Document Detail


Assessment of fluid-responsiveness parameters for off-pump coronary artery bypass surgery: a comparison among LiDCO, transesophageal echochardiography, and pulmonary artery catheter.
MedLine Citation:
PMID:  18375327     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To verify the reliability of different markers of fluid-responsiveness during off-pump cardiac surgery (OPCAB). DESIGN: A clinical prospective, nonblinded, nonrandomized study. SETTING: A community hospital. PARTICIPANTS: Nineteen patients. INTERVENTIONS: Pulmonary artery catheter (PAC), LiDCO (LiDCO, London, UK), and transesophageal echocardiography (TEE) parameters were measured before (t0) and after (t1) a fluid challenge was performed 20 minutes after induction of anesthesia, but before sternotomy and without inotropic infusion. A Student t test and Spearman test were performed for statistical analysis. MEASUREMENTS AND MAIN RESULTS: According to the variation of cardiac index after the fluid challenge (DeltaCI%), 2 groups of patients were identified: the responders (Re, DeltaCI% > 15%) and the nonresponders (nRe). Mean pulse pressure variation (PPV) and mean stroke volume variation (SVV) before the fluid challenge (t0) were significantly different between the 2 groups. No significant differences were shown in systolic pressure variation (SPV), left ventricular end-diastolic area, left ventricular end-diastolic volume, and peak changes of aortic flow (DeltaVAo). A statistically significant correlation was observed between DeltaCI% and PPV (R = 0.793), DeltaCI% and SVV (R = 0.809), and DeltaCI% and SPV (R = 0.766). No correlation with central venous pressure and pulmonary capillary wedge pressure was found. CONCLUSIONS: Dynamic parameters of fluid responsiveness by LiDCO are highly sensitive for assessment of intravascular volume status during OPCAB surgery. In contrast, even if static parameters by TEE reflect changes in ventricular diastolic volume, they are poor indicators of fluid responsiveness. Surprisingly, no significant correlation between DeltaVAo (TEE) and DeltaCI% was found.
Authors:
Luigi Belloni; Antonio Pisano; Armando Natale; Maria Rosario Piccirillo; Luigi Piazza; Gennaro Ismeno; Giovanni De Martino
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article     Date:  2007-10-29
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  22     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-31     Completed Date:  2008-06-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  243-8     Citation Subset:  IM    
Affiliation:
Department of Cardiac Anaesthesia and ICU, Sant'Anna e San Sebastiano Hospital, Caserta, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Volume / physiology*
Catheterization, Swan-Ganz / methods*
Coronary Artery Bypass, Off-Pump / methods*
Echocardiography, Transesophageal / methods*
Female
Fluid Therapy / methods*
Humans
Male
Middle Aged
Prospective Studies
Pulmonary Wedge Pressure / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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