A Prospective Randomized Trial Using Blood Volume Analysis in Addition to Pulmonary Artery Catheter, Compared With Pulmonary Artery Catheter Alone, to Guide Shock Resuscitation in Critically Ill Surgical Patients

Yu, Mihae; Pei, Kevin Y.; Moran, Sharon; Edwards, Kurt; Domingo, S; Steinemann, Susan; Ghows, Maimona; Takiguchi, Sharon A.; Tan, Andrew M.; Lurie, Fedor; Takanishi, Danny

doi:10.1097/shk.0b013e3181fc9178

Cited by 28 publications

(21 citation statements)

References 38 publications

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“…The group with evidence of volume overload showed an increased risk of death or need for urgent cardiac transplantation. In the intensive care unit, BVA provided additional information to clinicians over and above pulmonary capillary wedge pressure‐guided resuscitation resulting in a change in management in 44% of patients randomized to the BV group …”

Section: Discussionmentioning

confidence: 99%

“…Direct BV analysis (BVA) identifies absolute BV deficits and excesses relative to deviations from an ideal, which is individually calculated for each patient based on his or her body habitus . BVA has been utilized for estimation of BV in patients with congestive heart failure and patients admitted to critical care unit to guide fluid therapy . We measured BV in a group of HD patients using BVA‐100 (Daxor Corporation) before and after HD, and correlated the results with CLM‐III measurements and changes in weight.…”

Section: Introductionmentioning

confidence: 99%

“…22,23 BVA has been utilized for estimation of BV in patients with congestive heart failure 11 and patients admitted to critical care unit to guide fluid therapy. 24 We measured BV in a group of HD patients using BVA-100 (Daxor Corporation) before and after HD, and correlated the results with CLM-III measurements and changes in weight. This is the first study looking at the analysis of absolute BV in HD patients and its correlation with DW.…”

Section: Introductionmentioning

confidence: 99%

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Radioisotope blood volume measurement in hemodialysis patients

Puri

Park

Modersitzki

et al. 2013

Hemodialysis International

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Accurate assessment of blood volume (BV) may be helpful for prescribing hemodialysis (HD) and for reducing complications related to hypovolemia and volume overload. Monitoring changes in relative BV (RBV) using hematocrit, e.g., Crit-Line Monitor (CLM-III), an indirect method, cannot be used to determine absolute BV. We report the first study of BV measurement for assessing volume status in HD patients using the indicator dilutional method. Ten adult HD patients were enrolled in this prospective observational study. BV measurement was performed before and after HD using BV analysis (BVA)-100 (Daxor Corporation, New York, NY, USA). BVA-100 calculates BV using radiolabeled albumin (Iodine-131) followed by serial measures of the radioisotope. Fluid loss from the extravascular space was calculated by subtracting the change in BV from total weight loss. Intradialytic changes in RBV were measured by CLM-III. Eight out of 10 cases had significant hypervolemia, two cases were normovolemic. The range of BV variation from predicted normal was 156 to 1990 mL. Significant inter-individual differences in extravascular space fluid loss ranged from 54% to 99% of total weight loss. Spearman correlation showed a good correlation in the measurement of RBV by BVA-100 and CLM-III in 8 out of 10 patients (r(2) = 0.64). BV measurement using BVA-100 is useful to determine absolute BV as well as changes in BV and correlates reasonably well with CLM-III measurements. Individual refilling ability can be determined as well. This may prove useful in prescribing and monitoring ultrafiltration rates, establishment of optimal BV in HD patients and reducing morbidity and mortality associated with chronic HD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radioisotope blood volume measurement in hemodialysis patients

Puri

Park

Modersitzki

et al. 2013

Hemodialysis International

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“…Theoretically, RV EDV should be a good measure of preload. Still, resuscitation efforts adding measures of GEDVi to their resuscitation algorithms allowed caregivers to choose between volume, red cell transfusion and vasopressors in the management of critically ill patients [35]. So the use of GEDVi is not without value when used within a treatment algorithm.…”

Section: Predicting Volume Responsivenessmentioning

confidence: 99%

Functional Hemodynamic Monitoring

Pinsky

2015

Critical Care Clinics

103

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Functional hemodynamic monitoring is the assessment of the dynamic interactions of hemodynamic variables in response to a defined perturbation. Dynamic tissue O2 saturation (StO2) responses to complete stop flow conditions (vascular occlusion test), which can be created by measuring hand StO2 and occluding flow with a blood pressure cuff, assesses cardiovascular sufficiency and microcirculatory blood flow distribution. Recent interest in functional hemodynamic monitoring for the bedside assessment of cardiovascular insufficiency has heightened with the documentation of its accuracy in predicting volume responsiveness using a wide variety of monitoring devices both invasive and non-invasive and across multiple patient groups and clinical conditions. Accordingly, fluid responsiveness can be predicted in a quantities fashion by measuring as arterial pulse pressure variation, left ventricular stroke volume variation or their surrogates during positive pressure breathing or the change in cardiac output response to a passive leg raising maneuver. However, volume responsiveness, though important, reflects only part of the overall spectrum of functional physiological variables that can be measured to define physiologic state and monitor response to therapy.

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“…Research studies using radioactive iodinated serum albumin (RISA) and chromium 51 erythrocyte (RBC) labeling have been used to measure PV and RBC volumes, respectively. These studies have identified many areas where measurement of PV and BV would be clinically useful including congestive HF [21, 23-26], sepsis [27], and surgical patients [28]. Research radioisotope measurements, using the indicator dilution technique have traditionally been considered the gold standard for BV and PV assessment [22, 29-32], but they are cumbersome and expensive, especially at the bedside.…”

Section: Discussionmentioning

confidence: 99%

A Novel Fluorescent Clinical Method to Rapidly Quantify Plasma Volume

Molitoris¹,

George²,

Murray³

et al. 2019

Cardiorenal Med

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Objectives: To determine the performance of a rapid fluorescent indicator technique for measuring plasma volume (PV). Methods: This was an open-label, observational evaluation of a two-component intravenous visible fluorescent dye technique to rapidly measure PV in 16 healthy subjects and 16 subjects with chronic kidney disease (8 stage 3 and 8 stage 4 CKD), at 2 clinical research sites. The method consisted of a single intravenous injection of 12 mg of a large 150-kDa carboxy-methyl dextran conjugated to a fluorescent rhodamine-derived dye as the PV marker (PVM), and 35 mg of a small 5-kDa carboxy-methyl dextran conjugated to fluorescein, the renal clearance marker. Dye concentrations were quantified 15 min after the injections for initial PV measurements using the indicator-dilution principle. Additional samples were taken over 8 h to evaluate the stability of the PVM as a determinant of PV. Blood volumes (BV) were calculated based on PV and the subject’s hematocrit. Pharmacokinetic parameters were calculated from the plasma concentration data taken over several days using noncompartmental methods (Phoenix WinNonlin®). Linear correlation and Bland-Altman plots were used to compare visible fluorescent injectate-measured PV compared to Nadler’s formula for estimating PV. Finally, 8 healthy subjects received 350 mL infusion of a 5% albumin solution in normal saline over 30 min and a repeat PV determination was then carried out. Results: PV and BV varied according to weight and body surface area, with PV ranging from 2,115 to 6,234 mL and 28.6 to 41.9 mL/kg when weight adjusted. Both parameters were stable for > 6 h with repeated plasma measurements of the PVM. There was no difference between healthy subjects and CKD subjects. Overall, there was general agreement with Nadler’s estimation formula for the mean PV in subjects. A 24-h repeat dose measurement in 8 healthy subjects showed PV variability of 98 ± 121 mL (mean = 3.8%). Additionally, following an intravenous bolus of 350 mL of a 5% albumin solution in normal saline in 8 healthy subjects, the mean (SD) measured increase in PV was 356 (±50.0) mL post-infusion. There were no serious adverse events reported during the study. Conclusions: This minimally invasive fluorescent dye approach safely allowed for rapid, accurate, and reproducible determination of PV, BV, and dynamic monitoring of changes following fluid administration.

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A Prospective Randomized Trial Using Blood Volume Analysis in Addition to Pulmonary Artery Catheter, Compared With Pulmonary Artery Catheter Alone, to Guide Shock Resuscitation in Critically Ill Surgical Patients

Cited by 28 publications

References 38 publications

Radioisotope blood volume measurement in hemodialysis patients

Radioisotope blood volume measurement in hemodialysis patients

Functional Hemodynamic Monitoring

A Novel Fluorescent Clinical Method to Rapidly Quantify Plasma Volume

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