2.50
Hdl Handle:
http://hdl.handle.net/10755/157046
Category:
Abstract
Type:
Presentation
Title:
Predicting Fluid Responsiveness in Post Operative Liver Transplant Patients
Author(s):
Sawin, Laura; Barnes, Sarah
Author Details:
Laura Sawin, RN,BS,BHS,CCRN, University of Washington Medical Center, Seattle, Washington, USA, email: laurasawinbrown@yahoo.com; Sarah Barnes
Abstract:
POSTER PURPOSE: To determine the sensitivity and specificity of threshold values of central venous pressure (CVP), pulmonary artery end-diastolic pressure (PAEDP), and 2 functional hemodynamic indices: systolic pressure variation (SPV) and SPV% to predict fluid responsiveness (bolus-induced increase in stroke volume [SV] > 10%) during the first 2 hours after surgery in liver transplant patients receiving mechanical ventilation. BACKGROUND/SIGNIFICANCE:Fluid boluses to optimize SV are traditionally based on static indices (CVP/PAEDP). Functional indices are better predictors of fluid responsiveness than are static indices in critically ill patients. Only 1 study of functional indices in the acute postoperative period for liver transplant patients was found, and no study evaluated the SPV/SPV%, which can be obtained at the bedside. It was not known whether the SPV/SPV% would distinguish between fluid responders (Rs) and nonresponders (NRs). METHOD: Prospective observational study of a convenience sample of 20 ventilated (assist controltidal volume [Vt], mean [SD], 7.6 [1.4] mL/kg) liver transplant recipients, 10 of whom received a bolus (6 patients: 1 bolus/4 patients: 2 boluses). Monitors were (1) optimized arterial catheter and (2) PA catheter with stat continuous cardiac output (CCO). Transducers were leveled at the phlebostatic axis. CCO was obtained in triplicate immediately before and 5 minutes after bolus completion. Radial artery pressure and PAEDP were measured at end-expiration; SPV/SPV% was measured over 3 ventilator cycles and averaged. Data were printed in hard copy, digitized, and analyzed offline by using UnScanIt, with reviewers blinded to response status. Vasopressors and ventilators were unchanged during the study period. RESULTS: 13 boluses were given to 10 patients (R=4/NR =9). Bolus fluids were fresh frozen plasma, blood, albumin, or saline (bolus volume 250û500 mL) over 15 to 30 minutes. Median SV was lower in the R than the NR group: 66 mL/beat in R vs 102 mL/beat (P<.05) in NR. Median CVP and PAEDP were lower in the R vs the NR group: CVP in R, 6.8 mm Hg vs 9.2 mm Hg in NR; PAEDP in R, 11.4 mm Hg vs 16.3 mm Hg in NR. SPV/SPV% was higher in R vs NR: SPV in R, 8.3 mm Hg vs 7.9 mm Hg in NR; SPV%, 8.1% in R vs 5.8% in NR; differences were not significant. SPV% threshold >7.5% discriminated Rs with sensitivity (sens)=1.0, specificity (spec)=0.7, and area under curve (AUC)=0.78; SPV>7 mm Hg (sens= 0.7/spec=0.5; AUC=0.7). CVP>3.5, sens=0.75, spec=0.1; AUC=0.45); PAEDP>13 mm Hg (sens=0.5, spec=0.4, AUC= 0.21). CONCLUSIONS: SPV/SPV% was a better predictor of fluid responsiveness than was CVP/PAEDP in liver transplant patients. The small number of patients in the R group with normal CVP/PAEDP indicated adequate resuscitation. The results also reflect use of fresh frozen plasma/blood to correct coagulopathy vs optimizing SV. Vt < 8 mL/kg and vasopressors most likely caused smaller SPV/SPV%; however, they remained adequate response predictors. Research in a larger sample is needed to confirm Vt indexed thresholds and to determine if combining SV and SPV/SPV% improves predictive abilities.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titlePredicting Fluid Responsiveness in Post Operative Liver Transplant Patientsen_GB
dc.contributor.authorSawin, Lauraen_GB
dc.contributor.authorBarnes, Sarahen_GB
dc.author.detailsLaura Sawin, RN,BS,BHS,CCRN, University of Washington Medical Center, Seattle, Washington, USA, email: laurasawinbrown@yahoo.com; Sarah Barnesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157046-
dc.description.abstractPOSTER PURPOSE: To determine the sensitivity and specificity of threshold values of central venous pressure (CVP), pulmonary artery end-diastolic pressure (PAEDP), and 2 functional hemodynamic indices: systolic pressure variation (SPV) and SPV% to predict fluid responsiveness (bolus-induced increase in stroke volume [SV] > 10%) during the first 2 hours after surgery in liver transplant patients receiving mechanical ventilation. BACKGROUND/SIGNIFICANCE:Fluid boluses to optimize SV are traditionally based on static indices (CVP/PAEDP). Functional indices are better predictors of fluid responsiveness than are static indices in critically ill patients. Only 1 study of functional indices in the acute postoperative period for liver transplant patients was found, and no study evaluated the SPV/SPV%, which can be obtained at the bedside. It was not known whether the SPV/SPV% would distinguish between fluid responders (Rs) and nonresponders (NRs). METHOD: Prospective observational study of a convenience sample of 20 ventilated (assist controltidal volume [Vt], mean [SD], 7.6 [1.4] mL/kg) liver transplant recipients, 10 of whom received a bolus (6 patients: 1 bolus/4 patients: 2 boluses). Monitors were (1) optimized arterial catheter and (2) PA catheter with stat continuous cardiac output (CCO). Transducers were leveled at the phlebostatic axis. CCO was obtained in triplicate immediately before and 5 minutes after bolus completion. Radial artery pressure and PAEDP were measured at end-expiration; SPV/SPV% was measured over 3 ventilator cycles and averaged. Data were printed in hard copy, digitized, and analyzed offline by using UnScanIt, with reviewers blinded to response status. Vasopressors and ventilators were unchanged during the study period. RESULTS: 13 boluses were given to 10 patients (R=4/NR =9). Bolus fluids were fresh frozen plasma, blood, albumin, or saline (bolus volume 250&ucirc;500 mL) over 15 to 30 minutes. Median SV was lower in the R than the NR group: 66 mL/beat in R vs 102 mL/beat (P<.05) in NR. Median CVP and PAEDP were lower in the R vs the NR group: CVP in R, 6.8 mm Hg vs 9.2 mm Hg in NR; PAEDP in R, 11.4 mm Hg vs 16.3 mm Hg in NR. SPV/SPV% was higher in R vs NR: SPV in R, 8.3 mm Hg vs 7.9 mm Hg in NR; SPV%, 8.1% in R vs 5.8% in NR; differences were not significant. SPV% threshold >7.5% discriminated Rs with sensitivity (sens)=1.0, specificity (spec)=0.7, and area under curve (AUC)=0.78; SPV>7 mm Hg (sens= 0.7/spec=0.5; AUC=0.7). CVP>3.5, sens=0.75, spec=0.1; AUC=0.45); PAEDP>13 mm Hg (sens=0.5, spec=0.4, AUC= 0.21). CONCLUSIONS: SPV/SPV% was a better predictor of fluid responsiveness than was CVP/PAEDP in liver transplant patients. The small number of patients in the R group with normal CVP/PAEDP indicated adequate resuscitation. The results also reflect use of fresh frozen plasma/blood to correct coagulopathy vs optimizing SV. Vt < 8 mL/kg and vasopressors most likely caused smaller SPV/SPV%; however, they remained adequate response predictors. Research in a larger sample is needed to confirm Vt indexed thresholds and to determine if combining SV and SPV/SPV% improves predictive abilities.en_GB
dc.date.available2011-10-26T19:22:24Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:22:24Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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