TY - JOUR
T1 - Orthostatic intolerance after acute mild hypovolemia
T2 - incidence, pathophysiologic hemodynamics, and heart-rate variability analysis-a prospective observational cohort study
AU - Hristovska, Ana-Marija
AU - Uldall-Hansen, Bodil
AU - Mehlsen, Jesper
AU - Andersen, Louise B
AU - Kehlet, Henrik
AU - Foss, Nicolai B
N1 - © 2023. The Author(s).
PY - 2023/10
Y1 - 2023/10
N2 - PURPOSE: Early postoperative mobilization can be hindered by orthostatic intolerance (OI). Postoperative OI has multifactorial pathogenesis, possibly involving both postoperative hypovolemia and autonomic dysfunction. We aimed to investigate the effect of mild acute blood loss from blood donation simulating postoperative hypovolemia, on both autonomic function and OI, thus eliminating confounding perioperative factors such as inflammation, residual anesthesia, pain, and opioids.METHODS: This prospective observational cohort study included 26 blood donors. Continuous electrocardiogram data were collected during mobilization and night sleep, both before and after blood donation. A Valsalva maneuver and a standardized mobilization procedure were performed immediately before and after blood donation, during which cardiovascular and tissue oxygenation variables were continuously measured by LiDCOrapid™ and Massimo Root™, respectively. The incidence of OI, hemodynamic responses during mobilization and Valsalva maneuver, as well as heart rate variability (HRV) responses during mobilization and sleep were compared before and 15 min after blood donation.RESULTS: Prior to blood donation, no donors experienced OI during mobilization. After blood donation, 6/26 (23%; 95% CI, 9 to 44) donors experienced at least one OI symptom. Three out of 26 donors (12%; 95% CI, 2 to 30) terminated the mobilization procedure prematurely because of severe OI symptoms. Cardiovascular and cerebral tissue oxygenation responses were reduced in patients with severe OI. After blood loss, HRV indices of total autonomic power remained unchanged but increased sympathetic and decreased parasympathetic outflow was observed during mobilization, but also during sleep, indicating a prolonged autonomic effect of hypovolemia.CONCLUSION: We describe a specific hypovolemic component of postoperative OI, independent of postoperative autonomic dysfunction, inflammation, opioids, and pain.STUDY REGISTRATION: ClinicalTrials.gov (NCT04499664); registered 5 August 2020.
AB - PURPOSE: Early postoperative mobilization can be hindered by orthostatic intolerance (OI). Postoperative OI has multifactorial pathogenesis, possibly involving both postoperative hypovolemia and autonomic dysfunction. We aimed to investigate the effect of mild acute blood loss from blood donation simulating postoperative hypovolemia, on both autonomic function and OI, thus eliminating confounding perioperative factors such as inflammation, residual anesthesia, pain, and opioids.METHODS: This prospective observational cohort study included 26 blood donors. Continuous electrocardiogram data were collected during mobilization and night sleep, both before and after blood donation. A Valsalva maneuver and a standardized mobilization procedure were performed immediately before and after blood donation, during which cardiovascular and tissue oxygenation variables were continuously measured by LiDCOrapid™ and Massimo Root™, respectively. The incidence of OI, hemodynamic responses during mobilization and Valsalva maneuver, as well as heart rate variability (HRV) responses during mobilization and sleep were compared before and 15 min after blood donation.RESULTS: Prior to blood donation, no donors experienced OI during mobilization. After blood donation, 6/26 (23%; 95% CI, 9 to 44) donors experienced at least one OI symptom. Three out of 26 donors (12%; 95% CI, 2 to 30) terminated the mobilization procedure prematurely because of severe OI symptoms. Cardiovascular and cerebral tissue oxygenation responses were reduced in patients with severe OI. After blood loss, HRV indices of total autonomic power remained unchanged but increased sympathetic and decreased parasympathetic outflow was observed during mobilization, but also during sleep, indicating a prolonged autonomic effect of hypovolemia.CONCLUSION: We describe a specific hypovolemic component of postoperative OI, independent of postoperative autonomic dysfunction, inflammation, opioids, and pain.STUDY REGISTRATION: ClinicalTrials.gov (NCT04499664); registered 5 August 2020.
KW - Blood Pressure/physiology
KW - Heart Rate/physiology
KW - Hemodynamics
KW - Hemorrhage
KW - Humans
KW - Hypovolemia/epidemiology
KW - Incidence
KW - Inflammation
KW - Orthostatic Intolerance/epidemiology
KW - Pain
KW - Prospective Studies
KW - heart rate variability
KW - hemodynamics
KW - hypovolemia
KW - orthostatic intolerance
KW - perioperative care
UR - http://www.scopus.com/inward/record.url?scp=85172678504&partnerID=8YFLogxK
U2 - 10.1007/s12630-023-02556-6
DO - 10.1007/s12630-023-02556-6
M3 - Journal article
C2 - 37752379
SN - 0832-610X
VL - 70
SP - 1587
EP - 1599
JO - Canadian journal of anaesthesia = Journal canadien d'anesthesie
JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie
IS - 10
ER -