TITLE:
Extracellular Fluid Accumulation Predicts Fluid Responsiveness after Hydroxyethyl Starch 70/0.5 Bolus Infusion during Major Abdominal Surgery
AUTHORS:
Takeshi Ide, Tsuneo Tatara, Takahiko Kaneko, Shinichi Nishi
KEYWORDS:
Plasma Expanders; Blood Volume; Fluid Therapy; Abdominal Surgery
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.9,
November
21,
2013
ABSTRACT: Objective: The
purpose of this study was to test the hypothesis that extracellular fluid
accumulation predicts fluid responsiveness after hydroxyethyl starch (HES)
solution bolus infusion during major abdominal surgery. Methods: Twenty patients who underwent elective
pancreaticoduodenectomy under general anesthesia were studied. Patients received
4 mL/kg boluses of Ringer’s acetate or 6% HES 70/0.5 solution over 15 min in
random order when urine output decreased below 1.0 mL/kg/h. Stroke volume variation
(SVV) and stroke volume index (SVI) were measured using the FloTracTM/VigileoTM system at pre-bolus, 15, 30, and 60 min after initiating bolus infusion. The
percent change in pre-bolus extracellular fluid volume relative to that at the
skin incision for arm (ΔVECF)
was measured by bioelectrical impedance. Prediction of fluid responsiveness (an
increase in SVI of ≥5%) by pre-bolus SVV or pre-bolus ΔVECF was tested by calculating the area under the
receiver operating characteristic curve (AUC). Results: Fluid bolus infusions in this study consisted of 61
Ringer’s acetate infusions and 62 HES infusions. The best AUCs for identifying
fluid responsiveness were seen with pre-bolus ΔVECF for HES at 30 min and 60 min (AUC = 0.74, P = 0.022; AUC = 0.74, P = 0.0054, respectively). Optimal
threshold values of pre-bolus ΔVECF for predicting fluid responsiveness were 6.5% for 30 min (sensitivity: 78%,
specificity: 58%) and 7.7% for 60 min (sensitivity: 56%, specificity: 76%). Conclusion: Extracellular fluid volume
predicts fluid responsiveness after HES solution bolus infusion during major
abdominal surgery. Substantial fluid responsiveness is observed upon increased
accumulation of extracellular fluids.