Marc-Olivier Fischer1, Vincent Bonnet2, Emmanuel Lorne3, Jean-Yves Lefrant4, Olivier Rebet5, Benoît Courteille6, Charlotte Lemétayer7, Jean-Jacques Parienti8, Jean-Louis Gérard9, Jean-Luc Fellahi10, Jean-Luc Hanouz11. 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.
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.
Authors: Armin A Quispe-Cornejo; Ana L Alves da Cunha; Hassane Njimi; Wasineenart Mongkolpun; Ana L Valle-Martins; Mónica Arébalo-López; Jacques Creteur; Jean-Louis Vincent Journal: Crit Care Date: 2022-10-23 Impact factor: 19.334
Authors: William Fornier; Matthias Jacquet-Lagrèze; Thomas Collenot; Priscilla Teixeira; Philippe Portran; Rémi Schweizer; Michel Ovize; Jean-Luc Fellahi Journal: Crit Care Date: 2017-12-12 Impact factor: 9.097
Authors: Arnaldo Dubin; Cecilia Inés Loudet; Francisco Javier Hurtado; Mario Omar Pozo; Daniel Comande; Luz Gibbons; Federico Rodriguez Cairoli; Ariel Bardach Journal: Rev Bras Ter Intensiva Date: 2022 Apr-Jun