Transfusion and surgical outcomes adjusted by RDW/albumin.

Transfusion and surgical outcomes adjusted by RDW/albumin.</p

Cox regression analysis of 5-year mortality.

Cox regression analysis of 5-year mortality.</p

Improvement in AUC and NRI by addition of RDW/albumin to clinical predictive models.

Improvement in AUC and NRI by addition of RDW/albumin to clinical predictive models.</p

Unreliable Tracking Ability of the Third-Generation FloTrac/Vigileo™ System for Changes in Stroke Volume after Fluid Administration in Patients with High Systemic Vascular Resistance during Laparoscopic Surgery

<div><p>Background</p><p>The FloTrac/Vigileo^™ system does not thoroughly reflect variable arterial tones, due to a lack of external calibration. The ability of this system to measure stroke volume and track its changes after fluid administration has not been fully evaluated in patients with the high systemic vascular resistance that can develop during laparoscopic surgery.</p><p>Methods</p><p>In 42 patients undergoing laparoscopic prostatectomy, the stroke volume derived by the third-generation FloTrac/Vigileo^™ system (SV-Vigileo), the stroke volume measured using transesophageal echocardiography (SV-TEE) as a reference method, and total systemic vascular resistance were evaluated before and after 500 ml fluid administration during pneumoperitoneum combined with the Trendelenburg position.</p><p>Results</p><p>Total systemic vascular resistance was 2159.4 ± 523.5 dyn·s/cm⁵ before fluid administration. The SV-Vigileo was significantly higher than the SV-TEE both before (68.8 ± 15.9 vs. 57.0 ± 11.0 ml, <i>P</i> < 0.001) and after (73.0 ± 14.8 vs. 64.9 ± 12.2 ml, <i>P</i> = 0.003) fluid administration. During pneumoperitoneum combined with the Trendelenburg position, Bland-Altman analysis for repeated measures showed a 53.8% of percentage error between the SV-Vigileo and the SV-TEE. Four-quadrant plot (69.2% of a concordance rate) and polar plot analysis (20.6° of a mean polar angle, 16.4° of the SD of a polar angle, and ±51.5° of a radial sector containing 95% of the data points) did not indicate a good trending ability of the FloTrac/Vigileo^™ system.</p><p>Conclusions</p><p>The third-generation FloTrac/Vigileo^™ system may not be useful in patients undergoing laparoscopic surgery, based on unreliable performance in measuring the stroke volume and in tracking changes in the stroke volume after fluid administration during pneumoperitoneum combined with the Trendelenburg position.</p></div

Bland-Altman plot for the difference between the SV-TEE and the SV-Vigileo during pneumoperitoneum combined with the steep Trendelenburg position.

<p>SV-TEE, stroke volume measured using transesophageal echocardiography; SV-Vigileo, stroke volume derived by the third-generation FloTrac/Vigileo^™ system.</p

Demographics and preoperative characteristics.

<p>Data are presented as mean ± SD or number (percentage).</p><p>Demographics and preoperative characteristics.</p

Hemodynamic data at different time points.

<p>Data are presented as mean ± SD. T₀, after anesthetic induction in supine position; T₁, 3 minutes after the steep Trendelenburg position (35°) was added to pneumoperitoneum during which time insufflation pressure was set to 15 mmHg; T₂, 3 minutes after 500 ml of colloid infusion in T₁; SV-Vigileo, stroke volume derived by the FloTrac/Vigileo^™ system; SV-TEE, stroke volume measured using transesophageal echocardiography; MABP, mean arterial blood pressure; HR, heart rate; TSVR, total systemic vascular resistance; AC, arterial compliance.</p><p>*P < 0.05 vs T₀;</p><p>^† P < 0.05 vs T₁.</p><p>Hemodynamic data at different time points.</p

Correlation analyses

<p>(A) between total systemic vascular resistance (TSVR) and the differences between the stroke volumes measured using transesophageal echocardiography (SV-TEE) and the third-generation FloTrac/Vigileo^™ system (SV-Vigileo) and (B) between arterial compliance the differences between the SV-TEE and the SV-Vigileo.</p

The four-quadrant plot and polar plot analysis.

<p>These figures identify an unreliable ability of the third-generation FloTrac/Vigileo^™ system to track changes in the stroke volume after fluid administration in the high systemic vascular resistance state observed during laparoscopic prostatectomy. (A) The four-quadrant plot analysis shows a concordance rate of 69.2%, when applying an exclusion zone of 15%. (B) The polar plot analysis shows a mean polar angle of 20.6° and a radial sector containing 95% of the data points of ±51.5%, when applying an exclusion zone of 10%.</p