The Use of Bioreactance and Carotid Doppler to Determine Volume Responsiveness and Blood Flow Redistribution Following Passive Leg Raising in Hemodynamically Unstable Patients

Marik, Paul E.; Levitov, Alex; Young, Alisha Y; Andrews, Lois

doi:10.1378/chest.12-1274

Cited by 217 publications

(220 citation statements)

References 34 publications

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“…One concern for the use of esophageal Doppler (EDM) in CO measurement is determining if the ratio of blood entering the descending aorta from the left ventricle is constant. Previous studies have shown that in patients with unstable hemodynamic state, a disproportionate percentage of the CO increase following volume loading was directed to the carotid arteries [60]. Therefore, when conducting GDT based on esophageal Doppler in critically ill patients, one has to keep in mind that an increase in blood velocity in the descending aorta may not necessarily correlate with an increase in total SV [61].…”

Section: Ultrasoundmentioning

confidence: 99%

Guiding Goal-Directed Therapy

Suehiro

Joosten

Alexander

2014

Curr Anesthesiol Rep

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Several studies have demonstrated that perioperative hemodynamic optimization (or ''goal directed therapy'') using minimally invasive hemodynamic monitoring technologies has the ability to improve postoperative patients' outcome with lower complication rates, shorter hospital lengths of stay, and lower cost of surgery. This specific concept of goal-directed therapy (GDT) uses perioperative cardiac output monitoring and manipulation of physiologic parameters (dynamic parameters of fluid responsiveness) to guide intravenous fluids and inotropic therapy with the goal of ensuring adequate tissue perfusion. Recently, the evidence related to the implementation of GDT strategies has been considered strong enough to allow for the creation of national recommendations in the UK, in France, and by the European Society of Anaesthesiology. The aims of the programs are to apply best practices to high-risk surgical patients and requires the participation of all clinicians involved in patients' care. Considering the potential clinical and economic benefits of GDT protocols and the positive recommendations from influential scientific societies, more and more hospitals around the world have become interested in implementing hemodynamic optimization in their departments. This review provides the information about the evolution of hemodynamic monitoring from invasive to the more recent noninvasive devices, and how these devices can be used in the operating rooms through well-defined algorithms of GDT.

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Section: Ultrasoundmentioning

confidence: 99%

Guiding Goal-Directed Therapy

Suehiro

Joosten

Alexander

2014

Curr Anesthesiol Rep

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“…Transthoracic bioreactance is a new technique of continuous non-invasive cardiac output (CO) monitoring (NICOM; NICOM™, Cheetah Medical, Portland, Oreg., USA) that has demonstrated good reliability against invasive measures of CO in studies involving adults, children and small animals [1,2,3,4,5,6]. We recently demonstrated the feasibility and reliability of NICOM compared with echocardiography in a study of hemodynamically stable late preterm and term neonates [7].…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Cardiac Output Monitoring in Preterm Infants Undergoing Patent Ductus Arteriosus Ligation: A Comparison with Echocardiography

Weisz

Jain²,

Ting

et al. 2014

Neonatology

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Background: Non-invasive cardiac output monitoring (NICOM; NICOM™) may be useful in the management of extremely premature preterm infants. Objectives: To evaluate a new bioreactance-based method of continuous NICOM in preterm infants following patent ductus arteriosus (PDA) ligation. Methods: Infants underwent three paired NICOM and echocardiography assessments of stroke volume (SV) and left ventricular output (LVO) in the postoperative period: at 1, 6-8, and 16-18 h postoperatively. NICOM- and echocardiography-measured SV and LVO during those periods were compared using Bland-Altman analysis and the intraclass correlation coefficient (ICC). Results: Twenty-five infants with a median (interquartile range) gestational age and birth weight of 25.0 weeks (24.5-25.9) and 700 g (615-775), respectively, were included. The overall systematic bias (limits of agreement) across all time points between the NICOM and echocardiography SV readings was 39% (8-69) with NICOM consistently underestimating echocardiography values. There was moderate consistency between NICOM and echocardiography SV values (ICC 0.78, p < 0.001). Compared with the 1-hour scans, the 6- to 8- and 16- to 18-hour scans had increased biases of 7.9% (95% CI 2.5-13.2) and 9.7% (95% CI 3.6-15.8), respectively. Conclusion: Continuous LVO measurement using NICOM was feasible and demonstrated a consistent systematic bias compared with echocardiography in unstable extremely preterm infants without a PDA ligation. NICOM may be used as a trending tool for continuous monitoring in this population, but wide limits of agreement and increasing bias over time suggest it is not interchangeable with echocardiography.

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“…However, only a small number of published studies actually investigated the performance of PLR as a surrogate method to predict fluid responsiveness in cardiac surgical patients (26,27). These investigations mostly used bioreactance as a technology to measure SV changes rather than the devices based on pulse wave analysis, including PiCCO, rendering comparison with our results difficult (28,29). In a rigorous investigation of PLR to detect fluid responsiveness in patients after cardiac surgery, Benomar et al (27) determined the least minimum significant change (LMSC), i.e.…”

Section: Discussionmentioning

confidence: 96%

Reliability of Passive Leg Raising, Stroke Volume Variation and Pulse Pressure Variation to Predict Fluid Responsiveness During Weaning From Mechanical Ventilation After Cardiac Surgery: A Prospective, Observational Study

Hofer

Geisen

Hartnack

et al. 2018

Turk J Anaesth Reanim

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Objective: During assisted ventilation and spontaneous breathing, functional haemodynamic parameters, including stroke volume variation (SVV) and pulse pressure variation (PPV), are of limited value to predict fluid responsiveness, and the passive leg raising (PLR) manoeuvre has been advocated as a surrogate method. We aimed to study the predictive value of SVV, PPV and PLR for fluid responsiveness during weaning from mechanical ventilation after cardiac surgery. Methods: Haemodynamic variables and fluid responsiveness were assessed in 34 patients. Upon arrival at the intensive care unit, measurements were performed during continuous mandatory ventilation (CMV) and spontaneous breathing with pressure support (PSV) and after extubation (SPONT). The prediction of a positive fluid responsiveness (defined as stroke volume increase >15% after fluid administration) was tested by calculating the specific receiver operating characteristic (ROC) curves. Results: A significant increase in stroke volumes was observed during CMV, PSV and SPONT after fluid administration. There were 19 fluid responders (55.9%) during CMV, with 22 (64.7%) and 13 (40.6%) during PSV and SPONT, respectively. The predictive value for a positive fluid responsiveness (area under the ROC curve) for SVV was 0.88, 0.70 and 0.56; was 0.83, 0.69 and 0.48 for PPV; was 0.72, 0.74 and 0.70 for PLR during CMV, PSV and SPONT, respectively. Conclusion: During mechanical ventilation, adequate prediction of fluid responsiveness using SVV and PPV was observed. However, during spontaneous breathing, the reliability of SVV and PPV was poor. In this period, PLR as a surrogate was able to predict fluid responsiveness better than SVV or PPV but was less reliable than previously reported. Keywords: Stroke volume variation, pulse pressure variation, passive leg raising, functional haemodynamic parameter, pulse contour analysis Amaç: Yardımlı ventilasyon ve spontan solunum sırasında, Atım Hacmi Varyasyonu (SVV) ve Nabız Basıncı Varyasyonunun (PPV) dâhil olmak üzere fonksiyonel hemodinamik parametreler, sıvı duyarlılığını tahmin etmek için sınırlı değerdedir ve pasif bacak kaldırma (PLR) manevrası alternatif bir yöntem olarak savunulmuştur. Kalp cerrahisi sonrası mekanik ventilasyondan weaning sırasındaki sıvı yanıtı için SVV, PPV ve PLR'nin prediktif değerini araştırmayı amaçladık. Yöntemler: Hemodinamik değişkenler ve sıvı yanıtı 34 hastada değerlendirildi. Yoğun bakım ünitesine varışta, sürekli zorunlu ventilasyon (CMV) ve basınç desteği (PSV) ile spontan solunum esnasında ve ekstübasyon sonrası (SPONT) ölçümler yapıldı. Pozitif sıvı cevabı (sıvı uygulamasından sonra atım hacmi artışı >%15 olarak tanımlanır), belirli alıcı işlem karakteristik eğrileri-nin (ROC) hesaplanmasıyla test edildi. Bulgular: Sıvı uygulamasından sonra CMV, PSV ve SPONT esnasında, atım hacimlerinde belirgin bir artış gözlendi. CMV esnasında, 19 sıvı yanıtı (%55,9) ve PSV ve SPONT esnasında sırasıy-la 22 (%64,7) ve 13 (%40,6) sıvı yanıtı vardı. Pozitif sıvı cevabı (ROC eğrisinin altındaki alan) i...

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The Use of Bioreactance and Carotid Doppler to Determine Volume Responsiveness and Blood Flow Redistribution Following Passive Leg Raising in Hemodynamically Unstable Patients

Cited by 217 publications

References 34 publications

Guiding Goal-Directed Therapy

Guiding Goal-Directed Therapy

Non-Invasive Cardiac Output Monitoring in Preterm Infants Undergoing Patent Ductus Arteriosus Ligation: A Comparison with Echocardiography

Reliability of Passive Leg Raising, Stroke Volume Variation and Pulse Pressure Variation to Predict Fluid Responsiveness During Weaning From Mechanical Ventilation After Cardiac Surgery: A Prospective, Observational Study

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