None listed
Conditions
Brief summary
Background: Assessing preload dependence by means of static and dynamic indexes of fluid responsiveness is limited to a minority of critically ill and surgical patients. The lack in the sensitivity and specificity of these indexes in revealing fluid responsiveness before fluid challenge (FC) administration increases the risk of fluid overloading. Since, in responders and non-responders, the FC causes different hemodynamic effects in cardiac function and peripheral tone the outcome could be predicted before the entire infusion by dynamically assessing these variables. Methods: 50 patients scheduled for elective abdominal surgery. The FC was administered to improve an episode of hemodynamic instability, and consisted in 500 ml of crystalloids in 10 minutes. A bivariate logistic regression mode was constructed to predict the outcome of the FC including baseline pulse pressure variation (PPV), and four different cardiovascular indexes provided by the MostCare. Design: prospective multicentric study
Interventions
Fluid challenge consisting in 500 ml of intravenous crystalloids (both saline 0,9% or Ringer Acetate or Lactate were allowed), administered in 10 minutes.
The Fluid challenge is administered by the attending physician to correct hemodynamic instability during the surgical procedure (see also eligibility).
All the patients received hemodynamic monitoring with the MostCare system which provides all the hemodynamic variables evaluated in the study before and after fluid challenge administration (ca
Fluid challenge consisting in 500 ml of intravenous crystalloids (both saline 0,9% or Ringer Acetate or Lactate were allowed), administered in 10 minutes. The Fluid challenge is administered by the attending physician to correct hemodynamic instability during the surgical procedure (see also eligibility). All the patients received hemodynamic monitoring with the MostCare system which provides all the hemodynamic variables evaluated in the study before and after fluid challenge administration (cardiac output, stroke volume, arterial elastance, cardiac cycle efficiency) All patients will receive an echocardiographic assessment before and after the FC including, tissue doppler waveforms (both right and left ventricle), mitral pattern assessment (includine E/e'; E/A waves analysis), Velocity time integral of aortic flow pattern (VTI) and VTI variations
Sponsors
Antonio Messina
Study design
Allocation
Non-randomised trial
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1) to have > or = 18 years 2) to be scheduled for elective open abdominal surgery under general anesthesia with mechanical ventilation with a volume controlled mode (with a tidal volume (VT) < 8 ml/kg), 3) to require an invasive blood pressure monitoring.
Exclusion criteria
1) the American Society of Anesthesiologists' physical status classification (ASA) equal to 4, 2) presence of a previous history of arrhythmia, or left ventricular ejection fraction < 30%, or right ventricular dysfunction (assessed by a < 0.16 m/s of systolic peak velocity of tricuspid annular motion), or a moderate to severe valvular heart disease , or intra-cardiac shunt, 3) chronic medication with beta-blockers.
Outcome results
None listed