Key result
IV infusion of lactated Ringer's solution in patients undergoing open abdominal surgery decreased cardiac output in 6 of 10 patients, despite consistent increases in PAWP and CVP.
Why the study?
Does IV infusion of lactated Ringer's solution alter central hemodynamics in patients undergoing open abdominal surgery?
Does IV infusion of lactated Ringer's solution alter central hemodynamics in patients undergoing open abdominal surgery?
In patients undergoing open abdominal surgery, crystalloid fluid administration leads to variable cardiac output responses, with over half showing a decrease, while PAWP and CVP consistently track plasma dilution.
May reduce cardiac output despite rising PAWP/CVP in abdominal surgery; hypothesis-generating for fluid responsiveness assessment and requires prospective validation.
We studied whether central hemodynamics measured by a pulmonary artery catheter can serve as a pharmacodynamic expression of fluid therapy in 10 patients undergoing open abdominal surgery. We examined how closely hemodynamic variables follow plasma dilution, which is an index of plasma volume expansion, during and after an IV infusion of 25 mL/kg of lactated Ringer's solution over 45 min. Pulmonary artery wedge pressure and central venous pressure responded to IV fluid with an increase that correlated with accompanying plasma dilution. Six of 10 patients showed a decrease in cardiac output that was probably secondary to an increase in peripheral vascular resistance (nonresponders), whereas the rest increased cardiac output (responders). Volume kinetic analysis suggested that 54% of the infused fluid resided in the central fluid space at the end of the infusion and 25% at the end of the study in the responders compared with 25% and 3%, respectively, in nonresponders. In conclusion, half of the patients undergoing open abdominal surgery responded to crystalloid fluid with a decrease in cardiac output. Pulmonary artery wedge pressure and central venous pressure responded more consistently to different degrees of plasma dilution, which can be simulated for various fluid regimens using volume kinetics.
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n et al. (2006) studied open abdominal surgery (n=10). Lactated Ringer's solution was evaluated on central hemodynamics and plasma dilution. IV infusion of lactated Ringer's solution in patients undergoing open abdominal surgery decreased cardiac output in 6 of 10 patients, despite consistent increases in PAWP and CVP.
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