Arterial pressure allows monitoring the changes in cardiac output induced by volume expansion but not by norepinephrine*

Monnet, Xavier; Letierce, Alexia; Hamzaoui, Olfa; Chemla, Denis; Anguel, Nadia; Osman, David; Richard, Christian; Teboul, Jean‐Louis

doi:10.1097/ccm.0b013e31820edcf0

Cited by 103 publications

(82 citation statements)

References 15 publications

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“…In another study, there was no correlation between the changes in arterial pulse pressure and changes in cardiac output during a fluid challenge [83]. The discrepancy with the previous study [82] may be explained by the fact that the arterial pressure was measured at the radial artery and not the femoral site [83]. Nevertheless, both studies demonstrate that if one wants to precisely assess the effects of a fluid challenge, one must measure cardiac output and not rely on arterial pressure.…”

Section: Fluid Challenge: Maxi or Mini?mentioning

confidence: 86%

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Prediction of fluid responsiveness: an update

Monnet

Marik

Teboul

2016

Ann. Intensive Care

Self Cite

441

359

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In patients with acute circulatory failure, the decision to give fluids or not should not be taken lightly. The risk of overzealous fluid administration has been clearly established. Moreover, volume expansion does not always increase cardiac output as one expects. Thus, after the very initial phase and/or if fluid losses are not obvious, predicting fluid responsiveness should be the first step of fluid strategy. For this purpose, the central venous pressure as well as other “static” markers of preload has been used for decades, but they are not reliable. Robust evidence suggests that this traditional use should be abandoned. Over the last 15 years, a number of dynamic tests have been developed. These tests are based on the principle of inducing short-term changes in cardiac preload, using heart–lung interactions, the passive leg raise or by the infusion of small volumes of fluid, and to observe the resulting effect on cardiac output. Pulse pressure and stroke volume variations were first developed, but they are reliable only under strict conditions. The variations in vena caval diameters share many limitations of pulse pressure variations. The passive leg-raising test is now supported by solid evidence and is more frequently used. More recently, the end-expiratory occlusion test has been described, which is easily performed in ventilated patients. Unlike the traditional fluid challenge, these dynamic tests do not lead to fluid overload. The dynamic tests are complementary, and clinicians should choose between them based on the status of the patient and the cardiac output monitoring technique. Several methods and tests are currently available to identify preload responsiveness. All have some limitations, but they are frequently complementary. Along with elements indicating the risk of fluid administration, they should help clinicians to take the decision to administer fluids or not in a reasoned way.

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Section: Fluid Challenge: Maxi or Mini?mentioning

confidence: 86%

“…In this regard, the fluid challenge has no advantage over the PLR test (Table 2). In a study where 500 mL saline was administered to critically ill patients, the changes in arterial pulse pressure only roughly detected the concomitant changes in cardiac output [82]. In particular, there were 22% of false negatives.…”

Section: Fluid Challenge: Maxi or Mini?mentioning

confidence: 99%

Prediction of fluid responsiveness: an update

Monnet

Marik

Teboul

2016

Ann. Intensive Care

Self Cite

441

359

View full text Add to dashboard Cite

show abstract

“…This common clinical approach, which constitutes the first step in most optimization protocols, has some inherent flaws. Detecting the expected increase in CO is not a trivial task, because relying on changes in blood pressure alone may lead to many false negative results [19]. More reliable methods for the accurate assessment of the effect of a fluid challenge include detection of a change in the CVP of at least 2 mmHg [20] or, preferably, a change in the continuously measured CO itself [21].…”

Section: Inadequacy Of Commonly Used Parameters In Guiding Fluid Admimentioning

confidence: 99%

Bench-to-bedside review: Functional hemodynamics during surgery - should it be used for all high-risk cases?

2013

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The administration of a fluid bolus is done frequently in the perioperative period to increase the cardiac output. Yet fluid loading fails to increase the cardiac output in more than 50% of critically ill and surgical patients. The assessment of fluid responsiveness (the slope of the left ventricular function curve) prior to fluid administration may thus not only help in detecting patients in need of fluids but may also prevent unnecessary and harmful fluid overload. Unfortunately, commonly used hemodynamic parameters, including the cardiac output itself, are poor predictors of fluid responsiveness, which is best assessed by functional hemodynamic parameters. These dynamic parameters reflect the response of cardiac output to a preload-modifying maneuver (for example, a mechanical breath or passive leg-raising), thus providing information about fluid responsiveness without the actual administration of fluids. All dynamic parameters, which include the respiratory variations in systolic blood pressure, pulse pressure, stroke volume and plethysmographic waveform, have been repeatedly shown to be superior to commonly used static preload parameters in predicting the response to fluid loading. Within their respective limitations, functional hemodynamic parameters should be used to guide fluid therapy as part of or independently of goal-directed therapy strategies in the perioperative period.

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“…Accordingly, Monnet et al comparing patients with acute circulatory failure who received a fluid challenge or in whom NE was introduced or increased, showed that changes in pulse arterial pressure could not be used for monitoring the effects of NE on CO [34]. Natalini et al also showed that arterial pressure did not enable to predict the individual response to volume administration in a cohort of hypotensive patients receiving NE and dobutamine [35].…”

Section: Discussionmentioning

confidence: 99%

The increase of vasomotor tone avoids the ability of the dynamic preload indicators to estimate fluid responsiveness

Bouchacourt

Grignola

2013

BMC Anesthesiol

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BackgroundThe use of vasoconstrictor can affect the dynamic indices to predict fluid responsiveness. We investigate the effects of an increase of vascular tone on dynamic variables of fluid responsiveness in a rabbit model of hemorrhage, and to examine the ability of the arterial pressure surrogates dynamic indices to track systolic volume variation (SVV) during hypovolemia under increased vasomotor tone.MethodsEighteen anesthetized and mechanically ventilated rabbits were studied during normovolemia (BL) and after blood progressive removal (15 mL/kg, BW). Other two sets of data were obtained during PHE infusion with normovolemia (BL + PHE) and during hypovolemia (BW + PHE). We measured central venous and left ventricular (LV) pressures and infra diaphragmatic aortic blood flow (AoF) and pressure. Pulse pressure variation (PPV), systolic pressure variation (SPV) and SVV were estimated manually by the variation of beat-to-beat PP, SP and SV, respectively. We also calculated PPVapnea as 100 × (PPmax-PPmin)/PP during apnea. The vasomotor tone was estimated by total peripheral resistance (TPR = mean aortic pressure/mean AoF), dynamic arterial elastance (Eadyn = PPV/SVV) and arterial compliance (C = SV/PP). We assessed LV preload by LV end-diastolic pressure (LVEDP). We compared the trending abilities between SVV and pressure surrogate indices using four-quadrant plots and polar plots.ResultsBaseline PPV, SPV, PPVapnea, and SVV increased significantly during hemorrhage, with a decrease of AoF (P < 0.05). PHE induced significant TPR and Eadyn increase and C decrease in bled animals, and a further decrease in AoF with a significant decrease of all dynamic indices. There was a significant correlation between SVV and PPV, PPVapnea and SPV in normal vasomotor tone (r2 ≥ 0.5). The concordance rate was 91%, 95% and 76% between SVV and PPV, PPVapnea and SPV, respectively, in accordance with the polar plot analysis. During PHE infusion, there was no correlation between SVV and its surrogates, and both four-quadrant plot and polar plot showed poor trending.ConclusionIn this animal model of hemorrhage and increased vasomotor tone induced by phenylephrine the ability of dynamic indices to predict fluid responsiveness seems to be impaired, masking the true fluid loss. Moreover, the arterial pressure surrogates have not the reliable trending ability against SVV.

show abstract

Arterial pressure allows monitoring the changes in cardiac output induced by volume expansion but not by norepinephrine*

Cited by 103 publications

References 15 publications

Prediction of fluid responsiveness: an update

Prediction of fluid responsiveness: an update

Bench-to-bedside review: Functional hemodynamics during surgery - should it be used for all high-risk cases?

The increase of vasomotor tone avoids the ability of the dynamic preload indicators to estimate fluid responsiveness

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