title: Assessment of Changes in Hemodynamics and Intrathoracic Fluid Using Electrical Cardiometry During Autologous Blood Harvest.
abstract: OBJECTIVE
  To evaluate the effect of autologous blood harvest (ABH)-induced volume shifts using electrical cardiometry (EC) in patients with pulmonary artery hypertension secondary to left heart disease.
  
  
  METHODS
  Prospective, randomized, controlled trial.
  
  
  METHODS
  A tertiary care hospital.
  
  
  METHODS
  The study comprised 50 patients scheduled to undergo heart valve replacement.
  
  
  METHODS
  Patients were divided randomly into 2 experimental groups that were distinguished by whether ABH was performed. Blood volume extracted in the test group was replaced simultaneously with 1:1 colloid (Tetraspan; B Braun Melsungen, Melsungen, Germany). Hemodynamic, respiratory, and EC-derived parameters were recorded at predefined set points (T1 [post-induction/pre-ABH] and T2 [20 minutes post-ABH]).
  
  
  RESULTS
  Withdrawal of 15% of blood volume in the ABH group caused significant reductions in thoracic fluid content (TFC) (-10.1% [-15.0% to -6.1%]); right atrial pressure (-23% [-26.6% to -17.6%]); mean arterial pressure (-12.6% [-22.2% to -3.8%]); airway pressures: (peak -6.2% [-11.7% to -2.8%] and mean -15.4% [-25.0% to -8.3%]); and oxygenation index (-10.34% [-16.4% to -4.8%]). Linear regression analysis showed good correlation between the percentage change in TFC after ABH and the percentage of change in right atrial pressure, stroke volume variation, autologous blood extracted, peak and mean airway pressures, and oxygen index.
  
  
  CONCLUSIONS
  In addition to its proven role in blood conservation, therapeutic benefits derived from ABH include decongestion of volume-loaded patients, decrease in TFC, and improved gas exchange. EC tracks beat-to-beat fluid and hemodynamic fluctuations during ABH and helps in the execution of an early patient-specific, goal-directed therapy, allowing for its safe implementation in patients with pulmonary hypertension secondary to left heart disease.
authors.affiliation: Department of Cardiac Anesthesiology, Cardio-Thoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India. Electronic address: jatin.narula.13@gmail.com.
authors.forename: Jitin
authors.initials: J
authors.lastname: Narula
authors.affiliation: Department of Cardiac Anesthesiology, Cardio-Thoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Kiran
authors.affiliation: Department of Cardiac Anesthesiology, Cardio-Thoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Poonam
authors.initials: P
authors.lastname: Malhotra Kapoor
authors.affiliation: Department of Cardiac Anesthesiology, Cardio-Thoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Minati
authors.initials: M
authors.lastname: Choudhury
authors.affiliation: Department of Cardio-Thoracic and Vascular Surgery, Cardio and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Palleti
authors.initials: P
authors.lastname: Rajashekar
authors.affiliation: Department of Cardio-Thoracic and Vascular Surgery, Cardio and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ujjwal
authors.initials: U
authors.lastname: Kumar Chowdhary
mesh_terms: D000328:Adult; D001826:Body Fluids / Q000502:physiology*; D002307:Cardiography, Impedance / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D057725:Operative Blood Salvage / Q000379:methods*; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D035423:Thoracic Cavity / Q000503:physiopathology*; D055815:Young Adult
keywords: autologous blood harvest; electrical cardiometry; goal directed therapy; heart valve replacement; thoracic fluid content