title: Intraoperative management of heart-lung interactions: "from hypothetical prediction to improved titration".
abstract: Extensive literature describes the suitability of dynamic parameters to predict responsiveness in fluid. However, based on heart-lung interactions, these parameters can have serious limitations, including the use of protective lung ventilation. Although the latter seems to be beneficial for healthy patients undergoing high-risk surgery, the intraoperative interpretation of dynamic parameters to predict fluid responsiveness can be hazardous. In this context, the attending physician could, alternatively, titrate the need of fluids with a small fluid challenge, which remains unaffected by low tidal volume, the presence of arrhythmia, or the presence of spontaneous ventilation. When intraoperative prediction of fluid responsiveness is required in mechanically ventilated patients, "improved" titration should be preferred to a hypothetical prediction.
authors.affiliation: Université de Bordeaux, adaptation cardiovasculaire à l'ischémie, U1034, 33600 Pessac, France; Inserm, adaptation cardiovasculaire à l'ischémie, U1034, 33600 Pessac, France; Service d'anesthésie-réanimation II, maison du Haut-Lévêque, groupe hospitalier Sud, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France. Electronic address: alexandre.ouattara@chu-bordeaux.fr.
authors.forename: A
authors.initials: A
authors.lastname: Ouattara
authors.affiliation: Université de Bordeaux, adaptation cardiovasculaire à l'ischémie, U1034, 33600 Pessac, France; Service d'anesthésie-réanimation II, maison du Haut-Lévêque, groupe hospitalier Sud, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France; Université de Bordeaux, bioingénierie tissulaire, U1026, 33000 Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Dewitte
authors.affiliation: Université de Bordeaux, adaptation cardiovasculaire à l'ischémie, U1034, 33600 Pessac, France; Inserm, adaptation cardiovasculaire à l'ischémie, U1034, 33600 Pessac, France; Service d'anesthésie-réanimation II, maison du Haut-Lévêque, groupe hospitalier Sud, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France.
authors.forename: H
authors.initials: H
authors.lastname: Rozé
mesh_terms: D005440:Fluid Therapy; D006321:Heart / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008168:Lung / Q000503:physiopathology*; D063087:Noninvasive Ventilation; D012121:Respiration, Artificial
keywords: Hemodynamic; Prediction; Prédiction; Respiration; Stroke volume; Titration; Volume d’éjection systolique