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Perioperative intravascular fluid assessment and monitoring: a narrative review of established and emerging techniques.

Singh S, Kuschner WG, Lighthall G - Anesthesiol Res Pract (2011)

Bottom Line: Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient.Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes.In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2231, Los Angeles, CA, 90095, USA.

ABSTRACT
Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient. Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes. In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.

No MeSH data available.


Related in: MedlinePlus

A typical CVP waveform (lower tracing) and accompanying electrocardiogram (upper). The a, c, and v waves are shown, along with the z point (arrow), indicating the appropriate time in the cardiac cycle for CVP measurement.  All analyses need to occur at end expiration.
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fig1: A typical CVP waveform (lower tracing) and accompanying electrocardiogram (upper). The a, c, and v waves are shown, along with the z point (arrow), indicating the appropriate time in the cardiac cycle for CVP measurement. All analyses need to occur at end expiration.

Mentions: The CVP pressure tracing consists of three positive waves (a, c, and v) and two negative waves (x and y). The CVP is specifically measured at the ā€œzā€ point of the CVP tracing which corresponds to the leading edge of the c wave (Figure 1). At this part of the cardiac cycle, the catheter tip is in continuity with the ventricle and hence affords the best estimate of cardiac preload [6]. As with the measurement of jugular venous distension, the reference point for measurement of the CVP is the midaxillary line in the fifth intercostals space. Numerical recordings of CVP are measured at end expiration, a time in the respiratory cycle where the opposing forces of lung elasticity and chest recoil are balanced and exert the least pressure on the central and pulmonary vasculature. In patients with forcible expiration, the true CVP may be better represented by a value at the start of expiration [6]. Failure to attend to these basic principles will lead to erroneous data with little reproducibility across multiple users and time points.


Perioperative intravascular fluid assessment and monitoring: a narrative review of established and emerging techniques.

Singh S, Kuschner WG, Lighthall G - Anesthesiol Res Pract (2011)

A typical CVP waveform (lower tracing) and accompanying electrocardiogram (upper). The a, c, and v waves are shown, along with the z point (arrow), indicating the appropriate time in the cardiac cycle for CVP measurement.  All analyses need to occur at end expiration.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3139886&req=5

fig1: A typical CVP waveform (lower tracing) and accompanying electrocardiogram (upper). The a, c, and v waves are shown, along with the z point (arrow), indicating the appropriate time in the cardiac cycle for CVP measurement. All analyses need to occur at end expiration.
Mentions: The CVP pressure tracing consists of three positive waves (a, c, and v) and two negative waves (x and y). The CVP is specifically measured at the ā€œzā€ point of the CVP tracing which corresponds to the leading edge of the c wave (Figure 1). At this part of the cardiac cycle, the catheter tip is in continuity with the ventricle and hence affords the best estimate of cardiac preload [6]. As with the measurement of jugular venous distension, the reference point for measurement of the CVP is the midaxillary line in the fifth intercostals space. Numerical recordings of CVP are measured at end expiration, a time in the respiratory cycle where the opposing forces of lung elasticity and chest recoil are balanced and exert the least pressure on the central and pulmonary vasculature. In patients with forcible expiration, the true CVP may be better represented by a value at the start of expiration [6]. Failure to attend to these basic principles will lead to erroneous data with little reproducibility across multiple users and time points.

Bottom Line: Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient.Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes.In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2231, Los Angeles, CA, 90095, USA.

ABSTRACT
Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient. Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes. In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.

No MeSH data available.


Related in: MedlinePlus