Hemodynamics, fluids & transfusion
Detection of hypovolemia by non-invasive hemodynamic monitoring during major surgery using Ringer´s solution, 5% albumin, or 20% albumin as infusion fluid: a post-hoc analysis of a randomized clinical trial
Authors' conclusion
The trends in PPV, PVI, and CO reflected the changes in intravascular volume, but how well they indicated hypovolemia > 500 mL may differ depending on the choice of infusion fluid.
Study context
- Population
- Patients with hemorrhage during major surgery
- Participants
- 42 patients
- Comparison
- 5% albumin vs 20% albumin vs Ringer
- Primary endpoint
- Ability of PPV, PVI, CO and Guyton's approach to detect hypovolemia
Methodological detailspost-hoc analysis, single-centre
- Post-hoc analysis
- Single-centre
Primary result
As reported in the abstract
Detection of hypovolemia > 500 mL (ROC curves)
- Hypovolemia > 500 mL accurately detected by PPV only with 5% albumin
- Plethysmographic variation index (PVI) reliable with Ringer
- Cardiac output (CO) indicated hypovolemia with 20% albumin
Further findings
- Hemodynamic profile, Ringer-only program
- 313 · mean · mL
Hemodynamic profile, Ringer-only program
- Slight hypovolemia; decreased mean arterial pressure (MAP), increased HR, PPV and vasopressor requirement
Vascular filling, albumin programs · 5 h observation period
- 5% and 20% albumin more effective in filling the vascular system: higher mean circulatory filling pressure, unchanged or decreased PPV
- 20% albumin increased systemic vascular resistance and resistance to venous return
Original publication
Detection of hypovolemia by non-invasive hemodynamic monitoring during major surgery using Ringer´s solution, 5% albumin, or 20% albumin as infusion fluid: a post-hoc analysis of a randomized clinical trial. Crit Care. Published 23 March 2025. doi:10.
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