The effect of fluid bolus administration on cerebral tissue oxygenation in post-cardiac arrest patients

      Abstract

      Purpose

      Fluid boluses (FB) are often used in post-cardiac arrest (CA) patients with haemodynamic instability. Although FB may improve cardiac output (CO) and mean arterial pressure (MAP), FB may also increase central venous pressure (CVP), reduce arterial PaO2, dilute haemoglobin and cause interstitial oedema. The aim of the present study was to investigate the net effect of FB administration on cerebral tissue oxygenation saturation (SctO2) in post-CA patients.

      Methods

      Pre-planned sub-study of the Neuroprotect post-CA trial (NCT02541591). Patients with anticipated fluid responsiveness based on stroke volume variation (SVV) or passive leg raising test were administered a FB of 500 ml plasma-lyte A (Baxter Healthcare) and underwent pre- and post-FB assessments of stroke volume, CO, MAP, CVP, haemoglobin, PaO2 and SctO2.

      Results

      52 patients (mean age 64 ± 12 years, 75% male) received a total of 115 FB. Although administration of a FB resulted in a significant increase of stroke volume (63 ± 22 vs 67 ± 23 mL, p = 0.001), CO (4,2 ± 1,6 vs 4,4 ± 1,7 L/min, p = 0.001) and MAP (74,8 ± 13,2 vs 79,2 ± 12,9 mmHg, p = 0.004), it did not improve SctO2 (68.54 ± 6.99 vs 68.70 ± 6.80%, p = 0.49). Fluid bolus administration also resulted in a significant increase of CVP (10,0 ± 4,5 vs 10,7 ± 4,9 mmHg, p = 0.02), but did not affect PaO2 (99 ± 31 vs 94 ± 31 mmHg, p = 0.15) or haemoglobin concentrations (12,9 ± 2,1 vs 12,8 ± 2,2 g/dL, p = 0.10). In a multivariate model, FB-induced changes in CO (beta 0,77; p = 0.004) and in CVP (beta −0,23; p = 0.02) but not in MAP (beta 0,02; p = 0.18) predicted post-FB ΔSctO2.

      Conclusions

      Despite improvements in CO and MAP, FB administration did not improve SctO2 in post-cardiac arrest patients.

      Keywords

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      References

        • Marik P.E.
        • Monnet X.
        • Teboul J.L.
        Hemodynamic parameters to guide fluid therapy.
        Ann Intensive Care. 2011; 1: 1
        • Malbrain M.L.N.G.
        • Van Regenmortel N.
        • Saugel B.
        • et al.
        Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy.
        Ann Intensive Care. 2018; 8: 66
        • Malbrain M.L.N.G.
        • Rice T.W.
        • Mythen M.
        • Wuyts S.
        It is time f or improved fluid stewardship.
        ICU Manage Practice. 2018; 18
        • Ameloot K.
        • De Deyne C.
        • Eertmans W.
        • et al.
        Early goal-directed haemodynamic optimization of cerebral oxygenation in comatose survivors after cardiac arrest: the Neuroprotect post-cardiac arrest trial.
        Eur Heart J. 2019; 40: 1804-1814
        • Ameloot K.
        • Genbrugge C.
        • Meex I.
        • et al.
        Is venous congestion associated with reduced cerebral oxygenation and worse neurological outcome after cardiac arrest?.
        Crit Care. 2016; 20https://doi.org/10.1186/s13054-016-1297-2
        • Ameloot K.
        • Genbrugge C.
        • Meex I.
        • et al.
        Low hemoglobin levels are associated with lower cerebral saturations and poor outcome after cardiac arrest.
        Resuscitation. 2015; 96: 280-286
        • Peberdy M.A.
        • Callaway C.W.
        • Neumar R.W.
        • et al.
        Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
        Circulation. 2010; 122https://doi.org/10.1161/CIRCULATIONAHA.110.971002
        • Ameloot K.
        • Genbrugge C.
        • Meex I.
        • et al.
        An observational near-infrared spectroscopy study on cerebral autoregulation in post-cardiac arrest patients: time to drop 'one-size-fits-all' hemodynamic targets?.
        Resuscitation. 2015; 90: 121-126
        • Sundgreen C.
        • Larsen F.S.
        • Herzog T.M.
        • Knudsen G.M.
        • Boesgaard S.
        • Aldershvile J.
        Autoregulation of cerebral blood flow in patients resuscitated from cardiac arrest.
        Stroke. 2001; 32: 128-132
        • Malbrain M.L.N.G.
        • Marik P.E.
        • Witters I.
        • et al.
        Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice.
        Anaesthesiol Intensive Ther. 2014; 46: 361-380
        • Genbrugge C.
        • Eertmans W.
        • Meex I.
        • et al.
        What is the value of regional cerebral saturation in post-cardiac arrest patients? A prospective observational study.
        Crit Care. 2016; 20https://doi.org/10.1186/s13054-016-1509-9
        • Bouzat P.
        • Suys T.
        • Sala N.
        • Oddo M.
        Effect of moderate hyperventilation and induced hypertension on cerebral tissue oxygenation after cardiac arrest and therapeutic hypothermia.
        Resuscitation. 2013; 84: 1540-1545
        • Weigl W.
        • Milej D.
        • Gerega A.
        • et al.
        Confirmation of brain death using optical methods based on tracking of an optical contrast agent: assessment of diagnostic feasibility.
        Sci Rep. 2018; 8https://doi.org/10.1038/s41598-018-25351-6