Starling curves and central venous pressure

Berlin, David; Bakker, Jan

doi:10.1186/s13054-015-0776-1

Cited by 104 publications

(69 citation statements)

References 27 publications

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“…This observation was expected, as responders are positioned on the steep portion of the Frank-Starling curve [10].…”

Section: Discussionmentioning

confidence: 91%

Central venous pressure as an adjunct to flow-guided volume optimisation after induction of general anaesthesia

Hahn

He²,

2016

Anaesthesiol Intensive Ther

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Background: Although the central venous pressure (CVP) is often used as a guide to volume status in major surgery and intensive care, fluid therapy should be guided by the response of the stroke volume (SV) to a fluid bolus. The present study evaluates whether the central venous pressure (CVP) can serve as an adjunct to decisions of whether or not fluid should be infused. Methods: Stroke volume (SV) and stroke volume variation (SVV) was monitored with FloTrac/Vigileo and the CVP were measured in 80 patients just before general anaesthesia was induced (baseline) and then, before each of three successive bolus infusions of 3 mL kg -1 of 6% hydroxyethyl starch 130/0.4. A patient showed fluid responsiveness and was denoted a "responder" if SV increased by ≥10% from the bolus infusion. Results: The CVP was higher in non-responders (mean 7.2 mm Hg) than in responders (mean 5.8 mm Hg, P < 0.0001). In non-responders but not in responders, the absence or presence of a rise in CVP improved the prediction of whether the patient would show fluid responsiveness during the next fluid bolus. For example, if no rise in CVP occurred the chance was 48% of subsequent fluid responsiveness, while this chance was only 9% for those who had an increase in CVP (P < 0.004). There was only a fair concordance between fluid responsiveness as indicated by SV and SVV (Cohen´s kappa 0.28). Conclusions: A low CVP suggests that the patient is lower on the Frank-Starling curve than indicated by SV as measured by FloTrac/Vigileo.

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“…This observation was expected, as responders are positioned on the steep portion of the Frank-Starling curve [10].…”

Section: Discussionmentioning

confidence: 91%

Central venous pressure as an adjunct to flow-guided volume optimisation after induction of general anaesthesia

Hahn

He²,

2016

Anaesthesiol Intensive Ther

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“…B. durch einen Spannungspneumothorax oder eine Perikardtamponade -hindeuten. Auch eine unbemerkte Erhöhung des positiven endexspiratorischen Drucks ("positive end-expiratory pressure", PEEP) durch dynamische Hyperinflation mit Gefahr der Entwicklung eines Schocks kann einen ZVD-Anstieg bewirken [2].…”

Section: Kritische Bewertungunclassified

“…In diesem Fall können die Erhebung und die Beurteilung von druckbasierten Parametern sinnvoll sein, da hier bereits geringe Volumenzunahmen zu einer deutlichen Steigerung der ventrikulären Füllungsdrücke führen [2,34].…”

Section: Kritische Bewertungunclassified

ZVD – adé? Bitte nicht!

et al. 2015

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“…Following the description of the Frank-Starling curve in 1914 in an isolated heart-lung canine model for investigation of cardiac output, CVPs have been investigated and used as a measure of preload [13]. Therefore, it was assumed that any increase in CVP, as an independent variable (x-axis in the Frank-Starling curve), could be associated with a rise in cardiac output [4]. …”

Section: Static Measures Of Fluid Responsivenessmentioning

confidence: 99%

“…In the most optimistic view, the role of these aforementioned targets of IVF resuscitation is disputed in the literature, if not negated. The static measures of fluid responsiveness have proven to be inaccurate, resulting in significant volume overload and its related adverse effects [2,3,4,5]. On the other hand, the dynamic tests of fluid responsiveness are limited to a subgroup of patients who are mechanically ventilated and have no respiratory effort.…”

Section: Introductionmentioning

confidence: 99%

Fluid Management for Critically Ill Patients: A Review of the Current State of Fluid Therapy in the Intensive Care Unit

Frazee¹,

Kashani

2016

Kidney Dis

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Background: Intravenous fluids (IVF) are frequently utilized to restore intravascular volume in patients with distributive and hypovolemic shock. Although the benefits of the appropriate use of fluids in intensive care units (ICUs) and hospitals are well described, there is growing knowledge regarding the potential risks of volume overload and its impact on organ failure and mortality. To avoid volume overload and its associated complications, strategies to identify fluid responsiveness are developed and utilized more often among ICU patients. Apart from the amount of fluid utilized for resuscitation, the type of fluid used also impacts patient outcome. Colloids and crystalloids are two types of fluids that are utilized for resuscitation. The efficacy of each fluid type on the expansion of intravascular volume on one hand and the potential adverse effects of each individual fluid, on the other hand, need to be considered when choosing the type of fluid for resuscitation. The negative impact of hydroxyethyl starch on kidney function, of albumin on the mortality of head trauma patients and chloride-rich crystalloids on mortality and kidney function, are only examples of new developments in the field. Summary: In this paper, we will review the impact of fluid overload on patient outcomes, define the fluid challenge, describe the differences in static and dynamic estimates of fluid responsiveness, and review the effect of different types of fluid on patient outcome. Key Message: Avoiding fluid overload by choosing the appropriate amount of fluids in patients who are fluid-responsive on one hand, and treating IVF like other medications, on the other hand, are the major changes. Whenever clinicians decide to prescribe IVF, they need to weigh the risks and benefits of giving fluid and also the advantages and side effects of each fluid type in order to optimize patient outcomes.

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Starling curves and central venous pressure

Cited by 104 publications

References 27 publications

Central venous pressure as an adjunct to flow-guided volume optimisation after induction of general anaesthesia

Central venous pressure as an adjunct to flow-guided volume optimisation after induction of general anaesthesia

ZVD – adé? Bitte nicht!

Fluid Management for Critically Ill Patients: A Review of the Current State of Fluid Therapy in the Intensive Care Unit

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