Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Perioperative Medicine
Published in: Perioperative Medicine 1/2013

Open Access 01-12-2013 | Research

Neither dynamic, static, nor volumetric variables can accurately predict fluid responsiveness early after abdominothoracic esophagectomy

Authors: Hironori Ishihara, Eiji Hashiba, Hirobumi Okawa, Junichi Saito, Toshinori Kasai, Toshihito Tsubo

Published in: Perioperative Medicine | Issue 1/2013

Login to get access

Abstract

Background

Hypotension is common in the early postoperative stages after abdominothoracic esophagectomy for esophageal cancer. We examined the ability of stroke volume variation (SVV), pulse pressure variation (PPV), central venous pressure (CVP), intrathoracic blood volume (ITBV), and initial distribution volume of glucose (IDVG) to predict fluid responsiveness soon after esophagectomy under mechanical ventilation (tidal volume >8 mL/kg) without spontaneous respiratory activity.

Methods

Forty-three consecutive non-arrhythmic patients undergoing abdominothoracic esophagectomy were studied. SVV, PPV, cardiac index (CI), and indexed ITBV (ITBVI) were postoperatively measured by single transpulmonary thermodilution (PiCCO system) after patient admission to the intensive care unit (ICU) on the operative day. Indexed IDVG (IDVGI) was then determined using the incremental plasma glucose concentration 3 min after the intravenous administration of 5 g glucose. Fluid responsiveness was defined by an increase in CI >15% compared with pre-loading CI following fluid volume loading with 250 mL of 10% low molecular weight dextran.

Results

Twenty-three patients were responsive to fluids while 20 were not. The area under the receiver-operating characteristic (ROC) curve was the highest for CVP (0.690) and the lowest for ITBVI (0.584), but there was no statistical difference between tested variables. Pre-loading IDVGI (r = −0.523, P <0.001), SVV (r = 0.348, P = 0.026) and CVP (r = −0.307, P = 0.046), but not PPV or ITBVI, were correlated with a percentage increase in CI after fluid volume loading.

Conclusions

These results suggest that none of the tested variables can accurately predict fluid responsiveness early after abdominothoracic esophagectomy.
Appendix
Available only for authorised users
Literature
1.
Brodner G, Pogatzki E, Van Aken H, Buerkle H, Goeters C, Schulzki C, Nottberg H, Mertes N: A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy. Anesth Analg. 1998, 86: 228-234.PubMed
2.
Suzuki A, Ishihara H, Okawa H, Tsubo T, Matsuki A: Can initial distribution volume of glucose predict hypovolemic hypotension after radical surgery for esophageal cancer?. Anesth Analg. 2001, 92: 1146-1151.CrossRefPubMed
3.
Bendjelid K, Romand J-A: Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med. 2003, 29: 352-360.CrossRefPubMed
4.
Marik PE, Cavallazzi R, Vasu T, Hirani A: Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009, 37: 2642-2647. 10.1097/CCM.0b013e3181a590da.CrossRefPubMed
5.
Maguire S, Rinehart J, Vakharia S, Cannesson M: Technical communication: respiratory variation in pulse pressure and plethysmographic waveforms: intraoperative applicability in a North American academic center. Anesth Analg. 2011, 112: 94-96. 10.1213/ANE.0b013e318200366b.CrossRefPubMed
6.
Cannesson M, Manach YL, Hofer CK, Goarin JP, Lehot J-J, Vallet B, Tavernier B: Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness. A “Gray Zone” Approach. Anesthesiology. 2011, 135: 231-241.CrossRef
7.
Kobayashi M, Koh M, Irinoda T, Meguro E, Hayakawa Y, Takagane A: Stroke volume variation as a predictor of intravascular volume depression and possible hypotension during the early postoperative period after esophagectomy. Ann Surg Oncol. 2009, 16: 1371-1377. 10.1245/s10434-008-0139-0.CrossRefPubMed
8.
Ishihara H, Nakamura H, Okawa H, Yatsu Y, Tsubo T, Hirota K: Comparison of initial distribution volume of glucose and intrathoracic blood volume during hemodynamically unstable states early after esophagectomy. Chest. 2005, 128: 1713-1719. 10.1378/chest.128.3.1713.CrossRefPubMed
9.
Ishihara H, Suzuki A, Okawa H, Ebina T, Tsubo T, Matsuki A: Comparison of the initial distribution volume of glucose and plasma volume in thoracic fluid-accumulated patients. Crit Care Med. 2001, 29: 1532-1538. 10.1097/00003246-200108000-00006.CrossRefPubMed
10.
Iwakawa T, Ishihara H, Takamura K, Sakai I, Suzuki A: Measurements of extracellular fluid volume in highly perfused organs and lung water in hypo- and hypervolaemic dogs. Eur J Anaesthesiol. 1998, 15: 414-421. 10.1097/00003643-199807000-00006.CrossRefPubMed
11.
Ishihara H, Nakamura H, Okawa H, Takase H, Tsubo T, Hirota K: Initial distribution volume of glucose can be approximated using a conventional glucose analyzer in the intensive care unit. Crit Care. 2005, 9: R144-R149. 10.1186/cc3047.PubMedCentralCrossRefPubMed
12.
Rose BO, Ishihara H, Okawa H, Panning B, Piepenbrock S, Matsuki A: Repeatability of measurements of the initial distribution volume of glucose in haemodynamically stable patients. J Clin Pharm Ther. 2004, 29: 317-323. 10.1111/j.1365-2710.2004.00565.x.CrossRefPubMed
13.
Orban JC, Blasin-Chadoutaud A, Zolfaghari P, Ishihara H, Grimaud D, Ichai C: Hypovolaemic hypotension after abdominal aortic surgery is predicted by initial distribution volume of glucose. Eur J Anaesthesiol. 2010, 27: 364-368. 10.1097/EJA.0b013e328334257c.CrossRefPubMed
14.
He Z, Qiao H, Zhou W, Wang Y, Xu Z, Che X, Zhang J, Liang W: Assessment of cardiac preload status by pulse pressure variation in patients after anesthesia induction: comparison with central venous pressure and initial distribution volume of glucose. J Anesth. 2011, 25: 812-817. 10.1007/s00540-011-1225-1.CrossRefPubMed
15.
Obuchowski NA: Sample size tables for receiver operating characteristic studies. Am J Roentgenol. 2000, 175: 603-608. 10.2214/ajr.175.3.1750603.CrossRef
16.
Sakka SG, Rühl CC, Pfeiffer UJ, Beale R, McLuckie A, Reinhart K, Meier-Hellmann A: Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med. 2000, 26: 180-187. 10.1007/s001340050043.CrossRefPubMed
17.
Huang C-C, Fu J-Y, Hu H-C, Kao K-C, Chen N-H, Hsieh M-J, Tsai Y-H: Prediction of fluid responsiveness in acute respiratory distress syndrome patients ventilated with low tidal volume and high positive end-expiratory pressure. Crit Care Med. 2008, 36: 2810-2816. 10.1097/CCM.0b013e318186b74e.CrossRefPubMed
18.
De Backer D, Heenen S, Piagnerelli S, Koch M, Vincent JL: Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med. 2005, 31: 517-523. 10.1007/s00134-005-2586-4.CrossRefPubMed
19.
Ray P, Le Manach Y, Riou B, Houle TT: Statistical evaluation of a biomarker. Anesthesiology. 2010, 112: 1023-1040. 10.1097/ALN.0b013e3181d47604.CrossRefPubMed
20.
de Waal EE, Rex S, Kruitwagen CL, Kalkman CJ, Buhre WF: Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions. Crit Care Med. 2009, 37: 510-515. 10.1097/CCM.0b013e3181958bf7.CrossRefPubMed
21.
Gold MS: Perioperative fluid management. Crit Care Clin. 1992, 8: 409-421.PubMed
22.
Michard F, Teboul JL: Predicting fluid responsiveness in ICU patients: A critical analysis of the evidence. Chest. 2002, 121: 2000-2008. 10.1378/chest.121.6.2000.CrossRefPubMed
23.
Muller L, Louart G, Bengler C, Fabbro-Peray P, Carr J, Ripart J, de La Coussaye J-E, Lefrant J-Y: The intrathoracic blood volume index as an indicator of fluid responsiveness in critically ill patients with acute circulatory failure: a comparison with central venous pressure. Anesth Analg. 2008, 107: 607-613. 10.1213/ane.0b013e31817e6618.CrossRefPubMed
24.
Reuter DA, Goepfert MSG, Gorsch T, Schmoeckel M, Kilger E, Goetz AE: Assessing fluid responsiveness during open chest conditions. Br J Anaesth. 2005, 94: 318-323. 10.1093/bja/aei043.CrossRefPubMed
25.
Marino PL: Colloid and crystalloid resuscitation. The ICU Book. Edited by: Marino PL, Sutin KM. 2007, Philadelphia, PA: Lippincott Williams & Wilkins, 233-253. 3
26.
van Tulder L, Michaeli B, Chioléro R, Berger MM, Revelly JP: An evaluation of the initial distribution volume of glucose to assess plasma volume during a fluid challenge. Anesth Analg. 2005, 101: 1089-1093. 10.1213/01.ane.0000167769.84459.b7.CrossRefPubMed
27.
Harvey M, Voss L, Sleigh J: Preload response in patients after cardiac surgery: a comparison of systolic pressure and systolic area variability and initial distribution volume of glucose. Crit Care Resusc. 2003, 5: 171-176.PubMed
28.
Ishihara H: Initial distribution volume of glucose early after cardiac surgery (Letter to the Editor). Anesth Analg. 1904, 2005: 102-
29.
Hofer CK, Muller SM, Furrer L, Klaghofer R, Genoni M, Zollinger A: Stroke volume and pulse pressure variation for prediction of fluid responsiveness in patients undergoing off-pump coronary artery bypass grafting. Chest. 2005, 128: 848-854. 10.1378/chest.128.2.848.CrossRefPubMed
30.
Solus-Biguenet H, Fleyfel M, Tavernier B, Kipnis E, Onimus J, Robin E, Lebuffe G, Decoene C, Pruvot FR, Vallet B: Non-invasive prediction of fluid responsiveness during major hapatic surgery. Br J Anaesth. 2006, 97: 808-816. 10.1093/bja/ael250.CrossRefPubMed
Metadata
Title
Neither dynamic, static, nor volumetric variables can accurately predict fluid responsiveness early after abdominothoracic esophagectomy
Authors
Hironori Ishihara
Eiji Hashiba
Hirobumi Okawa
Junichi Saito
Toshinori Kasai
Toshihito Tsubo
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Perioperative Medicine / Issue 1/2013
Electronic ISSN: 2047-0525
DOI
https://doi.org/10.1186/2047-0525-2-3

Other articles of this Issue 1/2013

Perioperative Medicine 1/2013 Go to the issue

Opinion

Using bispectral index and cerebral oximetry to guide hemodynamic therapy in high-risk surgical patients

Consensus statement

Designing intelligent anesthesia for a changing patient demographic: a consensus statement to provide guidance for specialist and non-specialist anesthetists written by members of and endorsed by the Society for Obesity and Bariatric Anaesthesia (SOBA)

Research

Serum arterial lactate concentration predicts mortality and organ dysfunction following liver resection

Research

Choice of anesthetic technique on plasma concentrations of interleukins and cell adhesion molecules

Review

Introduction to the postanaesthetic care unit

Review

Less invasive methods of advanced hemodynamic monitoring: principles, devices, and their role in the perioperative hemodynamic optimization