title: A Theoretical Mathematical Model to Estimate Blood Volume in Clinical Practice.
abstract: Perioperative intravenous (IV) fluid management is controversial. Fluid therapy is guided by inaccurate algorithms and changes in the patient's vital signs that are nonspecific for changes to the patient's blood volume (BV). Anesthetic agents, patient comorbidities, and surgical techniques interact and further confound clinical assessment of volume status. Through adaptation of existing acute normovolemic hemodilution algorithms, it may be possible to predict patient's BV by measuring hematocrit (HcT) before and after hemodilution. Our proposed mathematical model requires the following four data points to estimate a patient's total BV: ideal BV, baseline HcT, a known fluid bolus (FB), and a second HcT following the FB. To test our method, we obtained 10 ideal and 10 actual subject BV data measures from 9 unique subjects derived from a commercially used Food and Drug Administration-approved, semi-automated, BV analyzer. With these data, we calculated the theoretical BV change following a FB. Using the four required data points, we predicted BVs (BVp) and compared our predictions with the actual BV (BVa) measures provided by the data set. The BVp calculated using our model highly correlated with the BVa provided by the BV analyzer data set (df = 8, r = .99). Our calculations suggest that, with accurate HcT measurement, this method shows promise for the identification of abnormal BV states such as hyper- and hypovolemia and may prove to be a reliable method for titrating IV fluid.
authors.affiliation: Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, MD, USA matthew.dangelo@usuhs.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: D'Angelo
authors.affiliation: Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, MD, USA.
authors.forename: R Kyle
authors.initials: RK
authors.lastname: Hodgen
authors.affiliation: Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, MD, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Wofford
authors.affiliation: School of Nursing, Duke University, Durham, NC, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Vacchiano
mesh_terms: D000465:Algorithms; D001810:Blood Volume; D005260:Female; D006400:Hematocrit; D006438:Hemodilution; D006801:Humans; D008962:Models, Theoretical; D011300:Preoperative Care; D014481:United States
keywords: blood volume determination; hematocrit; hemodilution; intravascular volume; intravenous infusions; mathematical model