ISCCM Guidelines for Hemodynamic Monitoring in the Critically Ill

Pichamuthu, Kishore; Venkataraman, Ramesh; Govil, Deepak; Srinivasan, Shrikanth; Ramasubban, Suresh; Samavedam, Srinivas; Kulkarni, Atul P; Myatra, Sheila Nainan; Jog, Sameer; Divatia, Jigeeshu Vasishtha

doi:10.5005/jp-journals-10071-24301

Cited by 3 publications

(3 citation statements)

References 91 publications

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“…Fluid responsiveness is defined as an increase in cardiac output (CO) by 10-15% in response to fluid administration [6]. The static measures of preload such as central venous pressure haven't shown consistency in assessing fluid responsiveness and dynamic indices have been proven to be more reliable in predicting fluid responsiveness than the static ones [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Carotid Blood Flow as a Surrogate for Pulse Contour Analysis in Assessment of Fluid Responsiveness: A Prospective, Observational, Single-Centre Study (Contour Study)

Karmarkar,

Pal,

Govil

et al. 2024

Cureus

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Background and objectivesThe quest for an accurate and reliable non-invasive method of assessing cardiac output in critically ill patients is still ongoing. Carotid artery Doppler is a promising non-invasive, reproducible, and feasible bedside monitor. So we compared the change in cardiac output derived from arterial pressure waveforms (pulse contour analysis) with that from carotid artery Doppler-derived measurements, in post-major elective abdominal surgery patients.

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Section: Introductionmentioning

confidence: 99%

Carotid Blood Flow as a Surrogate for Pulse Contour Analysis in Assessment of Fluid Responsiveness: A Prospective, Observational, Single-Centre Study (Contour Study)

Karmarkar,

Pal,

Govil

et al. 2024

Cureus

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“…The interest in CRT was emphasized by the ANDROMEDA-SHOCK study, which demonstrated that, in patients with septic shock, resuscitation aimed at either normalizing CRT or normalizing or decreasing lactate levels during an 8-h intervention period had a similar effect on 28-day mortality [ 3 , 6 ]. CRT is more and more considered as a core monitoring component during resuscitation of septic shock patients [ 7 – 10 ], particularly in low-resource settings [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Effect on capillary refill time of volume expansion and increase of the norepinephrine dose in patients with septic shock

Fage,

Moretto,

Rosalba

et al. 2023

Crit Care

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Background Capillary refill time (CRT) has been suggested as a variable to follow during the course of septic shock. We systematically investigated the effects on CRT of volume expansion and norepinephrine. Methods In 69 septic shock patients, we recorded mean arterial pressure (MAP), cardiac index (CI), and 5 consecutive CRT measurements (video method, standardized pressure applied on the fingertip) before and after a 500-mL saline infusion in 33 patients and before and after an increase of the norepinephrine dose in 36 different patients. Fluid responders were defined by an increase in CI ≥ 15%, and norepinephrine responders by an increase in MAP ≥ 15%. Results The least significant change of CRT was 23%, so that changes in CRT were considered significant if larger than 23%. With volume expansion, CRT remained unchanged on average in patients with baseline CRT < 3 s (n = 7) and in all but one patient with baseline CRT ≥ 3 s in whom fluid increased CI < 15% (n = 13 “fluid non-responders”). In fluid responders with baseline CRT ≥ 3 s (n = 13), CRT decreased in 8 patients and remained unchanged in the others, exhibiting a dissociation between CI and CRT responses. The proportion of patients included > 24 h after starting norepinephrine was higher in patients with such a dissociation than in the other ones (60% vs. 0%, respectively). Norepinephrine did not change CRT significantly (except in one patient) if baseline CRT was ≥ 3 s and the increase in MAP < 15% (n = 6). In norepinephrine responders with prolonged baseline CRT (n = 11), it increased in 4 patients and remained unchanged in the other ones, which exhibited a dissociation between MAP and CRT responses. Conclusions In septic shock patients with prolonged CRT, CRT very rarely improves with treatment when volume expansion increases cardiac output < 15% and increasing norepinephrine increases MAP < 15%. When the effects of fluid infusion on cardiac output and of norepinephrine on MAP are significant, the response of CRT is variable, as it decreases in some patients and remains stable in others which exhibit a dissociation between changes in macrohemodynamic variables and in CRT. In this regard, CRT behaves as a marker of microcirculation. Trial registration: ClinicalTrial.gov (NCT04870892). Registered January15, 2021. Ethics committee approval CE SRLF 21-25.

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“…Other static markers of cardiac preload are the global end-diastolic volume and the left end-diastolic area/volume, or aortic blood flow, measured by transpulmonary thermodilution, echocardiography, and esophageal Doppler, respectively. However, it has been well-evidenced that dynamic indices are more reliable in predicting fluid responsiveness than static indices [ 2 , 3 ]. This is because the value of these static indices could correspond to a preload responsive or unresponsive state depending on the part of the Frank-Starling curve where fluid resuscitation begins.…”

Section: Introductionmentioning

confidence: 99%

Fluid Responsiveness in Critically Ill Patients Using Carotid Peak Systolic Velocity Variability: A New Frontier

Roy¹,

Pachisia²,

Govil³

et al. 2023

Cureus

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Background and objectives A fluid responder is a patient who can increase his stroke volume/ cardiac output by more than 10%-15% after a fluid bolus. Left ventricular outflow tract (LVOT) velocity time integral (VTI) variability is widely used as an adynamic parameter of fluid responsiveness, but a transthoracic echo view of LVOT VTI is often time-consuming and, at times, difficult to achieve. So, in the quest for another parameter that might equally be a good surrogate marker of stroke volume variation, carotid peak systolic velocity (CPSV) variation has been studied. The objective was to assess CPSV variation in patients who are already fluid responders. Methods The sample size was calculated considering a minimum correlation coefficient of 0.5. Adult patients in whom the physician wanted to give a fluid bolus and whose average LVOT VTI was more than 15% over 3 respiratory cycles were included in the study. Demographic variables, along with hemodynamic parameters such as heart rate, blood pressure, the need for vasopressors, mode of breathing (spontaneous or mechanical ventilation), and CPSV variation,were noted and averaged over three respiratory cycles. Fluid bolus (Plasmalyte) 6 ml/kg bolus over 10-15 minutes. Post-fluid hemodynamic variables, along with averaged LVOT VTI over three respiratory cycles and averaged CPSV variation over three respiratory cycles, are noted. Results Thirty adult patients were evaluated in the study. In spontaneously breathing patients (n=12), the average CPSV variation expressed as mean + standard deviation before and after fluid administration of 6ml/kg of ideal body weight was 14.1 ± 3.4 and 5.4 ± 2.6, respectively (p < 0.05). In mechanically ventilated patients (n=18), the average CPSV variation expressed as mean + standard deviation before and after fluid administration of 6ml/kg of ideal body weight fluid was 15 ± 5.3 and 6.5 ± 3.1, respectively (p <0.005). Overall, there was a statistically significant positive correlation between LVOT VTI variation and CPSV variation before fluid therapy (correlation coefficient 0.56 and p-value 0.001) and a statistically significant moderate positive correlation post-fluid therapy (correlation coefficient 0.37 and p-value 0.043). Conclusion We found a significant decrease in CPSV variation post-fluid administration in patients who are fluid responders, which mimics a decrease in stroke volume variation after fluid administration in patients who are fluid responsive.

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ISCCM Guidelines for Hemodynamic Monitoring in the Critically Ill

Cited by 3 publications

References 91 publications

Carotid Blood Flow as a Surrogate for Pulse Contour Analysis in Assessment of Fluid Responsiveness: A Prospective, Observational, Single-Centre Study (Contour Study)

Carotid Blood Flow as a Surrogate for Pulse Contour Analysis in Assessment of Fluid Responsiveness: A Prospective, Observational, Single-Centre Study (Contour Study)

Effect on capillary refill time of volume expansion and increase of the norepinephrine dose in patients with septic shock

Fluid Responsiveness in Critically Ill Patients Using Carotid Peak Systolic Velocity Variability: A New Frontier

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