Unreliable Tracking Ability of the Third-Generation FloTrac/Vigileo™ System for Changes in Stroke Volume after Fluid Administration in Patients with High Systemic Vascular Resistance during Laparoscopic Surgery

Chin, Ji-Hyun; Kim, Wook-Jong; Choi, Jeong-Hyun; Han, Yun A.; Kim, Seon‐Ok; Choi, Woo-Young

doi:10.1371/journal.pone.0142125

Cited by 8 publications

(5 citation statements)

References 34 publications

(47 reference statements)

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“…Chin et al compared the SV derived by a radial artery uncalibrated pulse-contour method (the third generation FloTrac/Vigileo system, Edwards Lifesciences, Irvine, California, USA) with the SV derived by TEE Doppler in patients undergoing laparoscopic prostatectomy. [30] The percentage errors of the absolute values was 53.8%, with a concordance rate of 69.2% (four-quadrant plot), and the mean angular bias 20.6 degrees with radial limits of agreement of ±51.5 degrees in the polar plot. They concluded that the third-generation FloTrac/Vigileo system was not reliable in measuring SV or in tracking changes in the SV after fluid administration in the high systemic vascular resistance state.…”

Section: Discussionmentioning

confidence: 98%

Pilot Study: Estimation of Stroke Volume and Cardiac Output from Pulse Wave Velocity

et al. 2017

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BackgroundTransesophageal echocardiography (TEE) is increasingly replacing thermodilution pulmonary artery catheters to assess hemodynamics in patients at high risk for cardiovascular morbidity. However, one of the drawbacks of TEE compared to pulmonary artery catheters is the inability to measure real time stroke volume (SV) and cardiac output (CO) continuously. The aim of the present proof of concept study was to validate a novel method of SV estimation, based on pulse wave velocity (PWV) in patients undergoing cardiac surgery.MethodsThis is a retrospective observational study. We measured pulse transit time by superimposing the radial arterial waveform onto the continuous wave Doppler waveform of the left ventricular outflow tract, and calculated SV (SVPWV) using the transformed Bramwell-Hill equation. The SV measured by TEE (SVTEE) was used as a reference.ResultsA total of 190 paired SV were measured from 28 patients. A strong correlation was observed between SVPWV and SVTEE with the coefficient of determination (R2) of 0.71. A mean difference between the two (bias) was 3.70 ml with the limits of agreement ranging from -20.33 to 27.73 ml and a percentage error of 27.4% based on a Bland-Altman analysis. The concordance rate of two methods was 85.0% based on a four-quadrant plot. The angular concordance rate was 85.9% with radial limits of agreement (the radial sector that contained 95% of the data points) of ± 41.5 degrees based on a polar plot.ConclusionsPWV based SV estimation yields reasonable agreement with SV measured by TEE. Further studies are required to assess its utility in different clinical situations.

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Section: Discussionmentioning

confidence: 98%

Pilot Study: Estimation of Stroke Volume and Cardiac Output from Pulse Wave Velocity

et al. 2017

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“…Dynamic monitoring indices guide fluid replacement [ 5 ] but are not very reliable in the context of minimally invasive surgery. [ 6 7 ] This obligates a fluid management based upon haemodynamic profile, urine output and metabolic parameters such as lactate, which is an early indicator of tissue hypoperfusion. [ 8 ] The restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF) trial [ 9 ] while comparing a restrictive versus liberal fluid administration strategy has shown increased risk of renal failure, renal replacement therapy and surgical site infection in the restrictive group.…”

Section: Discussionmentioning

confidence: 99%

Effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot- assisted colorectal surgery

Kumar

Sandhya

et al. 2020

Indian J Anaesth

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Background and Aims: Minimally invasive and robotic surgeries need lesser fluid replacement but the role of restricted fluids in robotic surgeries other than prostatic surgeries has not been clearly defined. Our primary aim was to evaluate the effects of a restrictive fluid regimen versus a liberal policy on intra-operative lactate in robotic colorectal surgery. Secondary outcomes were need for vasopressors, extubation on table, post-operative renal functions and length of ICU (LOICU) stay. Methods: American society of anaesthesiologists (ASA) physical status I–II patients scheduled for robot-assisted colorectal surgery were randomised into one of two groups, receiving either 2 mL/kg/h (Group R) or 4mL/kg/h, (group L). Fluid boluses of 250 ml were administered if mean arterial pressure (MAP) <65 mmHg or urine output <0.5 ml/kg/h. Norepinephrine was added for the blood pressure after 2 fluid boluses. Surgical field was assessed by modified Boezaart's scale and surgeon satisfaction by Likert scale. Results: Demographics and baseline renal functions were comparable. Adjusted intra-operative lactate at 2 h, 4 h, and 6 h and need for noradrenaline and post-operative creatinine were similar. One patient in the group L was ventilated due to hypothermia. The field was better at the 4 h in group R and comparable at other time points. The LOICU stay was longer in Group L. Conclusion: The use of restrictive fluid strategy of 2 mL/kg/h (group R) does not increase lactate levels or creatinine, improves surgical field at 4 h and shortens ICU stay in comparison to a liberal 4 mL/kg/h (group L) in robotic colorectal surgery.

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“…The pulse contour systems (LiDCO and Vigileo) that were utilized for both studies have shown difficulty in tracking changes in CI. [181920] We used the latest software version for the FloTrac system, which has shown improved accuracy in measuring CI in patients with varying systemic vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic effects of low-dose bupivacaine spinal anesthesia for cesarean section: A randomized controlled trial

et al. 2019

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Background: Spinal anesthesia is the most common technique for cesarean section. The conventional local anesthetic dose has been decreasing over time to 8–12.5 mg of bupivacaine. Lower doses of bupivacaine may be associated with reduced incidence of hypotension and other complications. This low dose also may be associated with improved maternal cardiac index (CI). We hypothesized that low dose spinal anesthesia using 4.5 mg bupivacaine would result in improved maternal CI when compared with conventional dose (9 mg) intrathecal bupivacaine. Methods: This randomized controlled trial included all healthy parturients presenting for elective cesarean section. In addition to standard monitors, an arterial line was placed for pulse contour cardiac output measurement. Due to limited data on maternal cardiac output during cesarean section, we had to power our study on recovery room length of stay. Secondary outcomes included the change in maternal CI, fluid administration, vasopressor usage, maternal satisfaction, and adequacy of surgical blockade and recovery time from motor and sensory blockade. Results: The low dose group had significantly faster motor recovery times (132 [122–144] versus. 54 [48–66] min conventional versus. low-dose, respectively, P < 0.01), and a shorter recovery room stay (92 ± 21 vs 70 ± 11 min, conventional vs. low-dose, respectively, P < 0.01, 95% CI -35 to -10 min). There was no difference in CI between the conventional dose and low dose spinal groups. Both groups had a drop in CI with spinal anesthesia. The low-dose group demonstrated equivalent surgical anesthesia and block onset times compared to the conventional group. Conclusions: Low-dose spinal anesthesia provides adequate surgical anesthesia, improved recovery time, but no difference in maternal cardiac index when compared to conventional dose spinal anesthesia. NCT02046697

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Unreliable Tracking Ability of the Third-Generation FloTrac/Vigileo™ System for Changes in Stroke Volume after Fluid Administration in Patients with High Systemic Vascular Resistance during Laparoscopic Surgery

Cited by 8 publications

References 34 publications

Pilot Study: Estimation of Stroke Volume and Cardiac Output from Pulse Wave Velocity

Pilot Study: Estimation of Stroke Volume and Cardiac Output from Pulse Wave Velocity

Effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot- assisted colorectal surgery

Hemodynamic effects of low-dose bupivacaine spinal anesthesia for cesarean section: A randomized controlled trial

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