Goal-directed fluid therapy: stroke volume optimisation and cardiac dimensions in supine healthy humans.
BACKGROUND
Based on maximisation of cardiac stroke volume (SV), peri-operative individualised goal-directed fluid therapy improves patient outcome. It remains, however, unknown how fluid therapy by this strategy relates to filling of the heart during supine rest as reference for the anaesthetised patient and whether the heart becomes distended. To answer these questions, this study related SV to the diastolic filling of the heart while varying central blood volume (CBV) between hypo- and hyper-volaemia, simulating bleeding, and fluid loading, respectively, when exposing healthy human subjects to head-up (HUT) and head-down tilt (HDT).


METHODS
Twelve healthy volunteers underwent graded tilt from 20 degrees HDT to 30 degrees HUT. The end-diastolic dimensions of the heart were assessed by transthoracic echocardiography with independent evaluation of SV by Modelflow. The CBV was monitored by thoracic electrical admittance, central venous oxygenation and pressure, and arterial plasma atrial natriuretic peptide. Also, muscle and brain oxygenation were assessed by near infrared spectroscopy (n=7).


RESULTS
The HUT reduced the mentioned indices of CBV, the end-diastolic dimensions of the heart, and SV. Conversely, HDT-enhanced tissue oxygenation and the diastolic filling of the heart, but not SV.


CONCLUSIONS
In healthy supine humans, the heart is provided with a volume that is sufficient to secure a maximal SV without distending the heart. The implication for individualised goal-directed fluid therapy is that when a maximal SV is established for patients, cardiac pre-load is comparable to that of supine healthy subjects.
Jans
Ø
Ø
Department of Anaesthesia, The Copenhagen Muscle Research Centre, Copenhagen, Denmark. nhsecher@rh.regh.dk
Tollund
C
C
Bundgaard-Nielsen
M
M
Selmer
C
C
Warberg
J
J
Secher
N H
NH
D000328:Adult; D009320:Atrial Natriuretic Factor / Q000097:blood; D001810:Blood Volume / Q000502:physiology; D002496:Central Venous Pressure / Q000502:physiology; D004452:Echocardiography / Q000379:methods; D005440:Fluid Therapy / Q000379:methods*; D018475:Head-Down Tilt / Q000502:physiology; D006321:Heart / Q000033:anatomy & histology*; D006801:Humans; D008297:Male; D009929:Organ Size / Q000502:physiology; D010100:Oxygen / Q000097:blood; D012016:Reference Values; D019265:Spectroscopy, Near-Infrared; D013318:Stroke Volume / Q000502:physiology*; D016683:Supine Position
D009320:Atrial Natriuretic Factor; D010100:Oxygen