title: Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment.
abstract: The aim of this study was to compare stroke volume (SVI) to cardiac index (CI) guided resuscitation in a bleeding-resuscitation experiment. Twenty six pigs were randomized and bled in both groups till baseline SVI (T bsl) dropped by 50% (T 0), followed by resuscitation with crystalloid solution until initial SVI or CI was reached (T 4). Similar amount of blood was shed but animals received significantly less fluid in the CI-group as in the SVI-group: median = 900 (interquartile range: 850-1780) versus 1965 (1584-2165) mL, p = 0.02, respectively. In the SVI-group all variables returned to their baseline values, but in the CI-group animals remained underresuscitated as indicated by SVI, heart rate (HR) and stroke volume variation (SVV), and central venous oxygen saturation (ScvO2) at T 4 as compared to T bsl: SVI = 23.8 ± 5.9 versus 31.4 ± 4.7 mL, HR: 117 ± 35 versus 89 ± 11/min SVV: 17.4 ± 7.6 versus 11.5 ± 5.3%, and ScvO2: 64.1 ± 11.6 versus 79.2 ± 8.1%, p < 0.05, respectively. Our results indicate that CI-based goal-directed resuscitation may result in residual hypovolaemia, as bleeding caused stress induced tachycardia "normalizes" CI, without restoring adequate SVI. As the SVI-guided approach normalized most hemodynamic variables, we recommend using SVI instead of CI as the primary goal of resuscitation during acute bleeding.
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
authors.forename: Krisztián
authors.initials: K
authors.lastname: Tánczos
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
authors.forename: Márton
authors.initials: M
authors.lastname: Németh
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
authors.forename: Domonkos
authors.initials: D
authors.lastname: Trásy
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
authors.forename: Ildikó
authors.initials: I
authors.lastname: László
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Palágyi
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Szabó
authors.affiliation: Institute of Surgical Research, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Varga
authors.affiliation: Institute of Surgical Research, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
authors.forename: József
authors.initials: J
authors.lastname: Kaszaki
mesh_terms: D000818:Animals; D001784:Blood Gas Analysis; D000077324:Crystalloid Solutions; D005440:Fluid Therapy / Q000379:methods; D006439:Hemodynamics; D006470:Hemorrhage; D020896:Hypovolemia / Q000503:physiopathology* / Q000628:therapy*; D007552:Isotonic Solutions / Q000737:chemistry; D010100:Oxygen / Q000737:chemistry; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods*; D012769:Shock / Q000628:therapy; D013318:Stroke Volume / Q000502:physiology; D013552:Swine; D013610:Tachycardia / Q000209:etiology*
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010100:Oxygen