Changes in arterial blood pressure characteristics following an extrasystolic beat or a fast 50 ml fluid challenge do not predict fluid responsiveness during cardiac surgery
| Autor: | Dorthe Viemose Nielsen, Jonas M Berg, Vijoleta Abromaitiene, Simon T. Vistisen, NE Hjørnet |
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| Rok vydání: | 2021 |
| Předmět: |
Cardiac Complexes
Premature medicine.medical_specialty Blood Pressure Health Informatics Critical Care and Intensive Care Medicine 03 medical and health sciences Coronary artery bypass surgery 0302 clinical medicine 030202 anesthesiology Internal medicine medicine Humans Arterial Pressure Cardiac Output Cardiac Surgical Procedures Original Research Receiver operating characteristic Fluid responsiveness prediction business.industry Hemodynamics Stroke Volume 030208 emergency & critical care medicine Crystalloid Solutions Stroke volume Perioperative Cardiac surgery Perioperative fluid therapy Pulse pressure Preload Anesthesiology and Pain Medicine Blood pressure ROC Curve Cardiology Haemodynamic monitoring Fluid Therapy Extrasystoles business |
| Zdroj: | Berg, J M, Nielsen, D V, Abromaitiene, V, Hjørnet, N E & Vistisen, S T 2022, ' Changes in arterial blood pressure characteristics following an extrasystolic beat or a fast 50 ml fluid challenge do not predict fluid responsiveness during cardiac surgery ', Journal of Clinical Monitoring and Computing, vol. 36, no. 3, pp. 889-900 . https://doi.org/10.1007/s10877-021-00722-z Journal of Clinical Monitoring and Computing |
| ISSN: | 1573-2614 1387-1307 |
| DOI: | 10.1007/s10877-021-00722-z |
| Popis: | Prediction of fluid responsiveness is essential in perioperative goal directed therapy, but dynamic tests of fluid responsiveness are not applicable during open-chest surgery. We hypothesised that two methods could predict fluid responsiveness during cardiac surgery based on their ability to alter preload and thereby induce changes in arterial blood pressure characteristics: (1) the change caused by extrasystolic beats and (2) the change caused by a fast infusion of 50 ml crystalloid (micro-fluid challenge). Arterial blood pressure and electrocardiogram waveforms were collected during surgical preparation of the left internal mammary artery in patients undergoing coronary artery bypass surgery. Patients received a fluid challenge (5 ml/kg ideal body weight). The first 50 ml were infused in 10 s and comprised the micro-fluid challenge. Predictor variables were defined as post-ectopic beat changes (compared with sinus beats preceding ectopy) in arterial blood pressure characteristics, such as pulse pressure and systolic pressure, or micro-fluid challenge induced changes in the same blood pressure characteristics. Patients were considered fluid responsive if stroke volume index increased by 15% or more after the full fluid challenge. Diagnostic accuracy was calculated by the area under the receiver operating characteristics curve (AUC). Fifty-six patients were included for statistical analysis. Thirty-one had extrasystoles. The maximal AUC was found for the extrasystolic change in pulse pressure and was 0.70 (CI [0.35 to 1.00]). The micro-fluid challenge method generally produced lower AUC point estimates. Extrasystoles did not predict fluid responsiveness with convincing accuracy in patients undergoing cardiac surgery and changes in arterial waveform indices following a micro-fluid challenge could not predict fluid responsiveness. Given a low number of fluid responders and inherently reduced statistical power, our data does not support firm conclusions about the utility of the extrasystolic method. Clinical Trial Registration Unique identifier: NCT02903316. https://clinicaltrials.gov/ct2/show/NCT02903316?cond=NCT02903316&rank=1. Supplementary Information The online version contains supplementary material available at 10.1007/s10877-021-00722-z. |
| Databáze: | OpenAIRE |
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