Using extra systoles and the micro-fluid challenge to predict fluid responsiveness during cardiac surgery

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

Links

  • Simon Tilma Vistisen
  • Jonas Munksgaard Berg, Mattheus Boekel, 3University Medical Center Groningen, Department of Anesthesiology, University of Groningen, Groningen, the Netherlands., HollandMarco Modestini, 3University Medical Center Groningen, Department of Anesthesiology, University of Groningen, Groningen, the Netherlands., HollandRemco Bergman, 3University Medical Center Groningen, Department of Anesthesiology, University of Groningen, Groningen, the Netherlands., HollandJayant Jainandunsing, 3University Medical Center Groningen, Department of Anesthesiology, University of Groningen, Groningen, the Netherlands., HollandMassimo Mariani, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, HollandThomas W L Scheeren, 3University Medical Center Groningen, Department of Anesthesiology, University of Groningen, Groningen, the Netherlands., Holland
Fluid responsiveness prediction is difficult during cardiac surgery. The micro-fluid challenge (micro-FC; rapid central infusion of 50 ml) and the extrasystolic method utilising post-extrasystolic preload increases may predict fluid responsiveness. Two study windows during coronary artery bypass graft surgery were defined, 1: After anaesthesia induction until surgical incision, 2: Left internal mammarian artery surgical preparation period. Each window consisted of 10-15 min observation for extrasystoles before a micro-FC was performed, after which a traditional fluid challenge (FC) was performed (5 ml/kg). Extrasystolic and micro-FC induced changes in hemodynamic variables were derived as predictors of fluid responsiveness defined as stroke volume increasing > 10% following FC. 61 patients were studied. Post-ectopic changes in pulse pressure (PP) predicted fluid responsiveness with receiver operating characteristic area (AUC) of 0.69 [CI 0.40;0.97] in the first study window and 0.64 [0.44;0.86] in the second window. Other post-ectopic predictors such as pre-ejection period (PEP) and systolic blood pressure (SBP) had similar or lower AUCs. Heart rate was 52.9 (SD ±8.4) min- 1 and 53.6 (± 8.8) min- 1 in the two study windows. Micro-FC induced changes in PEP had AUC of 0.74 [0.57;0.90] in the first window and 0.60 [0.40;0.76] in the second window. Correcting micro-FC induced changes in PEP for the micro-FC induced changes in heart rate had AUCs of 0.84 [0.70;0.97] in the first window and 0.63 [0.47;0.79] in the second window. The investigated methods revealed insufficient validity during cardiac surgery. RR interval corrected changes during a micro-FC should be investigated further.
OriginalsprogDansk
TidsskriftJournal of Clinical Monitoring and Computing
Sider (fra-til)1-7
Antal sider7
ISSN1387-1307
StatusUdgivet - 9 nov. 2018

Se relationer på Aarhus Universitet Citationsformater

ID: 136076180