Wouden, GM van der (2013) Het gebruik van non-invasieve cardiac output meting (Nexfin) in het bepalen van adequate volumetherapie bij sepsis. thesis, Medicine.
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Abstract
Background: Fluid therapy is important in the resuscitation of septic patients in the emergency department (ED). However it is difficult to determine which patients need fluid therapy and how much fluid they need. Physicians make correct estimations of the underlying hemodynamic profile of acutely ill patients in a minority of cases. In addition, only 50% of hemodynamicly unstable patients respond positively to fluid resuscitation with a rise in cardiac output (CO). Heart rate (HR), blood pressure (BP), and invasive measurement of central venous pressure are probably not as accurate as CO in monitoring the response to fluid therapy. Therefore a noninvasive beat-to-beat CO monitoring may be a very useful tool in predicting and monitoring the effects of fluid therapy in the ED. Objective: Can Nexfin be used to monitor CO during fluid therapy, and can CO changes measured with Nexfin, during passive leg raising (PLR), be used to predict response to fluid therapy in septic patients in the ED? Methods: Nexfin (BMEYE B.V., Amsterdam, NL) provides continuous non-invasive BP measurement and, from the resulting pulse pressure waveform, calculates beat-to-beat CO. Thirty-one septic patients (18 men and 13 woman, mean age 55 years) were studied during fluid therapy. Before fluid therapy, PLR was performed by raising the legs from the supine position to a 45° angle . A patient with a 10% or more increase in CO was defined as a fluid responder. Results: During PLR, mean arterial pressure (MAP) increased (from 88,4±17,7 to 91,7±18,4 mmHg) , HR increased (from 101,6±14,7 to 103,1±15,4 bpm) and CO increased (from 7,6±2,3 to 7,9±2,2 l/min). There was no change in stroke volume (SV). After fluid therapy HR decreased (from 101,6±14,7 to 95,9±14,1 bpm) with an increase in SV (from 75,8±21,6 to 84,1±19,5 ml). This resulted in a non-significant increase in CO (from 7,6±2,3 to 8,0±2,0 l/min; p=0.09). MAP did not change. There were 8 PLR responders and 12 fluid therapy responders. The sensitivity of PLR to predict fluid responsiveness was 50%, the specificity 89%. The positive predictive value was 75%, the negative predictive value 74 %. Conclusion: Nexfin can monitor the response of fluid therapy in the ED. CO is a useful parameter of fluid response. PLR is a promising tool to further guide fluid resuscitation in the ED.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Harms, Dr. M.P.M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:38 |
| Last Modified: | 25 Jun 2020 10:38 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/22 |
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