The effect of fluid resuscitation on the effective circulating volume in patients undergoing liver surgery: a post-hoc analysis of a randomized controlled trial

Jaap Jan Vos*, A. F. Kalmar, H. G. D. Hendriks, J. Bakker, T. W. L. Scheeren

*Corresponding author for this work

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Abstract

To assess the significance of an analogue of the mean systemic filling pressure (Pmsa) and its derived variables, in providing a physiology based discrimination between responders and non-responders to fluid resuscitation during liver surgery. A post-hoc analysis of data from 30 patients undergoing major hepatic surgery was performed. Patients received 15 ml kg(-1) fluid in 30 min. Fluid responsiveness (FR) was defined as an increase of 20% or greater in cardiac index, measured by FloTrac-Vigileo(A (R)). Dynamic preload variables (pulse pressure variation and stroke volume variation: PPV, SVV) were recorded additionally. Pvr, the driving pressure for venous return (=Pmsa-central venous pressure) and heart performance (E-H; Pvr/Pmsa) were calculated according to standard formula. Pmsa increased following fluid administration in responders (n = 18; from 13 +/- 3 to 17 +/- 4 mmHg, p <0.01) and in non-responders (n = 12; from 14 +/- 4 to 17 +/- 4 mmHg, p <0.01). Pvr, which was lower in responders before fluid administration (6 +/- 1 vs. 7 +/- 1 mmHg; p = 0.02), increased after fluid administration only in responders (from 6 +/- 1 to 8 +/- 1 mmHg; p <0.01). E-H only decreased in non-responders (from 0.56 +/- 0.17 to 0.45 +/- 0.12; p <0.05). The area under the receiver operating characteristics curve of Pvr, PPV and SVV for predicting FR was 0.75, 0.73 and 0.72, respectively. Changes in Pmsa, Pvr and E-H reflect changes in effective circulating volume and heart performance following fluid resuscitation, providing a physiologic discrimination between responders and non-responders. Also, Pvr predicts FR equivalently compared to PPV and SVV, and might therefore aid in predicting FR in case dynamic preload variables cannot be used.

Original languageEnglish
Pages (from-to)73-80
Number of pages8
JournalJournal of clinical monitoring and computing
Volume32
Issue number1
Early online date16-Feb-2017
DOIs
Publication statusPublished - Feb-2018

Keywords

  • Hemodynamic monitoring
  • Fluid resuscitation
  • Circulating volume
  • Dynamic variables
  • Venous return
  • Mean systemic filling pressure
  • Liver surgery
  • SYSTEMIC FILLING PRESSURE
  • PULSE PRESSURE
  • VENOUS RETURN
  • STROKE VOLUME
  • RESPONSIVENESS
  • APPLICABILITY
  • CHALLENGE
  • VARIABLES
  • THERAPY
  • CURVES

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