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The following is a summary of “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,” published in the March 2025 issue of Critical Care by Jardot et al. 

Researchers conducted a retrospective study on hemodynamic profiles of fluid replacement therapies during major surgical hemorrhage, comparing pulse pressure variation (PPV), plethysmographic variation index (PVI), cardiac output (CO), and Guyton’s approach in detecting hypovolemia.  

They performed a randomized controlled trial (RCT) on fluid replacement therapy in 42 individuals for hemorrhage. Participants received either 5% albumin (12 mL/kg) or 20% albumin (3 mL/kg) over 30 minutes, both followed by Ringer lactate (RL) in a 1:1 ratio for blood loss replacement or Ringer solution alone in a 3:1 ratio. Measurements included CO, PPV, PVI, arterial and central venous pressures, and heart rate (HR). Guyton’s physiological parameters were calculated, and CO was assessed using an esophageal Doppler probe.  

The results showed that the Ringer-only program led to slight hypovolemia (mean, 313 mL), lower mean arterial pressure (MAP), higher HR, PPV, and increased vasopressor use. The 5% and 20% albumin programs provided better vascular filling, with higher mean circulatory filling pressure and stable or reduced PPV over 5 hours. The 20% albumin increased systemic vascular resistance (SVR) and resistance to venous return (RVR). Receiver operating characteristic (ROC) curves indicated that PPV accurately detected hypovolemia >500 mL with 5% albumin, PVI was reliable with Ringer solution, and CO identified hypovolemia with 20% albumin.  

Investigators concluded that while PPV, PVI, and CO trends mirrored intravascular volume changes, their accuracy in detecting hypovolemia exceeding 500mL varied with infusion fluid, and non-invasive hemodynamic monitors exhibited limited predictive value in identifying hypovolemia. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-025-05357-z