Functional intravascular volume deficit in patients before surgery.

Abstract:

BACKGROUND:Stroke volume (SV) maximization with a colloid infusion, referred to as individualized goal-directed therapy, improves outcome in high-risk surgery. The fraction of patients who need intravascular volume to establish a maximal SV has, however, not been evaluated, and there are only limited data on the volume required to establish a maximal SV before the start of surgery. Therefore, we estimated the occurrence and size of the potential functional intravascular volume deficit in surgical patients. METHODS:Patients scheduled for mastectomy (n=20), open radical prostatectomy (n=20), or open major abdominal surgery (n=20) were anaesthetized, and before the start of surgery, a 200 ml colloid fluid challenge was provided and repeated if a >or=10% increment in SV estimated by oesophageal Doppler was established. The volume needed for SV maximization defined the intravascular volume deficit. RESULTS:Forty-two (70%) of the patients needed volume to establish a maximal SV. For the patients needing volume, the required amount was median 200 ml (range 200-600 ml), with no significant difference between the three groups of patients. The required volume was >or=400 ml in nine patients (15%). CONCLUSION:The majority of anaesthetized patients present with a functional intravascular volume deficit before surgery. Although the deficit in general was minor, a fraction of patients presented with a deficit that may be of clinical relevance, emphasizing the importance of the individual approach of goal-directed fluid therapy.

authors

Bundgaard-Nielsen M,Jørgensen CC,Secher NH,Kehlet H

doi

10.1111/j.1399-6576.2009.02175.x

subject

Has Abstract

pub_date

2010-04-01 00:00:00

pages

464-9

issue

4

eissn

0001-5172

issn

1399-6576

pii

AAS2175

journal_volume

54

pub_type

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