title: The use of cardiac output monitoring to guide the administration of intravenous fluid during hyperthermic intraperitoneal chemotherapy.
abstract: OBJECTIVE
  The optimal strategy for intravenous (IV) fluid management during administration of hyperthermic intraperitoneal chemotherapy (HIPEC) is unclear. In this prospective study we describe the use of a LiDCOrapid™ (LiDCO, Cambridge, UK) cardiac output monitor to guide IV fluid management during cytoreductive surgery (CRS) with HIPEC. The aim of this study was to determine whether cardiac output monitoring will allow close maintenance of physiological parameters during the HIPEC phase.
  
  
  METHODS
  Twenty-five patients who underwent CRS combined with HIPEC were included in the study. Intra-operative IV fluid boluses were titrated using parameters measured by the LiDCOrapid™ monitor. Stroke volume variation was maintained below 10% with fluid boluses and mean arterial pressure was maintained within 20% of the baseline figure with vasopressors.
  
  
  RESULTS
  There was no significant change in heart rate and cardiac output. The systemic vascular resistance dropped from an average of 966 dyn.s/cm-5 to 797 dyn s/cm(5) at 60 min during the HIPEC phase (P = 0.62) despite an increase in the dose of phenylepherine. The average total volume of fluid given was 748 ml in the first 30 min and 630 ml in the second 30 min with an average urine output of 307 and 445 ml, respectively. The change in lactate levels was not statistically or clinically significant.
  
  
  CONCLUSIONS
  LiDCOrapid™ is an effective noninvasive tool for guiding fluid management in this population. It allows the anaesthesiologist to maintain tight control of essential physiological parameters during a phase of the procedure in which there is a risk of renal injury.
authors.affiliation: Department of Anaesthetics, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
authors.forename: K
authors.initials: K
authors.lastname: Thanigaimani
authors.forename: F
authors.initials: F
authors.lastname: Mohamed
authors.forename: T
authors.initials: T
authors.lastname: Cecil
authors.forename: B J
authors.initials: BJ
authors.lastname: Moran
authors.forename: J
authors.initials: J
authors.lastname: Bell
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002302:Cardiac Output / Q000502:physiology*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000379:methods; D007022:Hypotension / Q000209:etiology / Q000628:therapy*; D007263:Infusions, Parenteral / Q000379:methods; D008297:Male; D008654:Mesothelioma / Q000628:therapy*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010534:Peritoneal Neoplasms / Q000628:therapy*; D010656:Phenylephrine / Q000627:therapeutic use; D011446:Prospective Studies; D011553:Pseudomyxoma Peritonei / Q000628:therapy*; D013724:Teratoma / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D014662:Vasoconstrictor Agents; D010656:Phenylephrine
keywords: HIPEC; Hyperthermic intraperitoneal chemotherapy; LiDCOrapid; cardiac output monitoring; cytoreduction surgery; pseudomyxoma