Anomaly; Venous Return
Conditions
Keywords
morbidly obese patients,, preoperative volume-challenge,, transthoracic echocardiography,, TTE,, rapid weight loss,, venous return,, bariatric surgery,, left ventricular outflow tract,, stroke volume,, diastolic function,, hypervolemia,, hypovolemia
Brief summary
Preoperative venous return stability and euvolemia is essential in management of morbidly obese patients. Fluid therapy regimes for patients with high BMI, especially with focus on preoperative management, are rare and not in consensus.The aim of this study was to evaluate preoperative effects of a standardized, ideal body weight (IBW) based volume-challenge on hemodynamics, stroke volume and level of venous return to the heart.
Detailed description
34 morbidly obese patients scheduled for bariatric surgery underwent a preoperative three-week preparation by rapid-weight-loss-diet (RWL) to be accepted for bariatric surgery. Preoperative transthoracic echocardiography (TTE) was performed in the awake state before and after volume-challenge (VC) based on 6ml colloids /kg IBW. Feasibility of standardized VC was evaluated by TTE. Dynamic and non-dynamic echocardiographic indices for VC were studied. Main outcome measures: Volume-responsiveness and level of venous return before and after volume-challenge were assessed by TTE. An increase of stroke volume ≥ 13% was considered as a volume-responder.
Interventions
OTHERpreoperative venous return optimizing
Preoperative transthoracic echocardiography (TTE) was performed in the awake state before and after volume challenge based on 6ml colloids /kg ideal body weight.
Sponsors
Umeå University
Study design
Observational model
CASE_CROSSOVER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* enrolled for bariatric surgery * BMI ≥ 40 or ≥ 35kg/m2 with co-morbidities * preoperative three-weeks preparation by rapid-weight-loss-diet and weight loss
Exclusion criteria
* untreated significant hypertension * unstable angina pectoris * significant valve regurgitation or stenosis * known severe pulmonary disease
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| level of venous return | 0,1 hour |
Secondary
| Measure | Time frame |
|---|---|
| Volume-responsiveness | 0,1 hour |
Other
| Measure | Time frame |
|---|---|
| Evaluation of feasibility of dynamic and non-dynamic echocardiographic indices for volume challenge | 1 hour |
Countries
Sweden
Outcome results
None listed