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https://www.readbyqxmd.com/read/28211020/goal-directed-fluid-restriction-during-brain-surgery-a-prospective-randomized-controlled-trial
#1
Jinfeng Luo, Jing Xue, Jin Liu, Bin Liu, Li Liu, Guo Chen
BACKGROUND: The value of goal-directed fluid therapy in neurosurgical patients, where brain swelling is a major concern, is unknown. The aim of our study was to evaluate the effect of an intraoperative goal-directed fluid restriction (GDFR) strategy on the postoperative outcome of high-risk patients undergoing brain surgery. METHODS: High-risk patients undergoing brain surgery were randomly assigned to a usual care group (control group) or a GDFR group. In the GDFR group, (1) fluid maintenance was restricted to 3 ml/kg/h of a crystalloid solution and (2) colloid boluses were allowed only in case of hypotension associated with a low cardiac index and a high stroke volume variation...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28210935/the-effect-of-fluid-resuscitation-on-the-effective-circulating-volume-in-patients-undergoing-liver-surgery-a-post-hoc-analysis-of-a-randomized-controlled-trial
#2
Jaap Jan Vos, A F Kalmar, H G D Hendriks, J Bakker, T W L Scheeren
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(®). Dynamic preload variables (pulse pressure variation and stroke volume variation: PPV, SVV) were recorded additionally...
February 16, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28188261/role-of-genetic-variation-in-collateral-circulation-in-the-evolution-of-acute-stroke-a-multimodal-magnetic-resonance-imaging-study
#3
Yu-Chieh Jill Kao, Esteban A Oyarzabal, Hua Zhang, James E Faber, Yen-Yu Ian Shih
BACKGROUND AND PURPOSE: No studies have determined the effect of differences in pial collateral extent (number and diameter), independent of differences in environmental factors and unknown genetic factors, on severity of stroke. We examined ischemic tissue evolution during acute stroke, as measured by magnetic resonance imaging and histology, by comparing 2 congenic mouse strains with otherwise identical genetic backgrounds but with different alleles of the Determinant of collateral extent-1 (Dce1) genetic locus...
February 10, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28163065/a-standardized-method-to-measure-brain-shifts-with-decompressive-hemicraniectomy
#4
Askiel Bruno, Abdurrehman Zahran, Nina Paletta, Laith Maali, Fenwick T Nichols, Ramon Figueroa
BACKGROUND: A standardized, reliable, and practical method for measuring decompressive hemicraniectomy (DHC) defects and brain shifts in malignant middle cerebral artery (MCA) territory infarction is needed for reliable comparisons between computed tomography (CT) scans. Such a method could facilitate further studies on the effects of DHC. NEW METHOD: We describe and apply a method for measuring DHC defects and brain shifts on CT scans in 25 patients with malignant MCA territory infarction...
February 2, 2017: Journal of Neuroscience Methods
https://www.readbyqxmd.com/read/28096203/hospital-variation-in-functional-recovery-after-stroke
#5
Janet Prvu Bettger, Laine Thomas, Li Liang, Ying Xian, Cheryl D Bushnell, Jeffrey L Saver, Gregg C Fonarow, Eric D Peterson
BACKGROUND: Functional status is a key patient-centric outcome, but there are little data on whether functional recovery post-stroke varies among hospitals. This study examined the distribution of functional status 3 months after stroke, determined whether these outcomes vary among hospitals, and identified hospital characteristics associated with better (or worse) functional outcomes. METHODS AND RESULTS: Observational analysis of the AVAIL study (Adherence Evaluation After Ischemic Stroke-Longitudinal) included 2083 ischemic stroke patients enrolled from 82 US hospitals participating in Get With The Guidelines-Stroke and AVAIL...
January 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28074802/goal-directed-therapy-improves-the-outcome-of-high-risk-cardiac-patients-undergoing-off-pump-coronary-artery-bypass
#6
Poonam Malhotra Kapoor, Rohan Magoon, Rajinder Singh Rawat, Yatin Mehta, Sameer Taneja, R Ravi, Milind P Hote
BACKGROUND: There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT) for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28059848/hemodynamic-monitoring-in-thoracic-surgical-patients
#7
Jacob Raphael, Lindsay A Regali, Robert H Thiele
PURPOSE OF REVIEW: This article reviews the technology and clinical data describing hemodynamic monitoring devices available to anesthesiologists and intensivists caring for patients undergoing thoracic surgical procedures, so that they may better utilize available technology to improve outcomes in this high-risk surgical population. RECENT FINDINGS: Noninvasive stroke volume monitors are based on several different technology platforms, all of which have distinct performance characteristics...
January 3, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28039243/electrical-impedance-tomography-for-non-invasive-assessment-of-stroke-volume-variation-in-health-and-experimental-lung-injury
#8
C J C Trepte, C Phillips, J Solà, A Adler, B Saugel, S Haas, S H Bohm, D A Reuter
BACKGROUND: Functional imaging by thoracic electrical impedance tomography (EIT) is a non-invasive approach to continuously assess central stroke volume variation (SVV) for guiding fluid therapy. The early available data were from healthy lungs without injury-related changes in thoracic impedance as a potentially influencing factor. The aim of this study was to evaluate SVV measured by EIT (SVVEIT) against SVV from pulse contour analysis (SVVPC) in an experimental animal model of acute lung injury at different lung volumes...
January 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28039242/non-invasive-assessment-of-fluid-responsiveness-using-cnap%C3%A2-technology-is-interchangeable-with-invasive-arterial-measurements-during-major-open-abdominal-surgery
#9
J Renner, M Gruenewald, M Hill, L Mangelsdorff, H Aselmann, C Ilies, M Steinfath, O Broch
BACKGROUND: Dynamic variables of fluid responsiveness (FR), such as pulse pressure variation (PPV), have been shown to predict the response to a fluid challenge accurately. A recently introduced non-invasive technology based on the volume-clamp method (CNAP™) offers the ability to measure PPV continuously (PPVCNAP). However, the accuracy regarding the prediction of FR in the operating room has to be proved. METHODS: We compared PPVCNAP with an invasive approach measuring PPV using the PiCCO technology (PPVPiCCO)...
January 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28030505/ultrasound-assessment-of-volume-responsiveness-in-critically-ill-surgical-patients-two-measurements-are-better-than-one
#10
Sarah B Murthi, Syeda Fatima, Ashely R Menne, Jacob J Glaser, Samuel M Galvagno, Stephen Biederman, Raymond Fang, Hegang Chen, Thomas M Scalea
BACKGROUND: The intended physiologic response to a fluid bolus is an increase in stroke volume (SV). Several ultrasound (US) measures have been shown to be predictive. The best measure(s) in critically ill surgical patients remains unclear. METHODS: This is a prospective observational study in critically ill surgical patients receiving a bolus of crystalloid, colloid or blood. A transthoracic echocardiogram was performed before (pre-transthoracic echocardiogram) and after...
March 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28030449/hemodynamic-monitoring-in-thoracic-surgical-patients
#11
Jacob Raphael, Lindsay A Regali, Robert H Thiele
PURPOSE OF REVIEW: This article reviews the technology and clinical data describing hemodynamic monitoring devices available to anesthesiologists and intensivists caring for patients undergoing thoracic surgical procedures, so that they may better utilize available technology to improve outcomes in this high-risk surgical population. RECENT FINDINGS: Noninvasive stroke volume monitors are based on several different technology platforms, all of which have distinct performance characteristics...
February 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28000127/intensive-care-unit-admission-for-patients-in-the-interact2-ich-blood-pressure-treatment-trial-characteristics-predictors-and-outcomes
#12
Katja E Wartenberg, Xia Wang, Paula Muñoz-Venturelli, Alejandro A Rabinstein, Pablo M Lavados, Craig S Anderson, Thompson Robinson
BACKGROUND: Wide variation exists in criteria for accessing intensive care unit (ICU) facilities for managing patients with critical illnesses such as acute intracerebral hemorrhage (ICH). We aimed to determine the predictors of admission, length of stay, and outcome for ICU among participants of the main Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). METHODS: INTERACT2 was an international, open, blinded endpoint, randomized controlled trial of 2839 ICH patients (<6 h) and elevated systolic blood pressure (SBP) allocated to receive intensive (target SBP <140 mmHg within 1 h) or guideline-recommended (target SBP <180 mmHg) BP-lowering treatment...
December 20, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27984249/predicting-fluid-responsiveness-in-acute-liver-failure-a-prospective-study
#13
Vinod Kumar Audimoolam, Mark J W McPhail, Chris Willars, William Bernal, Julia A Wendon, Maurizio Cecconi, Georg Auzinger
BACKGROUND: The profound hemodynamic changes seen in acute liver failure (ALF) resemble the hyperdynamic state found in the later stages of septic shock. Vasopressor support frequently is required after initial volume therapy. Markers of preload dependency have not been studied in this patient group. Dynamic maneuvers such as passive leg raising or end-expiratory hold, which have shown good predictive accuracy in a general intensive care unit population, cannot be considered safe in this cohort because of the concerns of intracranial hypertension...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27982674/blood-pressure-and-hemodynamics-mayer-waves-in-different-phases-of-ovarian-and-menstrual-cycle-in-women
#14
O I Lutsenko, S O Kovalenko
The goal of the research is to investigate the special effect of ovarian-menstrual cycle phases on the level of women's blood pressure and characteristics of Mayer waves. 77 women aged 18-19 were tested under condition close to the state of basal metabolism in follicular phase (I), ovulation (II) and luteal phase (III) of ovarian-menstrual cycle. In phases II and III, the increase of mean and diastolic blood pressure level, in comparison with phase I in the prone position at rest and with psycho-emotional loading, were observed...
December 16, 2016: Physiological Research
https://www.readbyqxmd.com/read/27922879/the-changes-in-pulse-pressure-variation-or-stroke-volume-variation-after-a-tidal-volume-challenge-reliably-predict-fluid-responsiveness-during-low-tidal-volume-ventilation
#15
Sheila Nainan Myatra, Natesh R Prabu, Jigeeshu Vasishtha Divatia, Xavier Monnet, Atul Prabhakar Kulkarni, Jean-Louis Teboul
OBJECTIVES: Stroke volume variation and pulse pressure variation do not reliably predict fluid responsiveness during low tidal volume ventilation. We hypothesized that with transient increase in tidal volume from 6 to 8 mL/kg predicted body weight, that is, "tidal volume challenge," the changes in pulse pressure variation and stroke volume variation will predict fluid responsiveness. DESIGN: Prospective, single-arm study. SETTING: Medical-surgical ICU in a university hospital...
March 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/27922547/changes-in-stroke-volume-induced-by-lung-recruitment-maneuver-predict-fluid-responsiveness-in-mechanically-ventilated-patients-in-the-operating-room
#16
Matthieu Biais, Romain Lanchon, Musa Sesay, Lisa Le Gall, Bruno Pereira, Emmanuel Futier, Karine Nouette-Gaulain
BACKGROUND: Lung recruitment maneuver induces a decrease in stroke volume, which is more pronounced in hypovolemic patients. The authors hypothesized that the magnitude of stroke volume reduction through lung recruitment maneuver could predict preload responsiveness. METHODS: Twenty-eight mechanically ventilated patients with low tidal volume during general anesthesia were included. Heart rate, mean arterial pressure, stroke volume, and pulse pressure variations were recorded before lung recruitment maneuver (application of continuous positive airway pressure of 30 cm H2O for 30 s), during lung recruitment maneuver when stroke volume reached its minimal value, and before and after volume expansion (250 ml saline, 0...
February 2017: Anesthesiology
https://www.readbyqxmd.com/read/27903339/-effect-of-goal-directed-haemodynamic-management-on-the-postoperative-outcome-in-elderly-patients-with-fragile-cardiac-function-undergoing-abdominal-surgery
#17
L S Zheng, E W Gu, X H Peng, L Zhang, Y Y Cao
Objective: To investigate the effect of goal-directed haemodynamic management based on stroke volume variation (SVV), cardiac index (CI) and mean arterial blood pressure (MAP) on the postoperative outcome in elderly patients with fragile cardiac function undergoing gastrointestinal surgery. Methods: Ninety patients with fragile cardiac function, aged 65-90 years old, ASAⅡ or Ⅲ, NYHA Ⅱor Ⅲ, scheduled for abdominal surgery were enrolled in this study.The patients were randomly assigned to two groups: Experience anesthesia group (group E, n=45) and goal-directed hemodynamic management group (G group, n=45)...
November 22, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27891584/an-observational-study-of-the-macro-and-micro-haemodynamic-implications-of-epidural-anaesthesia-in-children
#18
L Triffterer, P Marhofer, G Lechner, T C Marksz, O Kimberger, W Schmid, D Marhofer
The haemodynamic implications of epidural anaesthesia in children are poorly documented. We report macro- and micro-haemodynamic data from an observational study of 25 children ranging from neonates to six-years old, who underwent surgery conducted with a specific combination of monitoring systems. We analysed 90 min of study-related monitoring after epidural catheterisation, with skin incision taking place after around 30 min. We recorded macrohaemodynamic parameters (monitored using LiDCOrapid) including heart rate, mean arterial pressure, cardiac output, stroke volume, systemic vascular resistance and stroke volume variation...
November 28, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27888580/biology-of-vo2-max-looking-under-the-physiology-lamp
#19
REVIEW
C Lundby, D Montero, M Joyner
In this review, we argue that several key features of maximal oxygen uptake (VO2 max) should underpin discussions about the biological and reductionist determinants of its interindividual variability: (i) training-induced increases in VO2 max are largely facilitated by expansion of red blood cell volume and an associated improvement in stroke volume, which also adapts independent of changes in red blood cell volume. These general concepts are also informed by cross-sectional studies in athletes that have very high values for VO2 max...
November 7, 2016: Acta Physiologica
https://www.readbyqxmd.com/read/27871513/disagreement-between-fourth-generation-flotrac-and-lidcorapid-measurements-of-cardiac-output-and-stroke-volume-variation-during-laparoscopic-colectomy
#20
Masato Nakasuji, Aki Okutani, Taeko Miyata, Norie Imanaka, Masuji Tanaka, Kae Nakasuji, Miwako Nagai
STUDY OBJECTIVE: To determine the agreement between cardiac output (CO) and stroke volume variation (SVV) measured simultaneously by the fourth generation FloTrac/Vigileo system and LiDCOrapid system during pneumoperitoneum in patients undergoing laparoscopic colectomy. DESIGN: Retrospective observational study. SETTINGS: Operating room in a general hospital. PATIENTS: Ten patients (American Society of Anesthesiologist 1 or 2) without preoperative anemia...
December 2016: Journal of Clinical Anesthesia
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