The Correlation between the Change in Thoracic Fluid Content and the Change in Patient Body Weight in Fontan Procedure.

Tae-Gyoon Yoon,Woon-Seok Kang,Chung-Sik Oh,Kyunghwan Jang,Seong-Hyop Kim

doi:10.1155/2018/3635708

Abstract

Background The thoracic fluid content (TFC) and its percent change compared to the baseline (TFCd0%) derived from a bioreactance technique using a noninvasive cardiac output monitoring (NICOM) device correlate well with the amount of fluid removal in patients undergoing hemodialysis and with intraoperative fluid balance in pediatric patients undergoing cardiac surgery. We hypothesized that TFC or TFCd0% would also be a useful indicator allowing fluid management in pediatric patients undergoing a Fontan procedure. Methods The medical records of patients who underwent an elective Fontan procedure were reviewed retrospectively. The intraoperative variables recorded at two time points were used in the analysis: when the NICOM data obtained just after anesthesia induction (T0) and just before transfer of the patient from the operating room to the ICU (T1). The analyzed variables were hemodynamic parameters, TFC, TFCd0%, stroke volume variation, body weight gain, change in the central venous pressure, and difference in the TFC (ΔTFC). Results The correlation coefficient between TFCd0% and body weight gain was 0.546 (p = 0.01); between TFCd0% and body weight gain% 0.572 (p = 0.007); and between TFCd0% and intraoperative fluid balance 0.554 (p = 0.009). The coefficient of determination derived from a linear regression analysis of TFCd0% versus body weight gain was 0.30 (p = 0.01); between TFCd0% and body weight gain% 0.33 (p = 0.007); and between TFCd0% and intraoperative fluid balance 0.31 (p = 0.009). Conclusions TFCd0% correlated well with body weight gain, body weight gain%, and intraoperative fluid balance. It is a useful indicator in the intraoperative fluid management of pediatric patients undergoing a Fontan procedure. Trial Registration This trial is registered with Clinical Research Information Service KCT0002062.

Highlights

During pediatric cardiac surgery, an accurate determination of the patient’s volume status, and the choice of an appropriate fluid management strategy are important factors leading to a stable hemodynamic status and a better clinical outcome
There were no differences in Mean arterial pressure (MAP), cardiac output (CO), and cardiac index (CI) at T1 versus T0, whereas HR, central venous pressure (CVP), thoracic fluid content (TFC), stroke volume variation (SVV), and body weight were significantly higher at T1 (p < 0.001, p < 0.001, p < 0.001, p = 0.009, and p < 0.001, resp.; Table 2)
The values of the correlation coefficients derived from the correlation analyses were acceptable, with the strongest correlations between TFCd0% and body weight gain and between body weight gain% and intraoperative fluid balance

Summary

Introduction

An accurate determination of the patient’s volume status, and the choice of an appropriate fluid management strategy are important factors leading to a stable hemodynamic status and a better clinical outcome. These considerations are even more important than in adult cardiac surgery, due to the potential for large fluid shifts compared with the pediatric patient’s small body surface area [1,2,3]. TFCd0% correlated well with body weight gain, body weight gain%, and intraoperative fluid balance It is a useful indicator in the intraoperative fluid management of pediatric patients undergoing a Fontan procedure. This trial is registered with Clinical Research Information Service KCT0002062

Methods

Results

Conclusion