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Critical Care (London, England) Feb 2024Volume replacement with crystalloid fluid is the conventional treatment of hemorrhage. We challenged whether a standardized amount of 5% or 20% albumin could be a viable... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Volume replacement with crystalloid fluid is the conventional treatment of hemorrhage. We challenged whether a standardized amount of 5% or 20% albumin could be a viable option to maintain the blood volume during surgery associated with major hemorrhage. Therefore, the aim of this study was to quantify and compare the plasma volume expansion properties of 5% albumin, 20% albumin, and Ringer-lactate, when infused during major surgery.
METHODS
In this single-center randomized controlled trial, fluid replacement therapy to combat hypovolemia during the hemorrhagic phase of cystectomy was randomly allocated in 42 patients to receive either 5% albumin (12 mL/kg) or 20% albumin (3 mL/kg) over 30 min at the beginning of the hemorrhagic phase, both completed by a Ringer-lactate replacing blood loss in a 1:1 ratio, or Ringer-lactate alone to replace blood loss in a 3:1 ratio. Measurements of blood hemoglobin over 5 h were used to estimate the effectiveness of each fluid to expand the blood volume using the following regression equation: blood loss plus blood volume expansion = factor + volume of infused albumin + volume of infused Ringer-lactate.
RESULTS
The median hemorrhage was 848 mL [IQR: 615-1145]. The regression equation showed that the Ringer-lactate solution expanded the plasma volume by 0.18 times the infused volume while the corresponding power of 5% and 20% albumin was 0.74 and 2.09, respectively. The Ringer-lactate only fluid program resulted in slight hypovolemia (mean, - 313 mL). The 5% and 20% albumin programs were more effective in filling the vascular system; this was evidenced by blood volume changes of only + 63 mL and - 44 mL, respectively, by long-lasting plasma volume expansion with median half time of 5.5 h and 4.8 h, respectively, and by an increase in the central venous pressure.
CONCLUSION
The power to expand the plasma volume was 4 and almost 12 times greater for 5% albumin and 20% albumin than for Ringer-lactate, and the effect was sustained over 5 h. The clinical efficacy of albumin during major hemorrhage was quite similar to previous studies with no hemorrhage.
TRIAL REGISTRATION
ClinicalTrials.gov NCT05391607, date of registration May 26, 2022.
Topics: Humans; Albumins; Blood Volume; Hemodynamics; Hemorrhage; Hypovolemia; Isotonic Solutions; Ringer's Lactate; Ringer's Solution
PubMed: 38317178
DOI: 10.1186/s13054-024-04821-6 -
JACC. Heart Failure Sep 2020
Topics: Blood Volume; Heart Failure; Humans; Splanchnic Nerves; Sympathetic Nervous System
PubMed: 32535121
DOI: 10.1016/j.jchf.2020.04.009 -
Critical Care (London, England) Jul 2021
Topics: Albumins; Blood Volume; COVID-19; Critical Illness; Humans
PubMed: 34332641
DOI: 10.1186/s13054-021-03699-y -
Blood Purification 2018Volume overload is an important, may be the foremost, independent prognostic factor determining the outcome of hemodialysis patients. Therefore, it is crucial to measure... (Review)
Review
Volume overload is an important, may be the foremost, independent prognostic factor determining the outcome of hemodialysis patients. Therefore, it is crucial to measure fluid status of these patients and avoid volume overload. This review aims to evaluate volume overload, its effects on patients with renal diseases and current methodologies measuring volume status in the body. These techniques will be first classified as clinical evaluation and non-clinical and/or instrumental techniques, which includes biomarkers, ultrasonography, relative blood volume monitoring, bioimpedance, echocardiography, pulmonary artery catheterization, esophageal and/or suprasternal Doppler, and blood viscosity. Advantages and limitations of these different techniques will be reviewed extensively by comparing each other. At last, insights gained from this review can highlight the future prospects in this active area of research.
Topics: Blood Volume; Electric Impedance; Humans; Kidney Failure, Chronic; Renal Dialysis; Ultrasonography; Water-Electrolyte Imbalance
PubMed: 29649794
DOI: 10.1159/000487702 -
Anaesthesiology Intensive Therapy 2022The mean systemic filling pressure (Pms) plays a central role for our understanding of the circulation. In a retrospective analysis of a clinical trial, we studied...
PURPOSE
The mean systemic filling pressure (Pms) plays a central role for our understanding of the circulation. In a retrospective analysis of a clinical trial, we studied whether Pms indicates fluid responsiveness and whether Pms can indicate an anaesthesia-induced increase of the unstressed blood volume, which is the volume that does not increase the transmural pressure.
METHODS
An analogue to P ms based on cardiac output, the mean arterial pressure and the central venous pressure, abbreviated to P msa , were calculated in 86 patients before induction of general anaesthesia and before 3 successive bolus infusions of 3 mL kg -1 of colloid fluid. An increase in stroke volume of ≥ 10% from a bolus infusion indicated fluid responsiveness. Receiver operator characteristic (ROC) curves were used to find the optimal cut-off for P msa to indicate fluid responsiveness. Changes in blood volume were estimated from anthropometric data and the haemodilution.
RESULTS
Pmsa was lower in fluid responders than in non-responders before induction (13.2 ± 2.2 vs. 14.7 ± 2.7 mmHg; mean ± SD, P < 0.01) and after induction of general anaesthesia (11.4 ± 2.1 vs. 12.8 ± 2.1 mmHg; P < 0.006). ROC curves showed that 14 mmHg before anaesthesia and 12 mmHg after anaesthesia induction served as optimal cut-offs for P msa to indicate fluid responsiveness. A linear correlation between P msa and blood volume changes suggested that the anaesthesia increased the unstressed blood volume by 1.2 L.
CONCLUSIONS
P msa was lower in fluid responders than in non-responders. General anaesthesia increased the need for blood volume by 1.2 L.
Topics: Humans; Hemodynamics; Retrospective Studies; Cardiac Output; Stroke Volume; Blood Volume; Anesthesia, General; Fluid Therapy; Blood Pressure; ROC Curve
PubMed: 36734447
DOI: 10.5114/ait.2022.121003 -
Molecular Cancer Nov 2023The limited sensitivity of circulating tumor cell (CTC) detection in pancreatic adenocarcinoma (PDAC) stems from their extremely low concentration in the whole...
The limited sensitivity of circulating tumor cell (CTC) detection in pancreatic adenocarcinoma (PDAC) stems from their extremely low concentration in the whole circulating blood, necessitating enhanced detection methodologies. This study sought to amplify assay-sensitivity by employing diagnostic leukapheresis (DLA) to screen large blood volumes. Sixty patients were subjected to DLA, with a median processed blood volume of ~ 2.8 L and approximately 5% of the resulting DLA-product analyzed using CellSearch (CS). Notably, DLA significantly increased CS-CTC detection to 44% in M0-patients and 74% in M1-patients, yielding a 60-fold increase in CS-CTC enumeration. DLA also provided sufficient CS-CTCs for genomic profiling, thereby delivering additional genomic information compared to tissue biopsy samples. DLA CS-CTCs exhibited a pronounced negative prognostic impact on overall survival (OS), evidenced by a reduction in OS from 28.6 to 8.5 months (univariate: p = 0.002; multivariable: p = 0.043). Additionally, a marked enhancement in sensitivity was achieved (by around 3-4-times) compared to peripheral blood (PB) samples, with positive predictive values for OS being preserved at around 90%. Prognostic relevance of CS-CTCs in PDAC was further validated in PB-samples from 228 PDAC patients, consolidating the established association between CTC-presence and reduced OS (8.5 vs. 19.0 months, p < 0.001). In conclusion, DLA-derived CS-CTCs may serve as a viable tool for identifying high-risk PDAC-patients and aiding the optimization of multimodal treatment strategies. Moreover, DLA enables comprehensive diagnostic profiling by providing ample CTC material, reinforcing its utility as a reliable liquid-biopsy approach. This high-volume liquid-biopsy strategy presents a potential pathway for enhancing clinical management in this malignancy.
Topics: Humans; Pancreatic Neoplasms; Adenocarcinoma; Neoplastic Cells, Circulating; Liquid Biopsy; Biomarkers, Tumor; Blood Volume
PubMed: 37957606
DOI: 10.1186/s12943-023-01880-1 -
Circulation. Cardiovascular Imaging Aug 2022The pulmonary vasculature is essential for gas exchange and impacts both pulmonary and cardiac function. However, it is difficult to assess and its characteristics in...
BACKGROUND
The pulmonary vasculature is essential for gas exchange and impacts both pulmonary and cardiac function. However, it is difficult to assess and its characteristics in the general population are unknown. We measured pulmonary blood volume (PBV) noninvasively using contrast enhanced, dual-energy computed tomography to evaluate its relationship to age and symptoms among older adults in the community.
METHODS
The MESA (Multi-Ethnic Study of Atherosclerosis) is an ongoing community-based, multicenter cohort. All participants attending the most recent MESA exam were selected for contrast enhanced dual-energy computed tomography except those with estimated glomerular filtration rate <60 mL/min per 1.73 m. PBV was calculated by material decomposition of dual-energy computed tomography images. Multivariable models included age, sex, race/ethnicity, education, height, weight, smoking status, pack-years, and scanner model.
RESULTS
The mean age of the 727 participants was 71 (range 59-94) years, and 55% were male. The race/ethnicity distribution was 41% White, 29% Black, 17% Hispanic, and 13% Asian. The mean±SD PBV in the youngest age quintile was 547±180 versus 433±194 mL in the oldest quintile (<0.001), with an approximately linear decrement of 50 mL per 10 years of age ([95% CI, 32-67]; <0.001). Findings were similar with multivariable adjustment. Lower PBV was associated independently with a greater dyspnea after a 6-minute walk (=0.04) and greater composite dyspnea symptom scores (=0.02). Greater PBV was also associated with greater height, weight, lung volume, Hispanic race/ethnicity, and nonsmoking history.
CONCLUSIONS
Pulmonary blood volume was substantially lower with advanced age and was associated independently with greater symptoms scores in the elderly.
Topics: Aged; Aged, 80 and over; Blood Volume; Cohort Studies; Dyspnea; Female; Humans; Lung; Male; Middle Aged; Tomography, X-Ray Computed
PubMed: 35938411
DOI: 10.1161/CIRCIMAGING.122.014380 -
Cytometry. Part a : the Journal of the... Dec 2019
Topics: Blood Vessels; Blood Volume; Flow Cytometry; Humans; Theranostic Nanomedicine
PubMed: 31670875
DOI: 10.1002/cyto.a.23916 -
Biosensors Dec 2022Hemorrhage is the leading cause of preventable death from trauma. Accurate monitoring of hemorrhage and resuscitation can significantly reduce mortality and morbidity...
Hemorrhage is the leading cause of preventable death from trauma. Accurate monitoring of hemorrhage and resuscitation can significantly reduce mortality and morbidity but remains a challenge due to the low sensitivity of traditional vital signs in detecting blood loss and possible hemorrhagic shock. Vital signs are not reliable early indicators because of physiological mechanisms that compensate for blood loss and thus do not provide an accurate assessment of volume status. As an alternative, machine learning (ML) algorithms that operate on an arterial blood pressure (ABP) waveform have been shown to provide an effective early indicator. However, these ML approaches lack physiological interpretability. In this paper, we evaluate and compare the performance of ML models trained on nine ABP-derived features that provide physiological insight, using a database of 13 human subjects from a lower-body negative pressure (LBNP) model of progressive central hypovolemia and subsequent progressive restoration to normovolemia (i.e., simulated hemorrhage and whole blood resuscitation). Data were acquired at multiple repressurization rates for each subject to simulate varying resuscitation rates, resulting in 52 total LBNP collections. This work is the first to use a single ABP-based algorithm to monitor both simulated hemorrhage resuscitation. A gradient-boosted regression tree model trained on only the half-rise to dicrotic notch (HRDN) feature achieved a root-mean-square error (RMSE) of 13%, an R of 0.82, and area under the receiver operating characteristic curve of 0.97 for detecting decompensation. This single-feature model's performance compares favorably to previously reported results from more-complex black box machine learning models. This model further provides physiological insight because HRDN represents an approximate measure of the delay between the ABP ejected and reflected wave and therefore is an indication of cardiac and peripheral vascular mechanisms that contribute to the compensatory response to blood loss and replacement.
Topics: Humans; Blood Pressure; Blood Volume; Hemorrhage; Hypovolemia; Vital Signs
PubMed: 36551134
DOI: 10.3390/bios12121168 -
Respiratory Physiology & Neurobiology Feb 2016Lung function abnormalities occur in children with sickle cell disease (SCD) and may be associated with elevated pulmonary blood volume. To investigate that association,...
Lung function abnormalities occur in children with sickle cell disease (SCD) and may be associated with elevated pulmonary blood volume. To investigate that association, we determined whether blood transfusion in SCD children acutely increased pulmonary capillary blood volume (PCBV) and increased respiratory system resistance (Rrs5). Measurements of Rrs5 and spirometry were made before and after blood transfusion in 18 children, median age 14.2 (6.6-18.5) years. Diffusing capacity for carbon monoxide and nitric oxide were assessed to calculate the PCBV. Post transfusion, the median Rrs5 had increased from 127.4 to 141.3% predicted (p<0.0001) and pulmonary capillary blood volume from 39.7 to 64.1 ml/m2 (p<0.0001); forced expiratory volume in one second (p=0.0056) and vital capacity (p=0.0008) decreased. The increase in Rrs5 correlated with the increase in PCBV (r=0.50, p=0.0493). Increased pulmonary capillary blood volume may at least partially explain the lung function abnormalities in SCD children.
Topics: Adolescent; Anemia, Sickle Cell; Blood Transfusion; Blood Volume; Blood Volume Determination; Capillaries; Capillary Resistance; Carbon Monoxide; Child; Female; Forced Expiratory Volume; Humans; Lung; Male; Nitric Oxide; Spirometry; Treatment Outcome
PubMed: 26592148
DOI: 10.1016/j.resp.2015.11.006