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J Crit Care. 2017 Aug;40:91-98. doi: 10.1016/j.jcrc.2017.03.021. Epub 2017 Mar 27.

Assessment of macro- and micro-oxygenation parameters during fractional fluid infusion: A pilot study.

Author information

1
Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France; EA 4650, Université de Caen Normandie, Esplanade de la Paix, CS 14 032, F-14 000 Caen, France. Electronic address: fischer-mo@chu-caen.fr.
2
Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France. Electronic address: bonnet-v@chu-caen.fr.
3
Anesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, F-80 054 Amiens, France; INSERM ERI12, Jules Vernes University of Picardy, 12 rue des Louvels, F-80 000 Amiens, France. Electronic address: lorne.emmanuel@chu-amiens.fr.
4
Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes, Nîmes, France. Electronic address: jean-yves.lefrant@wanadoo.fr.
5
Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France. Electronic address: olivier.rebet@free.fr.
6
Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France. Electronic address: benourt@gmail.com.
7
Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France. Electronic address: charlotte.lemetayer@gmail.com.
8
Department of Biostatistics and Clinical Research, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France. Electronic address: parienti-jj@chu-caen.fr.
9
Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France. Electronic address: gerard-jl@chu-caen.fr.
10
Service d'Anesthésie-Réanimation, Hôpital cardiologique Louis Pradel, Avenue du Doyen Lepine, F-69 677 Lyon, France; Faculty of Medicine, University of Lyon 1 Claude Bernard, F-69 008 Lyon, France. Electronic address: jean-luc.fellahi@chu-lyon.fr.
11
Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France; EA 4650, Université de Caen Normandie, Esplanade de la Paix, CS 14 032, F-14 000 Caen, France. Electronic address: hanouz-jl@chu-caen.fr.

Abstract

PURPOSE:

The main goal of this study was to assess whether maximal fluid infusion improves both oxygen delivery (DO2) and micro-circulatory parameters during hemodilution. The secondary objective was to assess the ability of baseline micro-circulatory parameters to predict oxygen consumption (VO2) response following fluid infusion.

MATERIALS AND METHODS:

In a postoperative cardiac ICU, patients received repeated fluid infusion until stroke volume (SV) was maximized. Before and after each fluid expansion, macro- (DO2, VO2) and micro-circulatory oxygenation parameters were recorded [central venous oxygen saturation (ScVO2), blood lactate, difference in veno-arterial carbon dioxide tension (P(v-a)CO2), somatic and cerebral oxygen saturation (rSO2)]. Patients were classified as VO2-Responders or VO2-Non-Responders according to an increase in VO2 above or below 15%, respectively.

RESULTS:

After maximal fluid infusion, all patients showed improved macro- and micro-circulatory oxygenation parameters, but VO2-Responders had lower values (especially for ScVO2 and cerebral rSO2). Only baseline ScVO2 and cerebral rSO2 were useful to predict the VO2 response to maximal fluid infusion (ROCAUC 0.80 (95% CI: 0.54-0.95, P=0.012) and 0.83 (95% CI: 0.57-0.96, P=0.001).

CONCLUSIONS:

Maximal fluid infusion improves macro- and micro-circulatory oxygenation parameters. For VO2-Responders, only ScVO2 and cerebral rSO2 could serve as markers of tissue hypoxia.

KEYWORDS:

Cardiac output; Fluid loading; Oxygen consumption; Oxygen delivery

PMID:
28364680
DOI:
10.1016/j.jcrc.2017.03.021
[Indexed for MEDLINE]

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