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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

Changes of blood volume dilution according to target dilution of body fluid space. (A) Hartmann's solution, (B) Voluven®, (C) Hextend®. The central box covers the interquartile range with the median indicated by the line within the box. The whiskers extend to the 10th percentile and 90th percentile values. More extreme values (•) are plotted individually. *P < 0.05 vs. 2% target dilution of body fluid space, †P < 0.05 vs. 3.5% target dilution of body fluid space. Target dilution of body fluid space (TD) shows statistically significant linear regression with blood volume dilution (BVD) in all groups. TD = 2.185 + 0.144 × BVD for Hartmann's solution (H group, R2 = 0.151, P = 0.01), TD = 0.239 + 0.498 × BVD for Voluven® (V group, R2 = 0.835, P < 0.001), TD = 0.718 + 0.408 × BVD for Hextend® (X group, R2 = 0.718, P < 0.001). Median (inter-quartile range) value of BVD for H group was 9.4 (9.0-11.4), 17.8 (16.5-18.7) and 22.7 (21.8-24.4) % for 2, 3.5, and 5% of target dilution, respectively. Median (inter-quartile range) value of BVD for V group was 4.0 (3.7-4.3), 6.7 (6.2-7.5) and 9.1 (8.2-9.7) % for 2, 3.5, and 5% of target dilution, respectively. Median (inter-quartile range) value of BVD for X group was 4.2 (3.9-4.6), 6.1 (5.7-6.8) and 9.7 (9.2-11.0) % for 2, 3.5, and 5% of target dilution, respectively.
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Figure 5: Changes of blood volume dilution according to target dilution of body fluid space. (A) Hartmann's solution, (B) Voluven®, (C) Hextend®. The central box covers the interquartile range with the median indicated by the line within the box. The whiskers extend to the 10th percentile and 90th percentile values. More extreme values (•) are plotted individually. *P < 0.05 vs. 2% target dilution of body fluid space, †P < 0.05 vs. 3.5% target dilution of body fluid space. Target dilution of body fluid space (TD) shows statistically significant linear regression with blood volume dilution (BVD) in all groups. TD = 2.185 + 0.144 × BVD for Hartmann's solution (H group, R2 = 0.151, P = 0.01), TD = 0.239 + 0.498 × BVD for Voluven® (V group, R2 = 0.835, P < 0.001), TD = 0.718 + 0.408 × BVD for Hextend® (X group, R2 = 0.718, P < 0.001). Median (inter-quartile range) value of BVD for H group was 9.4 (9.0-11.4), 17.8 (16.5-18.7) and 22.7 (21.8-24.4) % for 2, 3.5, and 5% of target dilution, respectively. Median (inter-quartile range) value of BVD for V group was 4.0 (3.7-4.3), 6.7 (6.2-7.5) and 9.1 (8.2-9.7) % for 2, 3.5, and 5% of target dilution, respectively. Median (inter-quartile range) value of BVD for X group was 4.2 (3.9-4.6), 6.1 (5.7-6.8) and 9.7 (9.2-11.0) % for 2, 3.5, and 5% of target dilution, respectively.

Mentions: The demographic data of patients enrolled in this study did not show significant differences between each group. Non per oral (NPO) time was not statistically different from three groups [median (25-75%): 8.3 (8.1-10.6) in H group, 9.8 (8.1-12.9) in V group, 8.3 (8.1-11.1) in X group, P = 0.144]. A total of 194 arterial blood samples, except baseline samples, were used to determine the predictive performance of fluid kinetic models for crystalloid and colloid solutions. Total volume and infusion rate of fluids infused by guidance of nomograms during 60 min are demonstrated in Table 3. As we expected, larger fluid volume was required to achieve higher target dilution of BFS. The results of predictive performance of fluid kinetic models are depicted in Table 4. Significant bias was observed in fluid kinetic models of H and X groups. The fluid kinetic model for Hartmann's solution tends to over-predict target dilution of BFS, whereas that of Hextend® tends to under-predict. Performance error and absolute performance error of target dilution in fluid kinetic models are displayed in Fig. 4, where median absolute performance error of the fluid kinetic model for Hartmann's solution was lower than those of other models. This finding indicates that the fluid kinetic model for Hartmann's solution has better predictive performance compared with other models, which was accordance with results calculated by a pooled data approach (See the inaccuracy of Table 4). Fig. 5 indicates changes blood volume dilution according to target dilution of body fluid space, where blood volume dilution and target dilution of BFS showed a strong linear relationship in each group. Also, blood volume dilution of H group was two or three times greater than other groups in a target dilution of BFS.


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)

Changes of blood volume dilution according to target dilution of body fluid space. (A) Hartmann's solution, (B) Voluven®, (C) Hextend®. The central box covers the interquartile range with the median indicated by the line within the box. The whiskers extend to the 10th percentile and 90th percentile values. More extreme values (•) are plotted individually. *P < 0.05 vs. 2% target dilution of body fluid space, †P < 0.05 vs. 3.5% target dilution of body fluid space. Target dilution of body fluid space (TD) shows statistically significant linear regression with blood volume dilution (BVD) in all groups. TD = 2.185 + 0.144 × BVD for Hartmann's solution (H group, R2 = 0.151, P = 0.01), TD = 0.239 + 0.498 × BVD for Voluven® (V group, R2 = 0.835, P < 0.001), TD = 0.718 + 0.408 × BVD for Hextend® (X group, R2 = 0.718, P < 0.001). Median (inter-quartile range) value of BVD for H group was 9.4 (9.0-11.4), 17.8 (16.5-18.7) and 22.7 (21.8-24.4) % for 2, 3.5, and 5% of target dilution, respectively. Median (inter-quartile range) value of BVD for V group was 4.0 (3.7-4.3), 6.7 (6.2-7.5) and 9.1 (8.2-9.7) % for 2, 3.5, and 5% of target dilution, respectively. Median (inter-quartile range) value of BVD for X group was 4.2 (3.9-4.6), 6.1 (5.7-6.8) and 9.7 (9.2-11.0) % for 2, 3.5, and 5% of target dilution, respectively.
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Figure 5: Changes of blood volume dilution according to target dilution of body fluid space. (A) Hartmann's solution, (B) Voluven®, (C) Hextend®. The central box covers the interquartile range with the median indicated by the line within the box. The whiskers extend to the 10th percentile and 90th percentile values. More extreme values (•) are plotted individually. *P < 0.05 vs. 2% target dilution of body fluid space, †P < 0.05 vs. 3.5% target dilution of body fluid space. Target dilution of body fluid space (TD) shows statistically significant linear regression with blood volume dilution (BVD) in all groups. TD = 2.185 + 0.144 × BVD for Hartmann's solution (H group, R2 = 0.151, P = 0.01), TD = 0.239 + 0.498 × BVD for Voluven® (V group, R2 = 0.835, P < 0.001), TD = 0.718 + 0.408 × BVD for Hextend® (X group, R2 = 0.718, P < 0.001). Median (inter-quartile range) value of BVD for H group was 9.4 (9.0-11.4), 17.8 (16.5-18.7) and 22.7 (21.8-24.4) % for 2, 3.5, and 5% of target dilution, respectively. Median (inter-quartile range) value of BVD for V group was 4.0 (3.7-4.3), 6.7 (6.2-7.5) and 9.1 (8.2-9.7) % for 2, 3.5, and 5% of target dilution, respectively. Median (inter-quartile range) value of BVD for X group was 4.2 (3.9-4.6), 6.1 (5.7-6.8) and 9.7 (9.2-11.0) % for 2, 3.5, and 5% of target dilution, respectively.
Mentions: The demographic data of patients enrolled in this study did not show significant differences between each group. Non per oral (NPO) time was not statistically different from three groups [median (25-75%): 8.3 (8.1-10.6) in H group, 9.8 (8.1-12.9) in V group, 8.3 (8.1-11.1) in X group, P = 0.144]. A total of 194 arterial blood samples, except baseline samples, were used to determine the predictive performance of fluid kinetic models for crystalloid and colloid solutions. Total volume and infusion rate of fluids infused by guidance of nomograms during 60 min are demonstrated in Table 3. As we expected, larger fluid volume was required to achieve higher target dilution of BFS. The results of predictive performance of fluid kinetic models are depicted in Table 4. Significant bias was observed in fluid kinetic models of H and X groups. The fluid kinetic model for Hartmann's solution tends to over-predict target dilution of BFS, whereas that of Hextend® tends to under-predict. Performance error and absolute performance error of target dilution in fluid kinetic models are displayed in Fig. 4, where median absolute performance error of the fluid kinetic model for Hartmann's solution was lower than those of other models. This finding indicates that the fluid kinetic model for Hartmann's solution has better predictive performance compared with other models, which was accordance with results calculated by a pooled data approach (See the inaccuracy of Table 4). Fig. 5 indicates changes blood volume dilution according to target dilution of body fluid space, where blood volume dilution and target dilution of BFS showed a strong linear relationship in each group. Also, blood volume dilution of H group was two or three times greater than other groups in a target dilution of BFS.

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