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Fischer M.-O.,Caen University Hospital Center | Fischer M.-O.,University of Caen Lower Normandy | Guinot P.-G.,Amiens University Medical Center | Guinot P.-G.,French Institute of Health and Medical Research | And 7 more authors.
Minerva Anestesiologica | Year: 2016

Dynamic indices (based on cardiopulmonary interactions in mechanically ventilated patients in sinus rhythm) have been developed as simple tools for predicting fluid responsiveness in the absence of cardiac output monitoring. Although the earliest dynamic indices relied on the invasive measurement of pulse pressure variations or stroke volume variations, the most recently developed indices are based on non-invasive photoplethysmography. However, a number of confounding factors have been found which decrease the clinical value of these indices. The present experts' opinion explains why changes in dynamic indices during hemodynamic maneuvers might be an interesting alternative to using them accurately at bedside. © 2016 Edizioni Minerva Medica.

Mallat J.,Center Hospitalier Du Dr Schaffner | Barrailler S.,Center Hospitalier Du Dr Schaffner | Lemyze M.,Center Hospitalier Du Dr Schaffner | Pepy F.,Center Hospitalier Du Dr Schaffner | And 3 more authors.
PLoS ONE | Year: 2013

Introduction: To investigate whether the difference between sodium and chloride ([Na+] - [Cl-]) and anion gap corrected for albumin and lactate (AGcorr) could be used as apparent strong ion difference (SIDapp) and strong ion gap (SIG) surrogates (respectively) in critically ill patients. Methods: A total of 341 patients were prospectively observed; 161 were allocated to the modeling group, and 180 to the validation group. Simple regression analysis was used to construct a mathematical model between SIDapp and [Na+] - [Cl-] and between SIG and AGcorr in the modeling group. Area under the receiver operating characteristic (ROC) curve was also measured. The mathematical models were tested in the validation group. Results: in the modeling group, SIDapp and SIG were well predicted by [Na+] - [Cl-] and AGcorr (R2 = 0.973 and 0.96, respectively). Accuracy values of [Na+] - [Cl-] for the identification of SIDapp acidosis (<42.7 mEq/L) and alkalosis (>47.5 mEq/L) were 0.992 (95% confidence interval [CI], 0.963-1) and 0.998 (95%CI, 0.972-1), respectively. The accuracy of AGcorr in revealing SIG acidosis (>8 mEq/L) was 0.974 (95%CI: 0.936-0.993). These results were validated by showing excellent correlations and good agreements between predicted and measured SIDapp and between predicted and measured SIG in the validation group (R2 = 0.977; bias = 0±1.5 mEq/L and R2 = 0.96; bias = -0.2±1.8 mEq/L, respectively). Conclusions: SIDapp and SIG can be substituted by [Na+] - [Cl-] and by AGcorr respectively in the diagnosis and management of acid-base disorders in critically ill patients. © 2013 Mallat et al.

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