Extracellular Fluid Accumulation Predicts Fluid Responsiveness after Hydroxyethyl Starch 70/0.5 Bolus Infusion during Major Abdominal Surgery

Takeshi Ide, Tsuneo Tatara, Takahiko Kaneko, Shinichi Nishi

Department of Anesthesiology, Hyogo College of Medicine, Nishinomiya, Japan.
Department of Intensive Care Medicine, Hyogo College of Medicine, Ni-shinomiya, Japan.

DOI: 10.4236/ojanes.2013.39087                

Abstract

Objective: The purpose of this study was to test the hypothesis that extracellular fluid accumulation predicts fluid responsiveness after hydroxyethyl starch (HES) solution bolus infusion during major abdominal surgery. Methods: Twenty patients who underwent elective pancreaticoduodenectomy under general anesthesia were studied. Patients received 4 mL/kg boluses of Ringer’s acetate or 6% HES 70/0.5 solution over 15 min in random order when urine output decreased below 1.0 mL/kg/h. Stroke volume variation (SVV) and stroke volume index (SVI) were measured using the FloTrac^TM/Vigileo^TM system at pre-bolus, 15, 30, and 60 min after initiating bolus infusion. The percent change in pre-bolus extracellular fluid volume relative to that at the skin incision for arm (ΔV_ECF) was measured by bioelectrical impedance. Prediction of fluid responsiveness (an increase in SVI of ≥5%) by pre-bolus SVV or pre-bolus ΔV_ECF was tested by calculating the area under the receiver operating characteristic curve (AUC). Results: Fluid bolus infusions in this study consisted of 61 Ringer’s acetate infusions and 62 HES infusions. The best AUCs for identifying fluid responsiveness were seen with pre-bolus ΔV_ECF for HES at 30 min and 60 min (AUC = 0.74, P = 0.022; AUC = 0.74, P = 0.0054, respectively). Optimal threshold values of pre-bolus ΔV_ECF for predicting fluid responsiveness were 6.5% for 30 min (sensitivity: 78%, specificity: 58%) and 7.7% for 60 min (sensitivity: 56%, specificity: 76%). Conclusion: Extracellular fluid volume predicts fluid responsiveness after HES solution bolus infusion during major abdominal surgery. Substantial fluid responsiveness is observed upon increased accumulation of extracellular fluids.

Keywords

Plasma Expanders; Blood Volume; Fluid Therapy; Abdominal Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

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