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The predictive performance of infusion strategy nomogram based on a fluid kinetic model.

Choi BM, Karm MH, Jung KW, Yeo YG, Choi KT - Korean J Anesthesiol (2015)

Bottom Line: A total of 194 hemoglobin measurements were used.The bias and inaccuracy of these models were -2.69 and 35.62 for the H group, -1.53 and 43.21 for the V group, and 9.05 and 41.82 for the X group, respectively.Based on the inaccuracy of predictive performance, the fluid-kinetic model for Hartmann's solution showed better performance than the other models.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea.

ABSTRACT

Background: In a previous study, fluid kinetic models were applied to describe the volume expansion of the fluid space by administration of crystalloid and colloid solutions. However, validation of the models were not performed, it is necessary to evaluate the predictive performance of these models in another population.

Methods: Ninety five consenting patients undergoing elective spinal surgery under general anesthesia were enrolled in this study. These patients were randomly assigned to three fluid groups i.e. Hartmann's solution (H group, n = 28), Voluven® (V group, n = 34), and Hextend® (X group, n = 33). After completion of their preparation for surgery, the patients received a loading and maintenance volume of each fluid predetermined by nomograms based on fluid pharmacokinetic models during the 60-minute use of an infusion pump. Arterial samples were obtained at preset intervals of 0, 10, 20, and 30 min after fluid administration. The predictive performances of the fluid kinetic modes were evaluated using the fractional change of arterial hemoglobin. The relationship between blood-volume dilution and target dilution of body fluid space was also evaluated using regression analysis.

Results: A total of 194 hemoglobin measurements were used. The bias and inaccuracy of these models were -2.69 and 35.62 for the H group, -1.53 and 43.21 for the V group, and 9.05 and 41.82 for the X group, respectively. The blood-volume dilution and target dilution of body-fluid space showed a significant linear relationship in each group (P < 0.05).

Conclusions: Based on the inaccuracy of predictive performance, the fluid-kinetic model for Hartmann's solution showed better performance than the other models.

No MeSH data available.


Related in: MedlinePlus

Nomograms showing the relation between infusion time and, infusion rate (left) and steady state (right) for Voluven®. The isobars (%) show the predicted target dilution of body fluid space. When a patient receives Voluven® for target dilution of body fluid space, loading and maintenance volume are determined by using left and right panels, respectively. For example, in such a case of 5% dilution, loading volume of Voluven® is infused at 20 ml/min for 13 minute, and then maintenance volume of Voluven® is infused at 1.4 ml/min. ki and steady state mean infusion rate for administration of loading volume and infusion rate for administration of maintenance volume, respectively (cited from Korean J Anesthesiol 2008; 54: 300-6).
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Figure 2: Nomograms showing the relation between infusion time and, infusion rate (left) and steady state (right) for Voluven®. The isobars (%) show the predicted target dilution of body fluid space. When a patient receives Voluven® for target dilution of body fluid space, loading and maintenance volume are determined by using left and right panels, respectively. For example, in such a case of 5% dilution, loading volume of Voluven® is infused at 20 ml/min for 13 minute, and then maintenance volume of Voluven® is infused at 1.4 ml/min. ki and steady state mean infusion rate for administration of loading volume and infusion rate for administration of maintenance volume, respectively (cited from Korean J Anesthesiol 2008; 54: 300-6).

Mentions: All patients fasted from midnight. Intravenous infusion of 0.9% saline with rate of 40 ml/h was started at 6 a.m. Once in the operating room, patients were monitored with electrocardiography, pulse oximetry, end-tidal carbon dioxide partial pressure. Anesthesia was induced with intravenous propofol 2 mg/kg, effect-site target controlled infusion (TCI) of remifentanil (2 ng/ml). Rocuronium (1 mg/kg) I.V. was used to facilitate tracheal intubation. All participant's lungs were ventilated in volume-controlled mode with tidal volume of 8-10 ml/kg at a frequency of 10 bpm and zero end-expiratory pressure. Anesthesia was maintained with remifentanil TCI (2 ng/ml) and desflurane inhalation with FIO2 0.5 of O2 and air. Vasopressors were not used during the study period. To achieve and maintain stable fluid space dilution, 2, 3.5 and 5% of target dilution, infusion rates for administration of loading and maintenance volumes were selected from nomograms for fluids (Figs. 1, 2 and 3) [7]. Infusion rate for loading volume in each patient was determined at the middle portion of nomograms (convex portion) except for both extremes. Target values of 2, 3.5, and 5% were chosen to evaluate the predictive performances of fluid kinetic models under consideration of patient safety during operation. These patients were randomly assigned to one of three fluid groups (Hartmann's solution [H group, n = 23], Voluven® [Fresenius Kabi, Bad Homburg, Germany, V group, n = 28], and Hextend® [Hospira, Lake Forest, IL, X group, n = 28]) in a sequence with one of the target dilution. After invasive arterial blood pressure monitoring was established, patients received each loading and maintenance volume of fluid predetermined by nomograms for 60 min using an infusion pump (Baxter Flo-Gard 6201, San Diego, CA). Four arterial blood samples for hemoglobin measurement were obtained at preset intervals; before infusion, 10, 20 and 30 min after loading volume of fluid (t-0, t-10, t-20, t-30, respectively). Hemoglobin was measured by Gem Premier 3000 (Instrumentation Laboratory, Lexington, MA, USA). Efforts to finish the study before surgical incision was carried out. If surgical incision began before completion of the study, further samplings were not gathered. Hemoglobin concentration higher than baseline value (t-0) were discarded assuming sampling error. As a result, 22 samples for error, 25 samples for t-30 (15 for H group, 6 for V group, 4 for X group) were missing and then, 61 samples from H group, 118 samples from V group and 98 samples from X group were collected and used to evaluate predictive performance of fluid kinetic models.


The predictive performance of infusion strategy nomogram based on a fluid kinetic model.

Choi BM, Karm MH, Jung KW, Yeo YG, Choi KT - Korean J Anesthesiol (2015)

Nomograms showing the relation between infusion time and, infusion rate (left) and steady state (right) for Voluven®. The isobars (%) show the predicted target dilution of body fluid space. When a patient receives Voluven® for target dilution of body fluid space, loading and maintenance volume are determined by using left and right panels, respectively. For example, in such a case of 5% dilution, loading volume of Voluven® is infused at 20 ml/min for 13 minute, and then maintenance volume of Voluven® is infused at 1.4 ml/min. ki and steady state mean infusion rate for administration of loading volume and infusion rate for administration of maintenance volume, respectively (cited from Korean J Anesthesiol 2008; 54: 300-6).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384399&req=5

Figure 2: Nomograms showing the relation between infusion time and, infusion rate (left) and steady state (right) for Voluven®. The isobars (%) show the predicted target dilution of body fluid space. When a patient receives Voluven® for target dilution of body fluid space, loading and maintenance volume are determined by using left and right panels, respectively. For example, in such a case of 5% dilution, loading volume of Voluven® is infused at 20 ml/min for 13 minute, and then maintenance volume of Voluven® is infused at 1.4 ml/min. ki and steady state mean infusion rate for administration of loading volume and infusion rate for administration of maintenance volume, respectively (cited from Korean J Anesthesiol 2008; 54: 300-6).
Mentions: All patients fasted from midnight. Intravenous infusion of 0.9% saline with rate of 40 ml/h was started at 6 a.m. Once in the operating room, patients were monitored with electrocardiography, pulse oximetry, end-tidal carbon dioxide partial pressure. Anesthesia was induced with intravenous propofol 2 mg/kg, effect-site target controlled infusion (TCI) of remifentanil (2 ng/ml). Rocuronium (1 mg/kg) I.V. was used to facilitate tracheal intubation. All participant's lungs were ventilated in volume-controlled mode with tidal volume of 8-10 ml/kg at a frequency of 10 bpm and zero end-expiratory pressure. Anesthesia was maintained with remifentanil TCI (2 ng/ml) and desflurane inhalation with FIO2 0.5 of O2 and air. Vasopressors were not used during the study period. To achieve and maintain stable fluid space dilution, 2, 3.5 and 5% of target dilution, infusion rates for administration of loading and maintenance volumes were selected from nomograms for fluids (Figs. 1, 2 and 3) [7]. Infusion rate for loading volume in each patient was determined at the middle portion of nomograms (convex portion) except for both extremes. Target values of 2, 3.5, and 5% were chosen to evaluate the predictive performances of fluid kinetic models under consideration of patient safety during operation. These patients were randomly assigned to one of three fluid groups (Hartmann's solution [H group, n = 23], Voluven® [Fresenius Kabi, Bad Homburg, Germany, V group, n = 28], and Hextend® [Hospira, Lake Forest, IL, X group, n = 28]) in a sequence with one of the target dilution. After invasive arterial blood pressure monitoring was established, patients received each loading and maintenance volume of fluid predetermined by nomograms for 60 min using an infusion pump (Baxter Flo-Gard 6201, San Diego, CA). Four arterial blood samples for hemoglobin measurement were obtained at preset intervals; before infusion, 10, 20 and 30 min after loading volume of fluid (t-0, t-10, t-20, t-30, respectively). Hemoglobin was measured by Gem Premier 3000 (Instrumentation Laboratory, Lexington, MA, USA). Efforts to finish the study before surgical incision was carried out. If surgical incision began before completion of the study, further samplings were not gathered. Hemoglobin concentration higher than baseline value (t-0) were discarded assuming sampling error. As a result, 22 samples for error, 25 samples for t-30 (15 for H group, 6 for V group, 4 for X group) were missing and then, 61 samples from H group, 118 samples from V group and 98 samples from X group were collected and used to evaluate predictive performance of fluid kinetic models.

Bottom Line: A total of 194 hemoglobin measurements were used.The bias and inaccuracy of these models were -2.69 and 35.62 for the H group, -1.53 and 43.21 for the V group, and 9.05 and 41.82 for the X group, respectively.Based on the inaccuracy of predictive performance, the fluid-kinetic model for Hartmann's solution showed better performance than the other models.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea.

ABSTRACT

Background: In a previous study, fluid kinetic models were applied to describe the volume expansion of the fluid space by administration of crystalloid and colloid solutions. However, validation of the models were not performed, it is necessary to evaluate the predictive performance of these models in another population.

Methods: Ninety five consenting patients undergoing elective spinal surgery under general anesthesia were enrolled in this study. These patients were randomly assigned to three fluid groups i.e. Hartmann's solution (H group, n = 28), Voluven® (V group, n = 34), and Hextend® (X group, n = 33). After completion of their preparation for surgery, the patients received a loading and maintenance volume of each fluid predetermined by nomograms based on fluid pharmacokinetic models during the 60-minute use of an infusion pump. Arterial samples were obtained at preset intervals of 0, 10, 20, and 30 min after fluid administration. The predictive performances of the fluid kinetic modes were evaluated using the fractional change of arterial hemoglobin. The relationship between blood-volume dilution and target dilution of body fluid space was also evaluated using regression analysis.

Results: A total of 194 hemoglobin measurements were used. The bias and inaccuracy of these models were -2.69 and 35.62 for the H group, -1.53 and 43.21 for the V group, and 9.05 and 41.82 for the X group, respectively. The blood-volume dilution and target dilution of body-fluid space showed a significant linear relationship in each group (P < 0.05).

Conclusions: Based on the inaccuracy of predictive performance, the fluid-kinetic model for Hartmann's solution showed better performance than the other models.

No MeSH data available.


Related in: MedlinePlus