Establishing goals of volume management in critically ill patients with renal failure

Mailloux, Patrick; Friderici, Jennifer; Freda, Benjamin J.; McGee, William T.

doi:10.5301/jn.5000076

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…Several studies have demonstrated that SVV is a reliable predictor of fluid responsiveness in various clinical settings. 26 , 27 In our study, patients in HD group underwent HD the day before surgery and a fair amount of fluid was removed. Therefore, it is reasonable to assume that the patients were in a relatively hypovolemic state on the day of surgery, as reflected by the high SVV.…”

Section: Discussionmentioning

confidence: 98%

Effect of fluid loading on left ventricular volume and stroke volume variability in patients with end-stage renal disease: a pilot study

Kanda

Hirasaki

Iida

et al. 2015

TCRM

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PurposeThe aim of this study was to investigate fluid loading-induced changes in left ventricular end-diastolic volume (LVEDV) and stroke volume variability (SVV) in patients with end-stage renal disease (ESRD) using real-time three-dimensional transesophageal echocardiography and the Vigileo-FloTrac system.Patients and methodsAfter obtaining ethics committee approval and informed consent, 28 patients undergoing peripheral vascular procedures were studied. Fourteen patients with ESRD on hemodialysis (HD) were assigned to the HD group and 14 patients without ESRD were assigned to the control group. Institutional standardized general anesthesia was provided in both groups. SVV was measured using the Vigileo-FloTrac system. Simultaneously, a full-volume three-dimensional transesophageal echocardiography dataset was acquired to measure LVEDV, left ventricular end-systolic volume, and left ventricular ejection fraction. Measurements were obtained before and after loading 500 mL hydroxyethyl starch over 30 minutes in both groups.ResultsIn the control group, intravenous colloid infusion was associated with a significant decrease in SVV (13.8%±2.6% to 6.5%±2.6%, P<0.001) and a significant increase in LVEDV (83.6±23.4 mL to 96.1±28.8 mL, P<0.001). While SVV significantly decreased after infusion in the HD group (16.2%±6.0% to 6.2%±2.8%, P<0.001), there was no significant change in LVEDV.ConclusionOur preliminary data suggest that fluid responsiveness can be assessed not by LVEDV but also by SVV due to underlying cardiovascular pathophysiology in patients with ESRD.

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Section: Discussionmentioning

confidence: 98%

Effect of fluid loading on left ventricular volume and stroke volume variability in patients with end-stage renal disease: a pilot study

Kanda

Hirasaki

Iida

et al. 2015

TCRM

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“…Recently, functional hemodynamic parameters derived from the arterial waveformpulse pressure variation (PPV), systolic pressure variation (SPV) or pulse contour analysis-stroke volume variation (SVV) to better predict the physiologic response to fluid resuscitation or fluid removal have been described. [32,33] Other uses for arterial cannulation are related to inability to use/inaccurate regular blood pressure monitoring (e.g., severe burns, morbid obesity, and severe peripheral vascular disease).…”

Section: Indications For Cannulationmentioning

confidence: 99%

Radial Artery Cannulation: A Review Article

Tiru¹,

Bloomstone²

2012

J Anesthe Clinic Res

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Percutaneous radial artery cannulation is a well established procedure that is commonly used in the operating room and intensive care units. Relevant anatomy and attention in detail during cannulation and maintenance are important aspects of the technique that enhance patient safety. Access to the arterial circulation will remain important for hemodynamic monitoring and access to arterial blood. This article reviews the current indications, contraindications, pre-procedure assessment, technique, complications, and monitoring of the site.

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“…A randomized controlled study by Benes et al [11] found that the Vigileo/FloTrac system's use to maintain SVV under 10% using colloid boluses of 3 ml/kg to guide uid therapy in patients undergoing elective intraabdominal surgery is associated with good intraoperative hemodynamic stability, decreased serum lactate at the end of the surgery, and few postoperative organ complications. Furthermore, SVV can be used to guide intraoperative uid therapy in patients with ESRD undergoing hemodialysis [12], [13].…”

Section: Introductionmentioning

confidence: 99%

Goal-directed fluid therapy in renal failure patients undergoing parathyroidectomy: a randomized, single-center, controlled trial

Yang

et al. 2022

Preprint

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Purpose: Parathyroidectomy, recommended when secondary hyperparathyroidism develops in renal failure patients on long-term renal dialysis, has high cardiovascular risks due to chronic fluid depletion. Stroke volume variation (SVV) is suitable for real-time liquid therapy titration under general anesthesia. We aimed to evaluate the Goal-directed fluid therapy by SVV for parathyroidectomy in renal failure patients. Materials and Methods: This randomized controlled trial enrolled renal failure patients (N = 121) scheduled for parathyroidectomy under general anesthesia. The Goal-directed fluid therapy (GDT) group monitor was infused with saline until SVV was under 10%; the controls received standard restricted fluid therapy (SRT). Vasoactive agents were also available to maintain systolic blood pressure (SBP)≥90mmHg, mean blood pressure (MAP)≥65mmHg, or cardiac index 2.5–4.5 (L/min/m2). Data were presented as mean or median. The primary outcome was the perioperative hemodynamic changes. The secondary outcomes were blood gas analysis, fluid supplementation, vasoactive drug dosage, operation time, dialysis parameters, postoperative complications, postoperative lactate levels, and total days of hospitalization. Results: Compared with SRT, GDT-Group patients needed more fluid, and their ephedrine use was reduced; they achieved stable blood flow changes during the perioperative period, who had lower serum lactic acid (cLAC) levels and postoperative complications. Conclusion: This is the first study to propose that goal-directed fluid therapy by SVV in renal failure patients undergoing short-term surgery under general anesthesia could correct volume depletion, optimize tissue perfusion, and reduce blood pressure fluctuations and postoperative complications, with no long-term adverse effects. Trial registration: Research Ethics Committee of Clinical Research Ethics Committee of China-Japan Friendship Hospital, Beijing, China (2018-125-K91-1). The study protocol was registered in Chinese Clinical Trial Register Network (ChiCTR1800019009, 21/10/2018).

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Establishing goals of volume management in critically ill patients with renal failure

Abstract: Physiologic variables assessing cardiac performance (SVI) and preload responsiveness (SVV) provide simple yet meaningful targets when one is determining the best approach for volume management in critically ill patients undergoing dialysis.

Cited by 6 publications

References 22 publications

Effect of fluid loading on left ventricular volume and stroke volume variability in patients with end-stage renal disease: a pilot study

Effect of fluid loading on left ventricular volume and stroke volume variability in patients with end-stage renal disease: a pilot study

Radial Artery Cannulation: A Review Article

Goal-directed fluid therapy in renal failure patients undergoing parathyroidectomy: a randomized, single-center, controlled trial

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