None listed
Conditions
Brief summary
Purpuse: Intravenous fluid replacement is one of the main treatments of cardiovascular dysfunction in anaesthesia and intensive therapy. Only certain patients will respond to the administered fluids with and increase in cardiac output/stroke volume. Extra fluid could worsen the condition for the rest of the patients. Traditional predictive indices are not capable of predicting haemodynamic response to fluids. Recently, dynamic indices have emerged as consistent and reliable predictive factors for fluid responsiveness. Yet they have to date not been verified in the setting of increased intraabdominal pressure. Hypothesis: Stroke volume variation and pulse pressure variation predict fluid responsiveness in patients with pneumoperitoneum. Background: Pneumoperitoneum as a clinical model of intraabdominal hypertension has an effect on haemodynamic variables. Because of the reduced lung compliance it also affects dynamic indices of fluid responsiveness. It was demonstrated in animal studies that their predictive value for fluid responsiveness is maintained, but different cut-off values have been proposed. The study design is explained above. We expect to find dynamic indices to have predictive value in the setting of pneumoperitoneum, possibly with different cut-off values. The result is important for both clinical practice and further research.
Interventions
The aim of our study is to investigate whether Pulse Pressure Variation (PPV) and Stroke Volume Variation (SVV) can be used as reliable predictors of fluid responsiveness in patients with pneumoperitoneum. Patients undergoing laparoscopic abdominal surgery will be included in the study. Standard operative monitoring (pulse oximetry, arterial blood pressure, electrocardiogram) as well as a LiDCO Rapid monitor (LiDCO Ltd, Cambridge, UK) will be connected. After induction of anaesthesia, the mechan
The aim of our study is to investigate whether Pulse Pressure Variation (PPV) and Stroke Volume Variation (SVV) can be used as reliable predictors of fluid responsiveness in patients with pneumoperitoneum. Patients undergoing laparoscopic abdominal surgery will be included in the study. Standard operative monitoring (pulse oximetry, arterial blood pressure, electrocardiogram) as well as a LiDCO Rapid monitor (LiDCO Ltd, Cambridge, UK) will be connected. After induction of anaesthesia, the mechanical ventilation will be commenced with the tidal volume set to at least 8ml/kg IBW. Immediately after commencing mechanical ventilation and applying maintenance dose of an anaesthetic, values of SVV, PPV, nCI (non-calibrated cardiac index) and nSI (non-calibrated stroke index) will be recorded for baseline values. The first fluid challenge will then take place. For the purpose of this study, a standard fluid challenge will consist of a bolus of 3ml/kg of body weight of a colloid solution (balanced electrolyte solution of hydroxyethyl starch, Volulyte [Registered Trademark], Fresenius Kabi AG, Bad Homburg, Germany) given intravenously in 5 minutes or less. The aforementioned set of variables will always be recorded immediately prior to fluid challenge and at 5 minutes. The same fluid challenge will be repeated on the same patient in the setting of a stable pneumoperitoneum. Stable pneumoperitoneum will be achieved using an automated system for laparoscopic surgery. The intraabdominal pressure is set to 10-15mmHg and is automatically sustained. The pressure rises at insuflation and then stabilises at the set value. The absolute value of pneumoperitoneum is not crucial for the study, it is however important, that the pressure remains stable during a fluid challenge.
Sponsors
University Medical Centre Ljubljana
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adult patients undergoing laparoscopic abdominal procedures.
Exclusion criteria
Patients with cardiac arrhythmias. Patients with spontaneous breathing activity. Patients with IAH before laparoscopy. Patients with severe aortic regurgitation. Pregnant women. Non-adults.
Outcome results
None listed