Perioperative monitoring of fluid responsiveness after esophageal surgery using stroke volume variation

Abstract

From May 2006, a new analyzing device (Vigileo monitor; Edwards Lifesciences LLC, Tokyo, Japan), which can be used in combination with the FloTrac and PreSep sensors, has been used in nine patients who have undergone radical operations for thoracic esophageal cancer at our hospital. Stroke volume variation (SVV), calculated for each respiratory cycle and displayed on the Vigileo monitor, precisely predicted intravascular hypovolemia. The maximum SVV of patients who needed fluid resuscitation was significantly higher than that of patients who had a stable circulation. The mean value of the maximum SVV in the patient with or without fluid resuscitation was 25 +/- 6.9 and 13 +/- 1.4%, respectively (p < 0.04). In addition, continuous monitoring of central venous oxygen saturation enabled evaluation of oxygen supply to tissues to aid in determining the need for red blood cell transfusion. The Vigileo monitor (with Flo Trac and PreSep sensors) provided reliable information for the perioperative management of high-risk patients after highly invasive general surgery without the need for an invasive central or pulmonary catheter.

Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study

“…Lopes et al (4) demonstrated that the GDT group received more fluid than the control group. The control group received fluid intraoperatively at the discretion of the anesthetist, according to the protocol proposed by Kobayashi et al (4).…”

Perioperative Lung Protection Strategies in One-lung and Two-lung Ventilation

“…There is some evidence that fluid therapies designed to achieve individualized and specific flow-related hemodynamic endpoints such as stroke volume or cardiac index (collectively referred to as goal-directed fluid therapy) may provide a superior alternative to fixed regimens or those based on static measures of cardiac filling, such as central venous pressure, which do not predict fluid responsiveness or correlate with circulating blood volume after transthoracic esophagectomy. 73,74 However, fluid responsiveness remains an elusive goal for managing patients ( Figure 5). As patients approach the upper inflection point of the Frank-Starling curve, small increases in cardiac output create large increases in lung water, and this effect is exacerbated in a situation of increased capillary permeability such as sepsis.…”

Are lung-protective ventilation strategies worth the effort?

“…For example, central venous pressure does not predict fluid responsiveness or correlate with circulating blood volume after transthoracic oesophagectomy. 89,90 In addition to the potential importance of the amount and timing of fluid administration, there is some clinical evidence that the choice of fluid type may be important in affecting clinical outcomes. 91 Intravascular colloid retention during the treatment of hypovolaemia may approach 90% vs. 40% when administered during normovolaemia.…”