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Purpose The purpose of this prospective, observational study was to respiratory variation of stroke volume (stroke volume variation, SVV) against central venous pressure (CVP) and pulmonary artery diastolic pressure (PADP) as an estimate of right and left ventricular preload. Methods With IRB approval and informed consent, 31 patients undergoing living related renal transplantation were analyzed. Under general anesthesia with positive pressure ventilation, stroke volume index and SVV were continuously monitored with FloTrac/Vigileo monitor. Right ventricular end-diastolic volume index (RVEDVI) as well as CVP and PADP were continuously monitored with volumetric pulmonary artery catheter. Data of every 30 min interval were used for analysis. The relationship between RVEDVI and CVP, PADP, SVV was analyzed with non-linear regression and the goodness-of-fit was assessed with coefficient of determination ([R.sup.2]) of each regression curve. The ability of CVP, PADP and SVV to correctly differentiate RVEDVI 138 ml/ [m.sup.2], which were used to guide fluid administration, was also assessed with ROC analysis. Results Three hundred forty-eight data sets were obtained and analyzed. The goodness of fit between RVEDVI and SVV ([R.sup.2] = 0.48) was better than that between RVEDVI and CVP or PADP ([R.sup.2] = 0.19 and 0.33, respectively). The area under the ROC curve of SVV was significantly high compared to CVP or PADP. Conclusions This study confirmed the theoretical framework of right ventricular preload and ventricular filling pressure and respiratory variation of stroke volume. The result also suggests that SVV can correctly predict preload status compared to pressure-based indices. Keywords Preload responsiveness * Dynamic parameter * Static parameter * Right ventricular end-diastolic volume * Renal transplantation, Introduction Conventionally, pressure-based static parameter such as central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP) has been used to guide fluid therapy. However, the validity of CVP and [...]

The purpose of this prospective study was to evaluate the accuracy and trending ability of a four-wavelength pulse-total hemoglobinometer that continuously and noninvasively measures hemoglobin in surgical patients. With IRB approval and informed consent, spectrophotometric hemoglobin (SpHb) was measured with a pulse-total hemoglobinometer manufactured by Nihon Kohden Corp (Tokyo, Japan) and compared to the CO-oximeter equipped with blood gas analyzer. Two hundred twenty-five samples from 56 subjects underwent analysis. Bland-Altman analysis revealed that the bias ± precision of the current technology was 0.0 ± 1.4 g/dl and -0.2 ± 1.3 g/dl for total samples and samples with 8 < Hb < 11 g/dl, respectively. The percentages of samples with intermediate risk of therapeutic error in error grid analysis and the concordance rate of 4-quadrant trending assay was 17% and 77%, respectively. The Cohen kappa statistic for Hb < 10 g/dl was 0.38, suggesting that the agreement between SpHb and CO-oximeter-derived Hb was fair. Collectively, wide limits of agreement, especially at the critical level of hemoglobin, and less than moderate agreement against CO-oximeter-derived hemoglobin preclude the use of the pulse-total hemoglobinometer as a decision-making tool for transfusion. Keywords Hemoglobin * Spectrophotometric * Pulse oximeter, The determination of hemoglobin (Hb) concentration is an essential test to initiate or withhold blood transfusion during the perioperative period. Traditionally, it has been measured intermittently with a CO-oximeter in [...]

Background This prospective observational study compared the volume effect between hydroxyethyl starch (HES) and crystalloid solution and its context dependency in intraoperative goal-directed fluid management. Methods With institutional review board (IRB) approval, 35 patients undergoing major gastrointestinal surgery were enrolled. Fluid challenge consisting of 250 ml of either bicarbonate Ringer solution (BRS) or low molecular weight pentastarch (HES 70/0.5) was given to maintain stroke volume index >35 ml/[m.sup.2]. The context of fluid challenge was classified as related to either epidural block (EB) or blood loss (BL) or as nonspecific. The primary end point was the interval between index fluid challenge and the next fluid challenge, and the secondary end point was the hemodynamic parameter at the end of fluid challenge. Differences in these parameters in each clinical context were compared between BRS and HES 70/0.5. A p value Keywords Goal-directed fluid management * Hydroxyethyl starch * Crystalloid * Stroke volume * Gastrointestinal surgery, Introduction Goal-directed fluid management is recommended to facilitate early recovery after surgery [1, 2]. Although not explicitly defined, it consists of a combination of restrictive crystalloid administration and fluid challenge [...]