Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read Online Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Hindawi Pub. Co Country of Publication: United States NLM ID: 101600173 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2314-6141 (Electronic) NLM ISO Abbreviation: Biomed Res Int Subsets: MEDLINE
    • Publication Information:
      Original Publication: New York, NY : Hindawi Pub. Co.
    • Subject Terms:
      Hypovolemia/*physiopathology ; Hypovolemia/*therapy ; Resuscitation/*methods ; Tachycardia/*etiology; Animals ; Blood Gas Analysis ; Crystalloid Solutions ; Fluid Therapy/methods ; Hemodynamics ; Hemorrhage ; Isotonic Solutions/chemistry ; Oxygen/chemistry ; Random Allocation ; Shock/therapy ; Stroke Volume/physiology ; Swine
    • Abstract:
      The aim of this study was to compare stroke volume (SVI) to cardiac index (CI) guided resuscitation in a bleeding-resuscitation experiment. Twenty six pigs were randomized and bled in both groups till baseline SVI (T bsl) dropped by 50% (T 0), followed by resuscitation with crystalloid solution until initial SVI or CI was reached (T 4). Similar amount of blood was shed but animals received significantly less fluid in the CI-group as in the SVI-group: median = 900 (interquartile range: 850-1780) versus 1965 (1584-2165) mL, p = 0.02, respectively. In the SVI-group all variables returned to their baseline values, but in the CI-group animals remained underresuscitated as indicated by SVI, heart rate (HR) and stroke volume variation (SVV), and central venous oxygen saturation (ScvO2) at T 4 as compared to T bsl: SVI = 23.8 ± 5.9 versus 31.4 ± 4.7 mL, HR: 117 ± 35 versus 89 ± 11/min SVV: 17.4 ± 7.6 versus 11.5 ± 5.3%, and ScvO2: 64.1 ± 11.6 versus 79.2 ± 8.1%, p < 0.05, respectively. Our results indicate that CI-based goal-directed resuscitation may result in residual hypovolaemia, as bleeding caused stress induced tachycardia "normalizes" CI, without restoring adequate SVI. As the SVI-guided approach normalized most hemodynamic variables, we recommend using SVI instead of CI as the primary goal of resuscitation during acute bleeding.
    • References:
      Ann Intensive Care. 2014 Jun 21;4:21. (PMID: 25110606)
      Chest. 2008 Jul;134(1):172-8. (PMID: 18628220)
      N Engl J Med. 2003 Jan 2;348(1):5-14. (PMID: 12510037)
      Acta Anaesthesiol Scand. 2014 May;58(5):611-9. (PMID: 24641618)
      Acta Anaesthesiol Scand. 2012 Mar;56(3):291-7. (PMID: 22260228)
      Intensive Care Med. 2005 Jun;31(6):818-22. (PMID: 15803301)
      Front Public Health. 2014 Apr 30;2:34. (PMID: 24818123)
      Minerva Anestesiol. 2011 May;77(5):483-4. (PMID: 21540801)
      N Engl J Med. 1986 Jul 17;315(3):153-6. (PMID: 3088448)
      Intensive Care Med. 2014 Dec;40(12):1795-815. (PMID: 25392034)
      J Cardiothorac Vasc Anesth. 2002 Feb;16(1):4-7. (PMID: 11854870)
      Perioper Med (Lond). 2015 Apr 10;4:3. (PMID: 25897397)
      Crit Care Resusc. 2012 Mar;14(1):44-52. (PMID: 22404061)
      J Int Med Res. 2012;40(4):1227-41. (PMID: 22971475)
      Crit Care. 2011;15(5):232. (PMID: 22047813)
      Crit Care Med. 1988 Nov;16(11):1117-20. (PMID: 3168504)
      Crit Care. 2000;4(5):282-9. (PMID: 11094507)
      Intensive Care Med. 2004 Aug;30(8):1572-8. (PMID: 15197435)
      Curr Pharm Des. 2012;18(38):6215-24. (PMID: 22762472)
      N Engl J Med. 2008 Jan 10;358(2):125-39. (PMID: 18184958)
      Crit Care. 2011;15(4):R197. (PMID: 21843353)
      Crit Care. 2011;15(3):R132. (PMID: 21624138)
      Ann Card Anaesth. 2008 Jan-Jun;11(1):27-34. (PMID: 18182756)
      Chest. 2002 Jun;121(6):2000-8. (PMID: 12065368)
      Nat Rev Nephrol. 2010 Feb;6(2):107-15. (PMID: 20027192)
      Crit Care Res Pract. 2013;2013:583598. (PMID: 24069537)
      AACN Adv Crit Care. 2006 Jul-Sep;17(3):306-16. (PMID: 16931926)
      Crit Care Med. 1990 Jun;18(6):585-9. (PMID: 2111753)
      Minerva Anestesiol. 2006 Jun;72(6):597-604. (PMID: 16682934)
      Ann Intensive Care. 2011 Mar 21;1(1):1. (PMID: 21906322)
      BMC Anesthesiol. 2015;15:82. (PMID: 26041437)
      Eur J Anaesthesiol. 2010 Sep;27(9):788-93. (PMID: 20613538)
      N Engl J Med. 2004 May 27;350(22):2247-56. (PMID: 15163774)
      Crit Care Med. 2009 Sep;37(9):2642-7. (PMID: 19602972)
      Crit Care. 2010;14(3):R118. (PMID: 20553586)
      Chest. 1992 Jul;102(1):208-15. (PMID: 1623755)
      Intensive Care Med. 2015 Sep;41(9):1529-37. (PMID: 26162676)
      Anesthesiology. 2013 Oct;119(4):824-36. (PMID: 23732173)
      Crit Care Med. 1987 May;15(5):516-8. (PMID: 3105960)
      N Engl J Med. 2012 Jul 12;367(2):124-34. (PMID: 22738085)
      Crit Care Med. 2013 Feb;41(2):580-637. (PMID: 23353941)
    • Accession Number:
      0 (Crystalloid Solutions)
      0 (Isotonic Solutions)
      S88TT14065 (Oxygen)
    • Publication Date:
      Date Created: 20151107 Date Completed: 20160927 Latest Revision: 20181202
    • Publication Date:
      20231215
    • Accession Number:
      PMC4620251
    • Accession Number:
      10.1155/2015/160979
    • Accession Number:
      26543848