuscitation is essential for patients with sepsis and septic shock; however, the response of blood pressure to fluids is still challenging. Dynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variation (PPV) and stroke volume variation (SVV), is one of the parameters that has been proposed to predict mean arterial pressure (MAP) response to fluid administration. PPV and SVV are obtained from the heart-lung interaction concepts, in which spontaneous breathing is an important limitation. In this study, we evaluate the accuracy (sensitivity and specificity) of Eadyn in predicting the MAP response after fluid administration in predicted fluid responsive, spontaneously breathing septic patients.
Methods: Spontaneously breathing patients with sepsis or septic shock and acute circulatory failure who were predicted to be fluid responders by the passive leg raising test or the mini-fluid challenge test were enrolled. PPV, SVV, Eadyn and the other hemodynamic parameters were measured by an arterial catheter connected to FloTracTM sensor integrated with the HemoSphereTM platform before and after a fluid challenge. Patients were classified according to the increase in MAP after fluid administration into 2 groups: MAP-responders (MAP increase ≥ 10%) and MAP-nonresponders (MAP increase < 10%).
Hypothesis: In predicted fluid responders and spontaneously breathing septic patients, Eadyn should have predicted blood responsiveness.
Ethics and dissemination: The Ramathibodi Human Research Ethics Committee has approved the trial. The findings plan to be presented in peer-reviewed publications and conferences in critical care medicine.
Background: Flexible scope intubation is an important airway management skill that requires hands-on training in a real airway. We compared flexible scope intubation by trainees between patients in the left lateral and supine positions.Methods: Forty patients aged 20 to 80 years with American Society of Anesthesiologists physical status I to III were scheduled for elective surgery under general endotracheal anesthesia in Ramathibodi Hospital from February 2020 to June 2020. Patients were randomly assigned to be intubated in one of two positions: supine (group S) or left lateral (group L). Trainees performed flexible scope intubation in sedated patients under the supervision of an attending anesthesiologist. Intubation success, time to successful intubation, number of attempts, airway adjustment maneuvers, and hemodynamic changes were compared between groups.Results: Patient characteristics did not differ between groups except for Mallampati airway classification. The rate of successful intubation on the first attempt and intubation time did not significantly differ between groups. The proportion of patients who required a jaw thrust during intubation was significantly lower in group L (10.5% vs. 85%; P <0.01). Blood pressure and oxygen saturation declined in both groups after intubation. Relative risk of desaturation in the left lateral position compared with the supine position was 0.44 (0.1649–1.1978). Conclusion: The rate of successful flexible scope intubation on the first attempt and intubation time did not differ between both groups. The proportion of patients who required a jaw thrust maneuver was significantly lower in patients in the left lateral position. Trial registration: https://www.thaiclinicaltrials.org/ (TCTR20200208001) on 08/02/2020.
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