The use of cardiac output monitoring to guide the administration of intravenous fluid during hyperthermic intraperitoneal chemotherapy

Our plain-English summary of The use of cardiac output monitoring to guide the administration of intravenous fluid during hyperthermic intraperitoneal chemotherapy, by K. Thanigaimani, F. Mohamed, T. Cecil, et al (Colorectal Disease, 2013).

The study

• Authors: K. Thanigaimani, F. Mohamed, T. Cecil, B.J. Moran, J. Bell
• Journal: Colorectal Disease
• Published: 2013;15(12):1537-42
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim: The optimal strategy for intravenous (IV) fluid management during administration of hyperthermic intraperitoneal chemotherapy (HIPEC) is unclear. In this prospective study we describe the use of a LiDCOrapid™ (LiDCO, Cambridge, UK) cardiac output monitor to guide IV fluid management during cytoreductive surgery (CRS) with HIPEC. The aim of this study was to determine whether cardiac output monitoring will allow close maintenance of physiological parameters during the HIPEC phase.

Method: Twenty-five patients who underwent CRS combined with HIPEC were included in the study. Intra-operative IV fluid boluses were titrated using parameters measured by the LiDCOrapid™ monitor. Stroke volume variation was maintained below 10% with fluid boluses and mean arterial pressure was maintained within 20% of the baseline figure with vasopressors.

Results: There was no significant change in heart rate and cardiac output. The systemic vascular resistance dropped from an average of 966 dyn.s/cm-5 to 797 dyn s/cm(5) at 60 min during the HIPEC phase (P = 0.62) despite an increase in the dose of phenylepherine. The average total volume of fluid given was 748 ml in the first 30 min and 630 ml in the second 30 min with an average urine output of 307 and 445 ml, respectively. The change in lactate levels was not statistically or clinically significant.

Conclusion: LiDCOrapid™ is an effective noninvasive tool for guiding fluid management in this population. It allows the anaesthesiologist to maintain tight control of essential physiological parameters during a phase of the procedure in which there is a risk of renal injury.

Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

In plain English

This UK hospital study did not examine asbestos exposure. It looked at intravenous fluid management during cytoreductive surgery with heated chemotherapy delivered into the abdomen (HIPEC). Data were collected prospectively for one year from August 2009 on 25 consecutive patients: 21 with pseudomyxoma peritonei of appendiceal origin, three with peritoneal mesothelioma and one with a cystic teratoma. Results were reported for all 25 patients together. Fluid was given according to readings from a LiDCOrapid cardiac output monitor, to keep stroke volume variation below 10%. During HIPEC, average body temperature rose from 36.6°C to 37.8°C. Heart rate and cardiac output did not change significantly. Systemic vascular resistance fell on average from 966 to 797 dyn s/cm5 at 60 minutes (not statistically significant, P = 0.62). Average urine output fell from 307.4 ml in the first 30 minutes of HIPEC to 199.4 ml in the 30 minutes afterwards (P = 0.021). The authors judged small statistically significant changes in pH and base deficit not clinically significant. They concluded that the monitor was an effective noninvasive tool for guiding fluid management in this population.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective observational study (service evaluation) of consecutive surgical patients, with no comparison group
• Who was studied: 25 patients (4 men, 21 women; mean age 55, range 19–78) who had cytoreductive surgery with HIPEC at Basingstoke and North Hampshire Hospital, UK, from August 2009 for one year. 21 had pseudomyxoma peritonei of appendiceal origin, 3 had peritoneal mesothelioma and 1 had a cystic teratoma.
• Exposure: No asbestos exposure was studied. The intervention was intravenous fluid guided by a LiDCOrapid cardiac output monitor during 60 minutes of HIPEC. Stroke volume variation was kept below 10% with fluid boluses, and mean arterial pressure was kept within 20% of baseline with a phenylepherine infusion.
• Main results:
  • In all 25 patients, average body temperature rose from 36.6°C at the start of HIPEC to 37.8°C at 60 minutes and was 37.0°C 30 minutes after HIPEC ended.
  • Heart rate and cardiac output did not change significantly during HIPEC.
  • Average systemic vascular resistance fell from 966 (SD 382.8) to 797 (SD 248.6) dyn s/cm5 at 60 minutes and was 822 (SD 357.2) at 90 minutes. This change was not statistically significant (P = 0.62).
  • Average urine output fell significantly, from 307.4 ml over the first 30 minutes of HIPEC to 199.4 ml in the 30 minutes after HIPEC ended (P = 0.021).
  • Average fluid given was 748 ml in the first 30 minutes of HIPEC and 630 ml in the second 30 minutes.
  • pH changed from 7.36 to 7.34 (P = 0.026) and base deficit increased from 3.2 to 5.4 (P = 0.001). The authors described these changes as small and not clinically significant. The change in lactate was not statistically or clinically significant.
  • Two patients developed postoperative complications, including hospital-acquired pneumonia and prolonged ileus.
• The authors' conclusion: The authors concluded that the LiDCOrapid is an effective noninvasive tool for guiding fluid management in this population. They also concluded that matching fluid to urine output, as earlier studies suggested, may not be sufficient.
• Limitations the authors state:
  • The authors noted that the low number of these operations at individual centres will make it difficult to repeat, in this patient group, the kinds of studies done for other major surgery.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: HIPEC, Cytoreductive Surgery.

Related studies

• Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk? — N. Tsilimparis, C. Bockelmann, et al. (2013)
• Outcomes of cytoreduction with hyperthermic intraperitoneal chemotherapy: our experience at a midwest community hospital — B. Goslin, S. Sevak, et al. (2012)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Body surface area predicts plasma oxaliplatin and pharmacokinetic advantage in hyperthermic intraoperative intraperitoneal chemotherapy — J.C. Leinwand, G.E. Bates, et al. (2013)
• Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability — P.F. Bagnoli, F.C. Cananzi, et al. (2015)

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