PURPOSE:Traditional measures including pulmonary artery or central venous pressure measurements to guide fluid management are unreliable. Physiologic management utilizing arterial pressure-based stroke volume (SV) and stroke volume variation (SVV) will facilitate fluid management in the operating room.
METHODS:A physiologic algorithm incorporating both SVV and SV (Figure 1) obtained from the arterial waveform was utilized to guide fluid management. Sixty-nine patients (mean age: 68; ASA: 3) at risk for hemodynamic instability during surgery were evaluated. Patients were anesthetized and mechanically ventilated. Volume was infused with the goal of maintaining stroke volume variability less than 13%. SV and SVV were simultaneously recorded. The goal was to maintain hemodynamic stability by following a physiologic algorithm based on SVV and SV. Volume infusion, vasopressors, and inotropic therapy were administered according to the algorithm.
RESULTS:Mean SV maximum was 69.4; minimum was 58.4 with simultaneous SVV of 8.2% and 15.9%, respectively. Maximum SV correlated with minimum SVV in this patient population.
CONCLUSION:A physiologic algorithm that incorporates both SVV and SV aids volume management in the operating room. Utilizing physiologic data in the operating room will aid hemodynamic management in a diverse group of high risk patients.
CLINICAL IMPLICATIONS:Basic physiologic parameters that are easily obtained in the operating room utilizing the arterial pressure waveform simplify hemodynamic management. The impact of optimal fluid management on clinically important parameters should be studied.
DISCLOSURE:William Mc Gee, No Financial Disclosure Information; No Product/Research Disclosure Information