The importance of information on volaemia during the perioperative period: new versus old technique

  • M. Girardis
  • A. Roberti
  • A. Pasetto
Conference paper


One of the main goals of medicine in anaesthesia and intensive care is to restore and maintain an adequate organ perfusion in the critically ill patient. To this aim, an accurate assessment of the cardiovascular system is mandatory. Among the different parameters used to monitor the cardiovascular system, circulating blood volume (CBV) is of paramount importance. While a severe reduction of CBV is associated with an easily recognizable clinical picture (i.e., shock state), a mild-to-moderate reduction causes only blurred clinical signs, due to the activation of compensatory mechanisms (i.e., normotensive compensated shock) [1]. These rapid compensatory mechanisms include venous vasoconstriction and decrease of blood flow in the cutaneous, splanchnic, and renal compartments. This condition frequently occurs in critically ill and post-surgical patients and it is associated with increased morbidity and mortality. In fact, untreated hypovolaemia leads to a state of tissue ischaemia that is able to induce a systemic inflammatory response [2]. On the other hand, an acute expansion of CBV can increase the volume of the interstitial compartment (i.e., oedema). This causes a reduction of the O2 diffusion capacity both at lung level (i.e., increase of the alveolar-arterial O2 gradient) and at the systemic level (i.e., increase of the capillary-tissue O2 gradient) [3, 4].


Indocyanine Green Fluid Responsiveness Hydroxyethyl Starch Circulate Blood Volume Cardiac Preload 
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  1. 1.
    Hillman K, Bishop G, Bristow P (1996) Focus on physiology and pathophysiology of fluids and electrolytes. Fluid resuscitation. Curr Anesth Crit Care 7:187–191CrossRefGoogle Scholar
  2. 2.
    Shoemaker WC, Montgomery ES, Kaplan E, Elwyn DH (1973) Physiological patterns in surviving and non surviving shock patients. Arch Surg 106:630–636PubMedCrossRefGoogle Scholar
  3. 3.
    Goshng P, Bascom JU, Zikria B A (1996) Capillary leak, oedema and organ failure: breaking the triad Care Crit Ill 12:191–7Google Scholar
  4. 4.
    Mitchell JP, Schuller D, Calandrino FS, Schuster DP (1992) Improved outcome based on fluid management in critically ill patients requiring pulmonary artery cathetarization. Am Rev Respir Disl45:990–998Google Scholar
  5. 5.
    Chung HM, Kluge R, Schrier RW, Anderson RJ (1987) Clinical assessment of extracellular fluid volume in hyponatremia. Am J Med 83:905–908PubMedCrossRefGoogle Scholar
  6. 6.
    Shippy CR, Appel PL, Shoemaker WG (1984) Reliability of clinical monitoring to assess blood volume in critically ill patients. Crit Care Med 12:107–112PubMedCrossRefGoogle Scholar
  7. 7.
    Jones JG, Wardrop A J (2000) Measurement of blood volume in surgical and intensive care practice. Br J Anaesth 84:226–235PubMedCrossRefGoogle Scholar
  8. 8.
    McGee S, Abemethy WB, Simel DL (1999) Is the patient hypovolemic? JAMA 281:1022–1029PubMedCrossRefGoogle Scholar
  9. 9.
    Stephan F, Flahault A, Dieudonne N et al (2001) Clinical evaluation of circulating blood volume in critically ill patients-contribution of clinical scoring system. Br J Anaesth 86:754–762PubMedCrossRefGoogle Scholar
  10. 10.
    Thomas E, Jones G, Souza P de, et al (2000) Measuring blood volume with fluorescent-labeled hydroxyetil starch. Crit Care Med 28:627–631PubMedCrossRefGoogle Scholar
  11. 11.
    Henschen S, Busse MW, Zisowsky S, Panning B (1993) Determination of plasma volume and total blood volume using indocyanine green: a short review. J Med 24:10–27PubMedGoogle Scholar
  12. 12.
    Sakai I, Ishihara H, Iwakawa A, et al (1998) Ratio of indocyanine green and glucose dilutions detects capillary protein leakage following endotoxin injecton in dogs. Br J Anaesth 81:193–197PubMedCrossRefGoogle Scholar
  13. 13.
    Ishihara H, Iwakawa T, Hasegawa T, et al (1999) Does indocyanine green accurately measure plasma volume independently of its disappearance rate from plasma in critically ill patients. Intensive Care Med 25:1252–1258PubMedCrossRefGoogle Scholar
  14. 14.
    Kisch H, Leucht S, Lichtwark-Aschoff M, Pfeiffer UJ (1995) Accuracy and reproducibility of the measurement of actively circulating blood volume with an integrated fiberoptic monitoring system. Crit Care Med 23:885–893PubMedCrossRefGoogle Scholar
  15. 15.
    He YL, Tanigami H, Ueyama H, et al (1998) Measurement of blood volume using indocyanine green measured with pulse-spectrophotometry: its reproducibilty and relibility. Crit Care Med 26:1446–1451PubMedCrossRefGoogle Scholar
  16. 16.
    Iijima T, Iwao Y, Sakawa II (1998) Circulating blood volume measured by pulse dye-densitometry: comparison with 131I analysis. Anesthesiology 89:1329–1335PubMedCrossRefGoogle Scholar
  17. 17.
    Sakka SG, Reinhart K, Wegscheider K, Meier Hellman A (2002) Comparison of cardiac output and circulating blood volumes by trans-pulmonary thermo-dye dilution and transcutaneous indocyanine green measurement in critcally ill patients. Chest 559–565Google Scholar
  18. 18.
    Saccomani MP, Bonadonna RC, Bier DM, et al (1996) A model to measure insulin effects on glucose transport and phosphorylation in muscle: a three tracer study. Am J Physiol 268: E712-E721Google Scholar
  19. 19.
    Ishihara H, Shimodate Y, Koh H, et al (1993) The initial distribution of glucose and cardiac output in the critically ill. Can J Anesth 40:28–31PubMedCrossRefGoogle Scholar
  20. 20.
    Ishihara H, Takamura K, Koh H, et al (1996) Does the initial distribution volume of glucose reflect the central extracellular fluid volume status in critically ill patients? Infusionstherapie Transfusionsmed 23:196–201Google Scholar
  21. 21.
    Michard F, Teboul JL (2002) Predictting fluid responsiveness in ICU patients. Chest 121: 2000–2008PubMedCrossRefGoogle Scholar
  22. 22.
    Thorborg P (2000) Is it time to use blood volume measurements as a clinical tool? Crit Care Med 28:883–884PubMedCrossRefGoogle Scholar

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© Springer-Verlag Italia 2003

Authors and Affiliations

  • M. Girardis
  • A. Roberti
  • A. Pasetto

There are no affiliations available

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