Assessment of fluid-responsiveness parameters for off-pump coronary artery bypass surgery: a comparison among LiDCO, transesophageal echochardiography, and pulmonary artery catheter. Export

@article{citeulike:3022052, abstract = {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.}, address = {Department of Cardiac Anaesthesia and ICU, Sant'Anna e San Sebastiano Hospital, Caserta, Italy.}, author = {Belloni, L. and Pisano, A. and Natale, A. and Piccirillo, M. R. and Piazza, L. and Ismeno, G. and De Martino, G.}, citeulike-article-id = {3022052}, citeulike-linkout-0 = {http://dx.doi.org/10.1053/j.jvca.2007.07.007}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/18375327}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=18375327}, doi = {10.1053/j.jvca.2007.07.007}, issn = {1532-8422}, journal = {Journal of cardiothoracic and vascular anesthesia}, keywords = {echo, pc, volume}, month = {April}, number = {2}, pages = {243--248}, posted-at = {2008-07-20 05:49:23}, priority = {2}, title = {Assessment of fluid-responsiveness parameters for off-pump coronary artery bypass surgery: a comparison among LiDCO, transesophageal echochardiography, and pulmonary artery catheter.}, url = {http://dx.doi.org/10.1053/j.jvca.2007.07.007}, volume = {22}, year = {2008} }

TY - JOUR ID - citeulike:3022052 L3 - citeulike-article-id:3022052 N2 - 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. IS - 2 JF - Journal of cardiothoracic and vascular anesthesia SN - 1532-8422 AD - Department of Cardiac Anaesthesia and ICU, Sant'Anna e San Sebastiano Hospital, Caserta, Italy. EP - 248 TI - Assessment of fluid-responsiveness parameters for off-pump coronary artery bypass surgery: a comparison among LiDCO, transesophageal echochardiography, and pulmonary artery catheter. VL - 22 SP - 243 KW - echo KW - pc KW - volume AU - Belloni, L AU - Pisano, A AU - Natale, A AU - Piccirillo, MR AU - Piazza, L AU - Ismeno, G AU - De Martino, G PY - 2008/04// UR - http://dx.doi.org/10.1053/j.jvca.2007.07.007 ER -