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Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment

INTRODUCTION: Fluid resuscitation is the cornerstone of treatment in hemorrhagic shock. Despite increasing doubts, several guidelines recommend to maintain mean arterial pressure (MAP) >65 mmHg as the most frequent indication of fluid therapy. Our aim was to investigate the effects of a MAP-guide...

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Autores principales: Öveges, Nándor, László, Ildikó, Tánczos, Krisztián, Németh, Márton, Lebák, Gábor, Tudor-Drobjewski, Bianca-Andreea, Érces, Dániel, Kaszaki, József, Rudas, László, Huber, Wolfgang, Molnár, Zsolt
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023124/
https://www.ncbi.nlm.nih.gov/pubmed/29953455
http://dx.doi.org/10.1371/journal.pone.0196188
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author Öveges, Nándor
László, Ildikó
Tánczos, Krisztián
Németh, Márton
Lebák, Gábor
Tudor-Drobjewski, Bianca-Andreea
Érces, Dániel
Kaszaki, József
Rudas, László
Huber, Wolfgang
Molnár, Zsolt
author_facet Öveges, Nándor
László, Ildikó
Tánczos, Krisztián
Németh, Márton
Lebák, Gábor
Tudor-Drobjewski, Bianca-Andreea
Érces, Dániel
Kaszaki, József
Rudas, László
Huber, Wolfgang
Molnár, Zsolt
author_sort Öveges, Nándor
collection PubMed
description INTRODUCTION: Fluid resuscitation is the cornerstone of treatment in hemorrhagic shock. Despite increasing doubts, several guidelines recommend to maintain mean arterial pressure (MAP) >65 mmHg as the most frequent indication of fluid therapy. Our aim was to investigate the effects of a MAP-guided management in a bleeding-resuscitation animal experiment. MATERIALS AND METHODS: After anesthesia and instrumentation (t(bsl)) animals were bled till the initial stroke volume index dropped by 50% (t(0)). Fluid replacement was performed in 4 equivalent steps (t(1-4)) with balanced crystalloid solution to reach the baseline values of MAP. Invasive hemodynamic measurements and blood gas analyses were performed after each step. RESULTS: Mean arterial pressure dropped from t(bsl) to t(0) (114±11 vs 76.9±16.9 mmHg, p<0.001) and returned to baseline by t(4) (101.4±14.4 mmHg). From t(bsl)-t(0) stroke volume index (SVI), cardiac index (CI) decreased (SVI: 40±8.6 vs 19.3±3.6 ml/m(2), p<0.001; CI: 3.4±0.3 vs 1.9±0.3 l/min/m(2), p<0.001), pulse pressure variation (PPV) increased (13.2±4.3 vs 22.1±4.3%, p<0.001). There was a decrease in oxygen delivery (464±45 vs 246±26.9 ml/min, p<0.001), central venous oxygen saturation (82.8±5.4 vs 53.6±12.1%, p<0.001) and increase in lactate levels (1.6±0.4 vs 3.5±1.6 mmol/l, p<0.005). SVI, CI and PPV returned to their initial values by t(2). To normalize MAP fluid therapy had to be continued till t(4), with the total infused volume of 4.5±0.8 l. CONCLUSION: In the current experiment bleeding led to hemorrhagic shock, while MAP remained higher than 65 mmHg. Furthermore, MAP was unable to indicate the normalization of SVI, CI and PPV that resulted in unnecessary fluid administration. Our data give further evidence that MAP may be an inappropriate parameter to follow during fluid resuscitation.
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spelling pubmed-60231242018-07-07 Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment Öveges, Nándor László, Ildikó Tánczos, Krisztián Németh, Márton Lebák, Gábor Tudor-Drobjewski, Bianca-Andreea Érces, Dániel Kaszaki, József Rudas, László Huber, Wolfgang Molnár, Zsolt PLoS One Research Article INTRODUCTION: Fluid resuscitation is the cornerstone of treatment in hemorrhagic shock. Despite increasing doubts, several guidelines recommend to maintain mean arterial pressure (MAP) >65 mmHg as the most frequent indication of fluid therapy. Our aim was to investigate the effects of a MAP-guided management in a bleeding-resuscitation animal experiment. MATERIALS AND METHODS: After anesthesia and instrumentation (t(bsl)) animals were bled till the initial stroke volume index dropped by 50% (t(0)). Fluid replacement was performed in 4 equivalent steps (t(1-4)) with balanced crystalloid solution to reach the baseline values of MAP. Invasive hemodynamic measurements and blood gas analyses were performed after each step. RESULTS: Mean arterial pressure dropped from t(bsl) to t(0) (114±11 vs 76.9±16.9 mmHg, p<0.001) and returned to baseline by t(4) (101.4±14.4 mmHg). From t(bsl)-t(0) stroke volume index (SVI), cardiac index (CI) decreased (SVI: 40±8.6 vs 19.3±3.6 ml/m(2), p<0.001; CI: 3.4±0.3 vs 1.9±0.3 l/min/m(2), p<0.001), pulse pressure variation (PPV) increased (13.2±4.3 vs 22.1±4.3%, p<0.001). There was a decrease in oxygen delivery (464±45 vs 246±26.9 ml/min, p<0.001), central venous oxygen saturation (82.8±5.4 vs 53.6±12.1%, p<0.001) and increase in lactate levels (1.6±0.4 vs 3.5±1.6 mmol/l, p<0.005). SVI, CI and PPV returned to their initial values by t(2). To normalize MAP fluid therapy had to be continued till t(4), with the total infused volume of 4.5±0.8 l. CONCLUSION: In the current experiment bleeding led to hemorrhagic shock, while MAP remained higher than 65 mmHg. Furthermore, MAP was unable to indicate the normalization of SVI, CI and PPV that resulted in unnecessary fluid administration. Our data give further evidence that MAP may be an inappropriate parameter to follow during fluid resuscitation. Public Library of Science 2018-06-28 /pmc/articles/PMC6023124/ /pubmed/29953455 http://dx.doi.org/10.1371/journal.pone.0196188 Text en © 2018 Öveges et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Öveges, Nándor
László, Ildikó
Tánczos, Krisztián
Németh, Márton
Lebák, Gábor
Tudor-Drobjewski, Bianca-Andreea
Érces, Dániel
Kaszaki, József
Rudas, László
Huber, Wolfgang
Molnár, Zsolt
Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment
title Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment
title_full Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment
title_fullStr Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment
title_full_unstemmed Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment
title_short Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment
title_sort mean arterial pressure targeted fluid resuscitation may lead to fluid overload: a bleeding-resuscitation animal experiment
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023124/
https://www.ncbi.nlm.nih.gov/pubmed/29953455
http://dx.doi.org/10.1371/journal.pone.0196188
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