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Preload-Dependent Monitoring

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Monitoring Technologies in Acute Care Environments

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Abstract

Preload-dependent monitoring is an important component of the resuscitation of critically ill patients. Cardiac preload is the maximum degree of myocardial fiber stretch, and increases in preload lead to a larger stroke volume. Although volume expansion is typically the first-line therapy for unstable patients, many are not preload responsive. Patient with hemodynamic compromise can be optimized through a careful assessment of their volume responsiveness. This is best achieved when clinicians understand the limitations of both static and dynamic parameters when making clinical decisions. Use of clinically reliable parameters that identify patients who will respond to volume expansion can help avoid potential harm to nonresponders.

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References

  1. Hall JE, Guyton AC. Guyton and hall textbook of medical physiology. 12th ed. Philadelphia: Saunders/Elsevier; 2011.

    Google Scholar 

  2. Sabatier C, Monge I, Maynar J, Ochagavia A. Assessment of cardiovascular preload and response to volume expansion. Med Intensiva. 2012;36(1):45–55.

    Article  PubMed  CAS  Google Scholar 

  3. Sant’Ana AJ, Otsuki DA, Noel-Morgan J, Leite VF, Fantoni DT, Abrahao Hajjar L, et al. Use of pulse pressure variation to estimate changes in preload during experimental acute normovolemic hemodilution. Minerva Anestesiol. 2012;78(4):426–33.

    PubMed  Google Scholar 

  4. Pereira de Souza Neto E, Grousson S, Duflo F, Ducreux C, Joly H, Convert J, et al. Predicting fluid responsiveness in mechanically ventilated children under general anaesthesia using dynamic parameters and transthoracic echocardiography. Br J Anaesth. 2011;106(6):856–64.

    Article  PubMed  CAS  Google Scholar 

  5. Eichhorn V, Trepte C, Richter HP, Kubitz JC, Goepfert MS, Goetz AE, et al. Respiratory systolic variation test in acutely impaired cardiac function for predicting volume responsiveness in pigs. Br J Anaesth. 2011;106(5):659–64.

    Article  PubMed  CAS  Google Scholar 

  6. Maguire S, Rinehart J, Vakharia S, Cannesson M. Technical communication: respiratory variation in pulse pressure and plethysmographic waveforms: intraoperative applicability in a North American Academic Center. Anesth Analg. 2011;112(1):94–6.

    Article  PubMed  Google Scholar 

  7. Heijmans JH, Ganushak YM, Theunissen MS, Maessen JG, Roekaerts PJ. Predictors of cardiac responsiveness to fluid therapy after cardiac surgery. Acta Anaesthesiol Belg. 2010;61(3):151–8.

    PubMed  CAS  Google Scholar 

  8. Hofer CK, Cannesson M. Monitoring fluid responsiveness. Acta Anaesthesiol Taiwan. 2011;49(2):59–65.

    Article  PubMed  Google Scholar 

  9. Cannesson M, Jian Z, Chen G, Vu TQ, Hatib F. The effects of phenylephrine on cardiac output and venous return depend on the position of the heart on the Frank Starling relationship. J Appl Physiol. 2012;113(2):81–289.

    Article  Google Scholar 

  10. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002;121(6):2000–8.

    Article  PubMed  Google Scholar 

  11. Pinsky MR. The hemodynamic consequences of mechanical ventilation: an evolving story. Intensive Care Med. 1997;23(5):493–503.

    Article  PubMed  CAS  Google Scholar 

  12. Bendjelid K, Romand JA. Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med. 2003;29(3):352–60.

    PubMed  Google Scholar 

  13. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al., Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.

    Google Scholar 

  14. Kumar A, Anel R, Bunnell E, Habet K, Zanotti S, Marshall S, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Critical Care Med. 2004;32(3):691–9.

    Article  Google Scholar 

  15. Malbrain ML. Is it wise not to think about intraabdominal hypertension in the ICU? Curr Opin Crit Care. 2004;10(2):132–45.

    Article  PubMed  Google Scholar 

  16. Pinsky MR. Clinical significance of pulmonary artery occlusion pressure. Intensive Care Med. 2003;29(2):175–8.

    PubMed  Google Scholar 

  17. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172–8.

    Article  PubMed  Google Scholar 

  18. Malbrain ML, Ameloot K, Gillebert C, Cheatham ML. Cardiopulmonary monitoring in intra-abdominal hypertension. Am Surg. 2011;77 Suppl 1:S23–30.

    PubMed  Google Scholar 

  19. Barbier C, Loubieres Y, Schmit C, Hayon J, Ricome JL, Jardin F, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med. 2004;30(9):1740–6.

    PubMed  Google Scholar 

  20. Feissel M, Michard F, Faller JP, Teboul JL. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med. 2004;30(9):1834–7.

    Article  PubMed  Google Scholar 

  21. Pepi M, Tamborini G, Galli C, Barbier P, Doria E, Berti M, et al. A new formula for echo-Doppler estimation of right ventricular systolic pressure. J Am Soc Echocardiogr. 1994;7(1):20–6.

    PubMed  CAS  Google Scholar 

  22. Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Ann Emerg Med. 2010;55(3):290–5.

    Article  PubMed  Google Scholar 

  23. Otto C. Textbook of clinical echocardiography. 3rd ed. Philadelphia: Elsevier/Saunders; 2004.

    Google Scholar 

  24. Ma OJ, Mateer J. Emergency ultrasound. New York: McGraw-Hill; 2003.

    Google Scholar 

  25. Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation. 1984;70(4):657–62.

    Article  PubMed  CAS  Google Scholar 

  26. Michard F, Alaya S, Zarka V, Bahloul M, Richard C, Teboul JL. Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest. 2003;124:1900–10.

    Article  PubMed  Google Scholar 

  27. Cecconi M, Alhashemi JA, Cannesson M, Hofer CK. Hemodynamic monitoring today. Anesthesiol Res Pract. 2011;2011:535912.

    PubMed  Google Scholar 

  28. Diebel LN, Wilson RF, Tagett MG, Kline RA. End-diastolic volume. A better indicator of preload in the critically ill. Arch Surg. 1992;127(7):817–21.

    Article  PubMed  CAS  Google Scholar 

  29. Reuse C, Vincent JL, Pinsky MR. Measurements of right ventricular volumes during fluid challenge. Chest. 1990;98(6):1450–4.

    Article  PubMed  CAS  Google Scholar 

  30. Coudray A, Romand JA, Treggiari M, Bendjelid K. Fluid responsiveness in spontaneously breathing patients: a review of indexes used in intensive care. Crit Care Med. 2005;33(12):2757–62.

    Article  PubMed  Google Scholar 

  31. Wagner JG, Leatherman JW. Right ventricular end-diastolic volume as a predictor of the hemodynamic response to a fluid challenge. Chest. 1998;113(4):1048–54.

    Article  PubMed  CAS  Google Scholar 

  32. Schneider AJ, Teule GJ, Groeneveld AB, Nauta J, Heidendal GA, Thijs LG. Biventricular performance during volume loading in patients with early septic shock, with emphasis on the right ventricle: a combined hemodynamic and radionuclide study. Am Heart J. 1988;116(1 Pt 1):103–12.

    Article  PubMed  CAS  Google Scholar 

  33. Calvin JE, Driedger AA, Sibbald WJ. The hemodynamic effect of rapid fluid infusion in critically ill patients. Surgery. 1981;90(1):61–76.

    PubMed  CAS  Google Scholar 

  34. Lamia B, Ochagavia A, Monnet X, Chemla D, Richard C, Teboul JL. Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity. Intensive Care Med. 2007;33(7):1125–32.

    Article  PubMed  Google Scholar 

  35. Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006;34(5):1402–7.

    Article  PubMed  Google Scholar 

  36. Soubrier S, Saulnier F, Hubert H, Delour P, Lenci H, Onimus T, et al. Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients? Intensive Care Med. 2007;33(7):1117–24.

    Article  PubMed  Google Scholar 

  37. Monge Garcia MI, Gil Cano A, Diaz Monrove JC. Arterial pressure changes during the valsalva maneuver to predict fluid responsiveness in spontaneously breathing patients. Intensive Care Med. 2009;35(1):77–84.

    Article  PubMed  Google Scholar 

  38. Delerme S, Castro S, Freund Y, Nazeyrollas P, Josse MO, Madonna-Py B, et al. Relation between pulse oximetry plethysmographic waveform amplitude induced by passive leg raising and cardiac index in spontaneously breathing subjects. Am J Emerg Med. 2010;28(4):505–10.

    Article  PubMed  Google Scholar 

  39. Delerme S, Renault R, Le Manach Y, Lvovschi V, Bendahou M, Riou B, et al. Variations in pulse oximetry plethysmographic waveform amplitude induced by passive leg raising in spontaneously breathing volunteers. Am J Emerg Med. 2007;25(6):637–42.

    Article  PubMed  Google Scholar 

  40. Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642–7.

    Article  PubMed  Google Scholar 

  41. Montenij LJ, de Waal EE, Buhre WF. Arterial waveform analysis in anesthesia and critical care. Curr Opin Anaesthesiol. 2011;24(6):651–6.

    Article  PubMed  Google Scholar 

  42. Michard F. Changes in arterial pressure during mechanical ventilation. Anesthesiology. 2005;103(2):419–28.

    Article  PubMed  Google Scholar 

  43. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med. 2000;162(1):134–8.

    Article  PubMed  CAS  Google Scholar 

  44. Berkenstadt H, Margalit N, Hadani M, Friedman Z, Segal E, Villa Y, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg. 2001;92(4):984–9.

    Article  PubMed  CAS  Google Scholar 

  45. Monnet X, Osman D, Ridel C, Lamia B, Richard C, Teboul JL. Predicting volume responsiveness by using the end-expiratory occlusion in mechanically ventilated intensive care unit patients. Crit Care Med. 2009;37(3):951–6.

    Article  PubMed  Google Scholar 

  46. Cannesson M, Le Manach Y, Hofer CK, Goarin JP, Lehot JJ, Vallet B, et al. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a “gray zone” approach. Anesthesiology. 2011;115(2):231–41.

    Article  PubMed  Google Scholar 

  47. Richter HP, Petersen C, Goetz AE, Reuter DA, Kubitz JC. Detection of right ventricular insufficiency and guidance of volume therapy are facilitated by simultaneous monitoring of static and functional preload parameters. J Cardiothorac Vasc Anesth. 2011;25(6):1051–5.

    Article  PubMed  Google Scholar 

  48. Jardin F, Vieillard-Baron A. Ultrasonographic examination of the venae cavae. Intensive Care Med. 2006;32(2):203–6.

    Article  PubMed  Google Scholar 

  49. Vieillard-Baron A, Chergui K, Rabiller A, Peyrouset O, Page B, Beauchet A, et al. Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med. 2004;30(9):1734–9.

    Article  PubMed  Google Scholar 

  50. Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, et al. Esophageal Doppler monitoring predicts fluid responsiveness in critically ill ventilated patients. Intensive Care Med. 2005;31(9):1195–201.

    Article  PubMed  Google Scholar 

  51. Slama M, Masson H, Teboul JL, Arnould ML, Nait-Kaoudjt R, Colas B, et al. Monitoring of respiratory variations of aortic blood flow velocity using esophageal Doppler. Intensive Care Med. 2004;30(6):1182–7.

    Article  PubMed  Google Scholar 

  52. Slama M, Masson H, Teboul JL, Arnout ML, Susic D, Frohlich E, Andrejak M. Respiratory variations of aortic VTI: a new index of hypovolemia and fluid responsiveness. Am J Physiol Heart Circ Physiol. 2002;283(4):H1729–33.

    PubMed  CAS  Google Scholar 

  53. Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL. Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest. 2001;119(3):867–73.

    Article  PubMed  CAS  Google Scholar 

  54. Cavallaro F, Sandroni C, Marano C, La Torre G, Mannocci A, De Waure C, et al. Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Intensive Care Med. 2010;36(9):1475–83.

    Article  PubMed  Google Scholar 

  55. Garcia X, Pinsky MR. Clinical applicability of functional hemodynamic monitoring. Ann Intensive Care. 2011;1:35.

    Article  PubMed  Google Scholar 

  56. Monnet X, Teboul JL. Passive leg raising. Intensive Care Med. 2008;34(4):659–63.

    Article  PubMed  Google Scholar 

  57. Jabot J, Teboul JL, Richard C, Monnet X. Passive leg raising for predicting fluid responsiveness: importance of the postural change. Intensive Care Med. 2009;35(1):85–90.

    Article  PubMed  Google Scholar 

  58. Mahjoub Y, Touzeau J, Airapetian N, Lorne E, Hijazi M, Zogheib E, et al. The passive leg-raising maneuver cannot accurately predict fluid responsiveness in patients with intra-abdominal hypertension. Crit Care Med. 2010;38(9):1824–9.

    Article  PubMed  Google Scholar 

  59. Malbrain ML, Reuter DA. Assessing fluid responsiveness with the passive leg raising maneuver in patients with increased intra-abdominal pressure: be aware that not all blood returns! Crit Care Med. 2010;38(9):1912–5.

    Article  PubMed  Google Scholar 

  60. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296–327.

    Article  PubMed  Google Scholar 

  61. Monnet X, Teboul JL. Early fluid resuscitation. Curr Infect Dis Rep. 2010;12(5):354–60.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported in part by the NIH grants HL67181 and HL073198.

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Authors and Affiliations

  1. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 605 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15213, USA

    Olufunmilayo Ogundele MD & Michael R. Pinsky MD

Authors
  1. Olufunmilayo Ogundele MD
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  2. Michael R. Pinsky MD
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Correspondence to Michael R. Pinsky MD .

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Editors and Affiliations

  1. Departments of Anesthesiology, Surgery, and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

    Jesse M. Ehrenfeld

  2. Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, California, USA

    Maxime Cannesson

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Ogundele, O., Pinsky, M.R. (2014). Preload-Dependent Monitoring. In: Ehrenfeld, J., Cannesson, M. (eds) Monitoring Technologies in Acute Care Environments. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8557-5_14

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  • DOI: https://doi.org/10.1007/978-1-4614-8557-5_14

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