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Evaluation of the effectiveness of different volume replacement therapies in postoperative hypovolemic patients using the PiCCO monitoring system

Introduction

We have no exact information about the hemodynamically relevant intravascular volume effect of different volume replacements. The aim of the study was to describe the changes in intravascular volume status 120 minutes after the start of the infusions using a transpulmonary thermodilution technique (PiCCO system; Pulsion).

Methods

The prospective, randomized, multicentre study of 11 ICUs involved 200 mixed postoperative hypovolemic patients in Hungary between 2005 and 2008. Ten millilitres per kilogram of lactated Ringer (LR) or 4% gelatin (GEL) or 6% hydroxyethylstarch 130/0.4 (HES), or 5% human albumin (HA) was infused to 50 patients in each group over 30 minutes. Hemodynamic measurements were taken at baseline, 30, 45, 60, 90 and 120 minutes after the start of infusion.

Results

There were no significant differences in basic demographic and laboratory data among the four groups. Differences between baseline and 120-minute values of the same solution were significant only for the colloids: mean arterial pressure (MAP): HES 9%, HA 6%; central venous pressure (CVP): GEL 14%, HES 28%, HA 19%; cardiac index (CI): GEL 15%, HES 29%, HA 20%; global end-diastolic volume index (GEDVI): GEL 6%, HES 17%, HA 11%; stroke volume variation (SVV): GEL -12%, HES -15%, HA -25%; oxygen delivery index (DO2I): GEL 10%, HES 15%, HA 12%; central venous oxygen saturation (ScvO2): GEL 5%, HES 6%, HA 3%. Significant intergroup differences at 120 minutes: MAP: HES–LR; CVP: HES–LR, HA–LR; CI: GEL–LR, HES–LR, HA–LR; GEDVI: GEL–LR, HES–LR, HA–LR, HES–GEL; SVV: HES–LR, HA–LR; DO2I: GEL–LR, HES–LR, HA–LR; ScvO2: GEL–LR, HES–LR, HA–LR. The ratio of patients with normalized baseline hypovolemia parameters at 120 minutes: CVP: LR 0%, GEL 27%, HES 47%, HA 20%; CI: LR 0%, GEL 50%, HES 64%, HA 50%; GEDVI: LR 0%, GEL 25%, HES 68%, HA 44%; SVV: LR 3%, GEL 20%, HES 11%, HA 25%.

Conclusion

In postoperative hypovolemic patients, 10 ml/kg LR solution has no demonstrable hemodynamic effect 120 minutes after the start of infusion. The colloid solutions have slightly different hemodynamic effects. Ten millilitres per kilogram of colloids can improve the hemodynamic parameters but their level is only 30% maximum comparing with the baseline at the end of the second hour.

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Gondos, T., Marjanek, Z., Ulakcsai, Z. et al. Evaluation of the effectiveness of different volume replacement therapies in postoperative hypovolemic patients using the PiCCO monitoring system. Crit Care 13, P220 (2009). https://doi.org/10.1186/cc7384

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Keywords

  • Mean Arterial Pressure
  • Cardiac Index
  • Central Venous Pressure
  • Lactate Ringer
  • Intravascular Volume