Document Detail


Stroke volume averaging for individualized goal-directed fluid therapy with oesophageal Doppler.
MedLine Citation:
PMID:  19032566     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: An individualized fluid optimization strategy, based on maximization of cardiac stroke volume (SV) with colloid boluses (goal-directed therapy), improves outcome after surgery. Oesophageal Doppler (OD) is used for SV maximization in most randomized studies, but evidence-based guidelines for the SV maximization procedure are lacking and variation in SV may influence the indication for fluid administration. We measured beat-to-beat OD SV before and after fluid optimization in order to estimate the number of heartbeats for which SV needs to be averaged to provide an acceptable accuracy for goal-directed therapy with this technology. METHODS: Twenty patients scheduled for surgery were anaesthetized, followed by OD SV assessment. Thirty seconds of beat-to-beat data were recorded before and after volume optimization performed by successive boluses of 200 ml colloid until SV did not increase >or=10%. SV variability was assessed before and after the volume optimization when SV was measured beat to beat and when it was averaged over 2-10 heartbeats. RESULTS: Nineteen (95%) and 17 (85%) patients demonstrated an SV variability >or=10% before and after volume optimization, respectively, when SV was measured beat to beat. However, when SV was averaged over 10 heartbeats, only two (10%) and one (5%) of the patients demonstrated an SV variability >or=10% before and after optimization, respectively (P<0.0001). CONCLUSION: OD SV variability is significantly reduced and reaches an acceptable level when SV is averaged over 10 heartbeats. The use of a shorter averaging period for SV may lead to incorrect volume administration in goal-directed fluid management.
Authors:
C C Jørgensen; M Bundgaard-Nielsen; L T Skovgaard; N H Secher; H Kehlet
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2008-11-11
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  53     ISSN:  1399-6576     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-08     Completed Date:  2009-02-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  England    
Other Details:
Languages:  eng     Pagination:  34-8     Citation Subset:  IM    
Affiliation:
Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Esophagus / surgery,  ultrasonography*
Female
Fluid Therapy*
Humans
Male
Middle Aged
Stroke Volume*
Ultrasonography, Doppler

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


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