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Review
. 2023 Mar 31;96(1):107-123.
doi: 10.59249/JOAP6662. eCollection 2023 Mar.

Current Commonly Used Dynamic Parameters and Monitoring Systems for Perioperative Goal-Directed Fluid Therapy: A Review

Chin Fung Kelvin Kan  1 , John D Skaggs  1
Affiliations
Review

Current Commonly Used Dynamic Parameters and Monitoring Systems for Perioperative Goal-Directed Fluid Therapy: A Review

Chin Fung Kelvin Kan et al. Yale J Biol Med. .

Abstract

Goal-directed fluid therapy (GDFT) is usually recommended in patients undergoing major surgery and is essential in enhanced recovery after surgery (ERAS) protocols. This fluid regimen is usually guided by dynamic hemodynamic parameters and aims to optimize patients' cardiac output to maximize oxygen delivery to their vital organs. While many studies have shown that GDFT benefits patients perioperatively and can decrease postoperative complications, there is no consensus on which dynamic hemodynamic parameters to guide GDFT with. Furthermore, there are many commercialized hemodynamic monitoring systems to measure these dynamic hemodynamic parameters, and each has its pros and cons. This review will discuss and review the commonly used GDFT dynamic hemodynamic parameters and hemodynamic monitoring systems.

Keywords: ClearSight; Flotrac; Goal-directed fluid therapy; LiDCO; PiCCO; aortic blood flow peak velocity variation; echocardiogram; enhanced recovery after surgery protocol; esophageal doppler; fluid resuscitation; hemodynamic monitor; pleth variability index; pulse pressure variation; stroke volume variation.

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Figures

Figure 1
Figure 1
Frank-Starling Curve. At the curve plateau, the end-diastolic volume increase does not increase the stroke volume as much. In contrast, at the lower part of the curve, the same amount of increase in end-diastolic volume increase the stroke volume much greater.
Figure 2
Figure 2
PPV and SVV calculations. A-D, EKG, arterial pressure, pulse oximetry plethysmography, respiratory pattern, respectively. B and C, both arterial pressure and pulse oximetry plethysmography oscillate during the respiratory cycles, which is shown in D, due to the change in intrathoracic pressure, preload, and LV SV during mechanical ventilation. In B, the area arterial pressure wave under the curve is the LV SV. SVV (%) can be calculated with the equation (SV max – SV min) / SV mean. The arterial pressure wave peak is the SBP, and the trough is the DBP, PP is the difference between SBP and DBP. PPV (%) is calculated from 100 × (PP max – PP min) / ([PP max + PP min]/2) [121,122].
Figure 3
Figure 3
Dynamic Parameters and Physiology Equations.
Figure 4
Figure 4
PVi and PI calculations. In A, DC is the total amount of light absorbed and AC is the light absorbed as a result of arterial pulsation, which oscillates during respiration. B, PI (%) is calculated with the equation (AC/DC) × 100%. C, PVi (%) is then calculated from the PI with the equation [(PI max – PI min) / PI max] × 100% [121].
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References

    1. Moghadamyeghaneh Z, Phelan MJ, Carmichael JC, Mills SD, Pigazzi A, Nguyen NT, et al. Preoperative dehydration increases risk of postoperative acute renal failure in colon and rectal surgery. J Gastrointest Surg. 2014. Dec;18(12):2178–85. 10.1007/s11605-014-2661-7 - DOI - PubMed
    1. Zanetti M, De Colle P, Omiciuolo C, Ratti C, Gortan Cappellari G, Barazzoni R, et al. Postoperative Dehydration Is Associated with Frailty and Decreased Survival in Older Patients with Hip Fracture. Nutrients. 2022. Feb;14(4):820. 10.3390/nu14040820 - DOI - PMC - PubMed
    1. Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al. Australian and New Zealand College of Anaesthetists Clinical Trials Network and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. N Engl J Med. 2018. Jun;378(24):2263–74. 10.1056/NEJMoa1801601 - DOI - PubMed
    1. Arieff AI. Fatal postoperative pulmonary edema: pathogenesis and literature review. Chest. 1999. May;115(5):1371–7. 10.1378/chest.115.5.1371 - DOI - PubMed
    1. Blank RS, Hucklenbruch C, Gurka KK, Scalzo DC, Wang XQ, Jones DR, et al. Intraoperative factors and the risk of respiratory complications after pneumonectomy. Ann Thorac Surg. 2011. Oct;92(4):1188–94. 10.1016/j.athoracsur.2011.06.022 - DOI - PubMed