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Reliability of Continuous Non-Invasive Assessment of Hemoglobin and Fluid Responsiveness: Impact of Obesity and Abdominal Insufflation Pressures

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Abstract

Background

During surgery, proper fluid resuscitation and hemostatic control is critical. Pleth variability index (PVI) is advocated as a reliable way of optimizing intraoperative fluid resuscitation. PVI is a measure of dynamic change in perfusion index during a complete respiratory cycle. Non-invasive monitoring of total hemoglobin could provide a reliable means to determine need for transfusion. We analyzed the impact of insufflation and obesity on non-invasive measurements of hemoglobin and PVI in laparoscopic procedures to validate reliability of fluid responsiveness and hemoglobin levels.

Methods

A non-invasive hemoglobin and PVI monitoring device was prospectively analyzed in patients undergoing abdominal operations. Patients were stratified by open and laparoscopic approach and obesity (body mass index (BMI) ≥35). PVI and hemoglobin values were assessed before, during, and after insufflation and compared to control patients undergoing open surgery.

Results

Sixty-three patients were enrolled (mean age 42 years; 71 % male; mean BMI 36) with 24 patients laparoscopic non-obese (LNO), 20 laparoscopic obese (LO), and 19 undergoing open operations. There was no significant blood loss. Hemoglobin did not change significantly before or after insufflation. There was false elevation of PVI with insufflation and more pronounced in obese patients.

Conclusions

Insufflation or obesity was not associated with significant variations in hemoglobin. Non-invasive monitoring of hemoglobin is useful in laparoscopic procedures in obese and non-obese patients. PVI values should be used cautiously during laparoscopic procedures, particularly in obese patients.

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References

  1. Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642–7.

    Article  PubMed  Google Scholar 

  2. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.

    Article  CAS  PubMed  Google Scholar 

  3. Teboul JL, Monnet X. Detecting volume responsiveness and unresponsiveness in intensive care unit patients: two different problems, only one solution. Crit Care. 2009;13(4):175.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Shah MR, Hasselblad V, Stevenson LW, et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA. 2005;294(13):1664–70.

    Article  CAS  PubMed  Google Scholar 

  5. Hadian M, Pinsky MR. Evidence-based review of the use of the pulmonary artery catheter: impact data and complications. Crit Care. 2006;10 Suppl 3:S8.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172–8.

    Article  PubMed  Google Scholar 

  7. Jefferson P, Ball DR. Central venous access in morbidly obese patients. Anesth Analg. 2002;95(3):782.

    PubMed  Google Scholar 

  8. Trick WE, Miranda J, Evans AT, et al. Prospective cohort study of central venous catheters among internal medicine ward patients. Am J Infect Control. 2006;34(10):636–41.

    Article  PubMed  Google Scholar 

  9. Brusasco C, Corradi F, Zattoni PL, et al. Ultrasound-guided central venous cannulation in bariatric patients. Obes Surg. 2009;19(10):1365–70.

    Article  PubMed  Google Scholar 

  10. Cotter G, Moshkovitz Y, Kaluski E, et al. Accurate, noninvasive continuous monitoring of cardiac output by whole-body electrical bioimpedance. Chest. 2004;125(4):1431–40.

    Article  PubMed  Google Scholar 

  11. Bodo M, Settle T, Royal J, et al. Multimodal noninvasive monitoring of soft tissue wound healing. J Clin Monit Comput. 2013;27(6):677–88.

    Article  PubMed  Google Scholar 

  12. Muller JC, Kennard JW, Browne JS, et al. Hemodynamic monitoring in the intensive care unit. Nutr Clin Pract. 2012;27(3):340–51.

    Article  PubMed  Google Scholar 

  13. Lipcsey M, Woinarski NC, Bellomo R. Near infrared spectroscopy (NIRS) of the thenar eminence in anesthesia and intensive care. Ann Intensive Care. 2012;2(1):11.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Mohan VK, Chanderlekha, Kashyap L. Cardiac output monitoring based on thoracic electrical bioimpedance. J Postgrad Med. 2002;48(4):329–30.

    CAS  PubMed  Google Scholar 

  15. Cannesson M, Desebbe O, Rosamel P, et al. Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre. Br J Anaesth. 2008;101(2):200–6.

    Article  CAS  PubMed  Google Scholar 

  16. Feissel M, Teboul JL, Merlani P, et al. Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients. Intensive Care Med. 2007;33(6):993–9.

    Article  PubMed  Google Scholar 

  17. Loupec T, Nanadoumgar H, Frasca D, et al. Pleth variability index predicts fluid responsiveness in critically ill patients. Crit Care Med. 2011;39(2):294–9.

    Article  PubMed  Google Scholar 

  18. Causey MW, Miller S, Foster A, et al. Validation of noninvasive hemoglobin measurements using the masimo radical-7 SpHb station. Am J Surg. 2011;201(5):592–8.

    Article  CAS  PubMed  Google Scholar 

  19. Henny CP, Hofland J. Laparoscopic surgery: pitfalls due to anesthesia, positioning, and pneumoperitoneum. Surg Endosc. 2005;19(9):1163–71.

    Article  CAS  PubMed  Google Scholar 

  20. Jafari MD, Jafari F, Young MT, et al. Volume and outcome relationship in bariatric surgery in the laparoscopic era. Surg Endosc. 2013;27(12):4539–46.

    Article  PubMed  Google Scholar 

  21. Nguyen NT, Nguyen B, Gebhart A, et al. Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy. J Am Coll Surg. 2013;216(2):252–7.

    Article  PubMed  Google Scholar 

  22. Brandt S, Regueira T, Bracht H, et al. Effect of fluid resuscitation on mortality and organ function in experimental sepsis models. Crit Care. 2009;13(6):R186.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Verdant C, De Backer D. How monitoring of the microcirculation may help us at the bedside. Curr Opin Crit Care. 2005;11(3):240–4.

    Article  PubMed  Google Scholar 

  24. Lv L, Shao YF, Zhou YB. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials. Int J Colorectal Dis. 2012;27(12):1549–54.

    Article  PubMed  Google Scholar 

  25. Hoiseth LO, Hoff IE, Myre K, et al. Dynamic variables of fluid responsiveness during pneumoperitoneum and laparoscopic surgery. Acta Anaesthesiol Scand. 2012;56(6):777–86.

    Article  CAS  PubMed  Google Scholar 

  26. Holodinsky JK, Roberts DJ, Ball CG, et al. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Crit Care. 2013;17(5):R249.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Robinson BR, Cotton BA, Pritts TA, et al. Application of the Berlin definition in PROMMTT patients: the impact of resuscitation on the incidence of hypoxemia. J Trauma Acute Care Surg. 2013;75(1 Suppl 1):S61–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Kulemann B, Timme S, Seifert G, et al. Intraoperative crystalloid overload leads to substantial inflammatory infiltration of intestinal anastomoses—a histomorphological analysis. Surgery. 2013;154(3):596–603.

    Article  PubMed  Google Scholar 

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors have no conflict of interests to declare. The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the US Government.

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Authors and Affiliations

  1. Department of Surgery, Madigan Army Medical Center, 9040a Fitzsimmons Drive, Tacoma, WA, 98431, USA

    Mia DeBarros, Marlin W. Causey, Patrick Chesley & Matthew Martin

  2. Legacy Emanuel Medical Center, Portland, OR, USA

    Matthew Martin

Authors
  1. Mia DeBarros
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  2. Marlin W. Causey
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  3. Patrick Chesley
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  4. Matthew Martin
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Correspondence to Mia DeBarros.

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DeBarros, M., Causey, M.W., Chesley, P. et al. Reliability of Continuous Non-Invasive Assessment of Hemoglobin and Fluid Responsiveness: Impact of Obesity and Abdominal Insufflation Pressures. OBES SURG 25, 1142–1148 (2015). https://doi.org/10.1007/s11695-014-1505-6

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  • DOI: https://doi.org/10.1007/s11695-014-1505-6

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