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BioMed Research International
Volume 2015, Article ID 160979, 8 pages
http://dx.doi.org/10.1155/2015/160979
Research Article

Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment

1Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary
2Institute of Surgical Research, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary

Received 24 July 2015; Accepted 10 September 2015

Academic Editor: Mitja Lainscak

Copyright © 2015 Krisztián Tánczos et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 () dropped by 50% (), followed by resuscitation with crystalloid solution until initial SVI or CI was reached (). 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, , 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 () at as compared to : 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 : 64.1 ± 11.6 versus 79.2 ± 8.1%, , 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.