Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?

Alves, Daniel Rodrigues; Ribeiras, Regina

doi:10.1016/j.bjane.2015.11.002

Cited by 4 publications

(6 citation statements)

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“…The value in replacing this volume has therefore been questioned. [ 13 ] Similarly, evidence for insensible losses, or third space losses, requiring liberal replacement, is inconsistent. [ 14 ]…”

Section: Liberal Versus Restrictive Strategiesmentioning

confidence: 99%

Perioperative fluid management: From physiology to improving clinical outcomes

Bennett

Cecconi

2017

Indian J Anaesth

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Perioperative fluid management is a key component in the care of the surgical patient. It is an area that has seen significant changes and developments, however there remains a wide disparity in practice between clinicians. Historically, patients received large volumes of intravenous fluids perioperatively. The concept of goal directed therapy was then introduced, with the early studies showing significant improvements in morbidity and mortality. The current focus is on fluid therapy guided by an individual patient's physiology. A fluid challenge is commonly performed as part of an assessment of a patient's fluid responsiveness. There remains wide variation in how clinicians perform a fluid challenge and this review explores the evidence for how to administer an effective challenge that is both reliable and reproducible. The methods for monitoring cardiac output have evolved from the pulmonary artery catheter to a range of less invasive techniques. The different options that are available for perioperative use are considered. Fluid status can also be assessed by examining the microcirculation and the importance of recognising the possibility of a lack of coherence between the macro and microcirculation is discussed. Fluid therapy needs to be targeted to specific end points and individualised. Not all patients who respond to a fluid challenge will necessarily require additional fluid administration and care should be aimed at identifying those who do. This review aims to explain the underlying physiology and describe the evidence base and the changes that have been seen in the approach to perioperative fluid therapy.

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Section: Liberal Versus Restrictive Strategiesmentioning

confidence: 99%

Perioperative fluid management: From physiology to improving clinical outcomes

Bennett

Cecconi

2017

Indian J Anaesth

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“…To date, there are no published studies evaluating the accuracy of non-invasive ET-CO 2 to predict volume responsiveness in the spontaneously breathing patient. It is well known that healthy individuals can work at various points of the Frank-Starling curve at different times due to small changes in their cardiac contractility and/or effective vascular volume, so a percentage of them can respond to volume at a given moment [ 15 ]. Therefore, the objective of this study is to evaluate the performance of the expired CO 2 gradient (ΔET-CO 2 ) after a PLR maneuver to predict volume responsiveness in spontaneously breathing healthy adults.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of end-tidal carbon dioxide gradient as a predictor of volume responsiveness in spontaneously breathing healthy adults

Arango-Granados

Zarama

Llanos

et al. 2018

ICMx

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BackgroundMethods to guide fluid therapy in spontaneously breathing patients are scarce. No studies have reported the accuracy of end-tidal CO2 (ET-CO2) to predict volume responsiveness in these patients. We sought to evaluate the ET-CO2 gradient (ΔET-CO2) after a passive leg rise (PLR) maneuver to predict volume responsiveness in spontaneously breathing healthy adults.MethodsWe conducted a prospective study in healthy adult human volunteers. A PLR maneuver was performed and cardiac output (CO) was measured by transthoracic echocardiography. ET-CO2 was measured with non-invasive capnographs. Volume responsiveness was defined as an increase in cardiac output (CO) > 12% at 90 s after PLR.ResultsOf the 50 volunteers, 32% were classified as volume responders. In this group, the left ventricle outflow tract velocity time integral (VTILVOT) increased from 17.9 ± 3.0 to 20.4 ± 3.4 (p = 0.0004), CO increased from 4.4 ± 1.5 to 5.5 ± 1.6 (p = 0.0), and ET-CO2 rose from 32 ± 4.84 to 33 ± 5.07 (p = 0.135). Within the entire population, PLR-induced percentage ∆CO was not correlated with percentage ∆ET-CO2 (R2 = 0.13; p = 0.36). The area under the receiver operating curve for the ability of ET-CO2 to discriminate responders from non-responders was of 0.67 ± 0.09 (95% CI 0.498–0.853). A ΔET-CO2 ≥ 2 mmHg had a sensitivity of 50%, specificity of 97.06%, positive likelihood ratio of 17.00, negative likelihood ratio of 0.51, positive predictive value of 88.9%, and negative predictive value of 80.5% for the prediction of fluid responsiveness.ConclusionsΔET-CO2 after a PLR has limited utility to discriminate responders from non-responders among healthy spontaneously breathing adults.Electronic supplementary materialThe online version of this article (10.1186/s40635-018-0187-0) contains supplementary material, which is available to authorized users.

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“…1) [6]. В условиях оказания как ургентной, так и плановой хирургической помощи периоперационная ИТ является динамическим процессом дооперационной ликвидации гиповолемии, интраоперационной поддержки эффективных значений объема циркулирующей крови (ОЦК) с его последующей послеоперационной стабилизацией [1-5, [10][11][12][13][14]. Эти цели достигаются путем:…”

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“…Либеральный режим ИТ, целью которого является поддержание адекватного объема циркулирующей крови, обеспечивающего эффективный системный транспорт кислорода и восстановление перфузии тканей. Либеральный режим ИТ базируется на расчетном способе определения необходимого количества жидкости -учитывает почасовую потребность ((м. тела + 40) × 1 мл/кг/час), патологические (рвота, диарея, интраоперационная кровопотеря и потери в «третье пространство», гипертермия, выделяемое через дренажи, повязки) и физиологические (перспирация и диурез) потери [8][9][10][11][12][13][14][15][16][31][32][33][34][35][36][37][38][39][40]. Либеральный режим ИТ направлен на достижение гиперволемической гемодилюции и всегда сопровождается положительным водным балансом ввиду использования:…”

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“…1). Понимание этих патологических изменений расширилось благодаря новым понятиям о перераспределении жидкости через эндотелиальный барьер [13]. В норме сосудистый эндотелий покрыт двойной мембраной гликопротеинов и протеогликанов, эндотелиальным гликокаликсом, которому отводится ведущая роль в регуляции проницаемости эндотелия.…”

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Оптимальный Режим Периоперационной Инфузии: За И Против

Kravets¹,

Кlygunenko²

2021

ЕМ

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Лечение абдоминальной патологии в 80 % случаев проводится хирургическим путем. По данным Национального конфиденциального комитета подсчета результатов лечения и смертности (NCEPOD, 2016), послеоперационная летальность при плановых оперативных вмешательствах составляет 4 %, в ургентной хирургии колеблется от 19,7 до 23,1 %. Периоперационная инфузионная терапия является динамичным процессом дооперационной ликвидации гиповолемии, интраоперационной поддержки эффективного объема циркулирующей крови и его послеоперационной стабилизации и влияет на развитие послеоперационных осложнений, длительность стационарного лечения и уровень летальности. Поиск проводился по ключевым словам в базах данных Scopus, Web of Science, MedLine, The Cochrane Library.

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Does fasting influence preload responsiveness in ASA 1 and 2 volunteers?

Cited by 4 publications

References 32 publications

Perioperative fluid management: From physiology to improving clinical outcomes

Perioperative fluid management: From physiology to improving clinical outcomes

Evaluation of end-tidal carbon dioxide gradient as a predictor of volume responsiveness in spontaneously breathing healthy adults

Оптимальный Режим Периоперационной Инфузии: За И Против

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