Current Commonly Used Dynamic Parameters and Monitoring Systems for
Perioperative Goal-Directed Fluid Therapy: A Review

Kan, Chin Fung Kelvin; Skaggs, John D

doi:10.59249/joap6662

Cited by 7 publications

(17 citation statements)

References 133 publications

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“…TEE can intermittently measure the CO , however, with less accuracy than the PAC and both methods cannot be used interchangeably for CO measurement [18,99]. TEE can help guide fluid responsiveness and goal-directed therapy by measuring the respiratory variation in stroke volume (SVV), peak aortic blood flow velocity (ΔVpeak), and inferior and superior vena cava sizes [9 ▪▪ ,21,41]. TEE can confirm correct bypass cannula placement in veno-venous bypass and can evaluate the adequacy of veno-venous bypass flow and quickly diagnose life-threatening complications [2 ▪ ].…”

Section: Transesophageal Echocardiographymentioning

confidence: 99%

“…PWA accuracy is improved when monitoring the femoral artery instead of the radial artery [49]. PWA devices measure the SVV, which is a reliable indicator for fluid responsiveness and a cornerstone of goal-directed hemodynamic therapy [9 ▪▪ ,22,37,41,68 ▪▪ ]. In liver transplantation, SVV of 10% discriminated fluid responders from nonresponders with a 93% sensitivity and 94% specificity [37,41].…”

Section: Pulse Wave Analysis Based - Cardiac Outputmentioning

confidence: 99%

“…Contrary to the PWA-derived CO , the SVV is accurate even in patients on high dose vasopressor [34,37]. The concept behind SVV is that mechanical ventilation causes cyclic changes in intrathoracic pressure (ITP) that significantly affects the venous return to the heart causing SVV during the respiratory cycle that is proportional to the degree of hypovolemia and fluid responsiveness [9 ▪▪ ,68 ▪▪ ,103]. The accuracy of SVV is decreased if the cyclic changes in ITP are not adequate to affect VR to the heart causing a falsely decreased SVV.…”

Section: Pulse Wave Analysis Based - Cardiac Outputmentioning

confidence: 99%

“…That happens with tidal volume less than 8 ml/kg, high respiratory rate and low heart rate (HR) (HR/RR < 3.6), and low pulmonary compliance [103]. Spontaneous breathing, arrhythmias, right ventricular failure, and high intrabdominal pressure will cause falsely increased SVV [9 ▪▪ ,13,68 ▪▪ ,103]. Overdamping, underdamping, and intra-aortic balloon pulsations (IABP) make it difficult for the PWA to detect the dicrotic notch that distinguishes systole from diastole [26,49,68 ▪▪ ].…”

Section: Pulse Wave Analysis Based - Cardiac Outputmentioning

confidence: 99%

“…Monitor in Latin means ‘warner’ and ‘adviser’. Hemodynamic monitoring (HDM) has evolved from just being a warner to being both a warner and adviser [7 ▪▪ ,9 ▪▪ ,11,13,18,23]. No HDM can improve the clinical outcomes unless the data are properly interpreted then used to guide an effective hemodynamic therapy [1 ▪▪ ,3 ▪ ,8 ▪ ,11].…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic monitoring in liver transplantation ‘the hemodynamic system’

Kandil,

Sedra

2023

Current Opinion in Organ Transplantation

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Purpose of review The purpose of this article is to provide a comprehensive review of hemodynamic monitoring in liver transplantation. Recent findings Radial arterial blood pressure monitoring underestimates the aortic root arterial blood pressure and causes excessive vasopressor and worse outcomes. Brachial and femoral artery monitoring is well tolerated and should be considered in critically ill patients expected to be on high dose pressors. The pulmonary artery catheter is the gold standard of hemodynamic monitoring and is still widely used in liver transplantation; however, it is a highly invasive monitor with potential for serious complications and most of its data can be obtained by other less invasive monitors. Rescue transesophageal echocardiography relies on few simple views and should be available as a standby to manage sudden hemodynamic instability. Risk of esophageal bleeding from transesophageal echocardiography in liver transplantation is the same as in other patient populations. The arterial pulse waveform analysis based cardiac output devices are minimally invasive and have the advantage of real-time beat to beat monitoring of cardiac output. No hemodynamic monitor can improve clinical outcomes unless integrated into a goal-directed hemodynamic therapy. The hemodynamic monitoring technique should be tailored to the patient's medical status, surgical technique, and the anesthesiologist's level of expertise. Summary The current article provides a review of the current hemodynamic monitoring systems and their integration in goal-directed hemodynamic therapy.

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Section: Transesophageal Echocardiographymentioning

confidence: 99%

Section: Pulse Wave Analysis Based - Cardiac Outputmentioning

confidence: 99%

Section: Pulse Wave Analysis Based - Cardiac Outputmentioning

confidence: 99%

Section: Pulse Wave Analysis Based - Cardiac Outputmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hemodynamic monitoring in liver transplantation ‘the hemodynamic system’

Kandil,

Sedra

2023

Current Opinion in Organ Transplantation

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Pulse pressure variation guided goal-direct fluid therapy decreases postoperative complications in elderly patients undergoing laparoscopic radical resection of colorectal cancer: a randomized controlled trial

Wu,

Zhao,

Fan

et al. 2024

Int J Colorectal Dis

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Objective The use of goal-directed fluid therapy (GDFT) has been shown to reduce complications and improve prognosis in high-risk abdominal surgery patients. However, the utilization of pulse pressure variation (PPV) guided GDFT in laparoscopic surgery remains a subject of debate. We hypothesized that utilizing PPV guidance for GDFT would optimize short-term prognosis in elderly patients undergoing laparoscopic radical resection for colorectal cancer compared to conventional fluid therapy. Methods Elderly patients undergoing laparoscopic radical resection of colorectal cancer were randomized to receive either PPV guided GDFT or conventional fluid therapy and explore whether PPV guided GDFT can optimize the short-term prognosis of elderly patients undergoing laparoscopic radical resection of colorectal cancer compared with conventional fluid therapy. Results The incidence of complications was significantly lower in the PPV group compared to the control group (32.8% vs. 57.1%, P = .009). Additionally, the PPV group had a lower occurrence of gastrointestinal dysfunction (19.0% vs. 39.3%, P = .017) and postoperative pneumonia (8.6% vs. 23.2%, P = .033) than the control group. Conclusion Utilizing PPV as a monitoring index for GDFT can improve short-term prognosis in elderly patients undergoing laparoscopic radical resection of colorectal cancer. Registration number ChiCTR2300067361; date of registration: January 5, 2023.

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Respiratory variation in the internal jugular vein does not predict fluid responsiveness in the prone position during adolescent idiopathic scoliosis surgery: a prospective cohort study

Wu,

Dai,

Liang

et al. 2023

BMC Anesthesiol

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Background Respiratory variation in the internal jugular vein (IJVV) has not shown promising results in predicting volume responsiveness in ventilated patients with low tidal volume (Vt) in prone position. We aimed to determine whether the baseline respiratory variation in the IJVV value measured by ultrasound might predict fluid responsiveness in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) with low Vt. Methods According to the fluid responsiveness results, the included patients were divided into two groups: those who responded to volume expansion, denoted the responder group, and those who did not respond, denoted the non-responder group. The primary outcome was determination of the value of baseline IJVV in predicting fluid responsiveness (≥15% increases in stroke volume index (SVI) after 7 ml·kg-1 colloid administration) in patients with AIS undergoing PSF during low Vt ventilation. Secondary outcomes were estimation of the diagnostic performance of pulse pressure variation (PPV), stroke volume variation (SVV), and the combination of IJVV and PPV in predicting fluid responsiveness in this surgical setting. The ability of each parameter to predict fluid responsiveness was assessed using a receiver operating characteristic curve. Results Fifty-six patients were included, 36 (64.29%) of whom were deemed fluid responsive. No significant difference in baseline IJVV was found between responders and non-responders (25.89% vs. 23.66%, p = 0.73), and no correlation was detected between baseline IJVV and the increase in SVI after volume expansion (r = 0.14, p = 0.40). A baseline IJVV greater than 32.00%, SVV greater than 14.30%, PPV greater than 11.00%, and a combination of IJVV and PPV greater than 64.00% had utility in identifying fluid responsiveness, with a sensitivity of 33.33%, 77.78%, 55.56%, and 55.56%, respectively, and a specificity of 80.00%, 50.00%, 65.00%, and 65.00%, respectively. The area under the receiver operating characteristic curve for the baseline values of IJVV, SVV, PPV, and the combination of IJVV and PPV was 0.52 (95% CI, 0.38–0.65, p=0.83), 0.54 (95% CI, 0.40–0.67, p=0.67), 0.58 (95% CI, 0.45–0.71, p=0.31), and 0.57 (95% CI, 0.43–0.71, p=0.37), respectively. Conclusions Ultrasonic-derived IJVV lacked accuracy in predicting fluid responsiveness in patients with AIS undergoing PSF during low Vt ventilation. In addition, the baseline values of PPV, SVV, and the combination of IJVV and PPV did not predict fluid responsiveness in this surgical setting. Trail registration This trial was registered at www.chictr.org (ChiCTR2200064947) on 24/10/2022. All data were collected through chart review.

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Current Commonly Used Dynamic Parameters and Monitoring Systems for Perioperative Goal-Directed Fluid Therapy: A Review

Cited by 7 publications

References 133 publications

Hemodynamic monitoring in liver transplantation ‘the hemodynamic system’

Hemodynamic monitoring in liver transplantation ‘the hemodynamic system’

Pulse pressure variation guided goal-direct fluid therapy decreases postoperative complications in elderly patients undergoing laparoscopic radical resection of colorectal cancer: a randomized controlled trial

Respiratory variation in the internal jugular vein does not predict fluid responsiveness in the prone position during adolescent idiopathic scoliosis surgery: a prospective cohort study

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