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The article

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From the DepartmeAnaesthesiology an(ME); Institute of NuLeipzig University HHamburg-EppendorMedicine, UniversityObstetrics and GynDepartment of AnaeRWTH Aachen, AacEpidemiology, RuhrUniversity HospitalGermany (KZ)

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GUIDELINES

Intravascular volume therapy

in adults

Guidelines from the Association of the Scientific MedicalSocieties in Germany

Gernot Marx, Achim W. Schindler, Christoph Mosch, Joerg Albers, Michael Bauer, Irmela Gnass,

Carsten Hobohm, Uwe Janssens, Stefan Kluge, Peter Kranke, Tobias Maurer, Waltraut Merz,

Edmund Neugebauer, Michael Quintel, Norbert Senninger, Hans-Joachim Trampisch,

Christian Waydhas, Rene Wildenauer, Kai Zacharowski and Michaela Eikermann

accompanied by the following Invited Commentary:

E, Afshari A, Longrois D. The quest for the holy volume therapy. Eur J Anaesthesiol 2016;

Index

Table of contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2List of abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2A. Rationale and goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

A1: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3A2: Initial situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3A3: Guideline requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4A4: Guideline objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4A5: Target user group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

B: Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4B1: Literature search and selection of evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Use of existing guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Systematic literature search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Selection of literature identified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

B2: Appraisal and extraction of evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

pean Society of Anaesthesiology. Unauthorized reproduction of this article is prohibited.

of Cardiothoracic and Vascular Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz (JA); Department oftensive Care Medicine, Jena University Hospital, Jena (MB); Institute for Research in Operative Medicine, Witten/Herdecke University, Cologneg Science and Practice, Paracelsus Private Medical University, Salzburg, Austria (IG); Department of Internal Medicine, Neurology and Dermatology,ital, Leibzig (CH); Department of Cardiology, St Antonius Hospital, Eschweiler (UJ); Centre for Intensive Care Medicine, Universitatsklinikum,K); Department of Anaesthesia and Critical Care, University Hospital of Wurzburg, Wurzburg (PK); Department of Intensive and Intermediate Carespital of RWTH Aachen, Aachen (GM); Urological Unit and Outpatient Clinic, University Hospital rechts der Isar, Munich (TM); Department of

ology, Bonn University Hospital, Bonn (WM); Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne (CM, EN);esiology, University Medical Centre Gottingen, Gottingen (MQ); Department of Intensive and Intermediate Care Medicine, University Hospital of(AWS); Department of General and Visceral Surgery, Munster University Hospital, Munster (NS); Department of Health Informatics, Biometry and

iversitat Bochum, Bochum (HJT); Department of Trauma Surgery, Essen University Hospital, Essen (CW); Department of General Surgery,urzburg, Wurzburg (RW); and Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt,

ofessor Gernot Marx, FRCA, Department of Intensive and Intermediate Care Medicine, University Hospital of RWTH Aachen, Pauwelsstr. 30,ny4; fax: +49 241 80 33 80 444; E-mail: gmarx@ukaachen.de

2016 European Society of Anaesthesiology. All rights reserved. DOI:10.1097/EJA.0000000000000447article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License, where it is permissible to

e work provided it is properly cited. The work cannot be changed in any way or used commercially.

mailto:gmarx@ukaachen.dehttp://dx.doi.org/10.1097/EJA.0000000000000447

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B3: Formulation and consensus-forming for recommendations and statements . . . . . . . . . . . . . . . . . . . . 6Formulation of recommendations and statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Consensus building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Grades of Recommendation (GoR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

B4 Dissemination and implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7B5: Quality indicators and evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7B6: Validity and revisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7B7: Funding and disclosure of possible conflicts of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Table of contentsOverall recommendations/statements: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Chapter 1: Diagnosis of hypovolaemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Chapter 2: Therapy during the fasting phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Chapter 3: Differences between peri-interventional and ICU patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Chapter 4a: Differences between colloids and crystalloids in peri-interventional patients . . . . . . . . . . . . . . 17Chapter 4b: Differences between colloids and crystalloids in ICU patients . . . . . . . . . . . . . . . . . . . . . . . . 18Chapter 5a: Differences between colloids in peri-interventional patients . . . . . . . . . . . . . . . . . . . . . . . . . . 20Chapter 5b: Differences between various colloids in ICU patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Chapter 6a: Differences between the crystalloids in peri-interventional patients . . . . . . . . . . . . . . . . . . . . 22Chapter 6b: Differences between crystalloids in ICU Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Chapter 7a: Management of volume therapy in peri-interventional patients . . . . . . . . . . . . . . . . . . . . . . . . 23Chapter 7b: Management of volume therapy in ICU patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

List of Abbreviations95% CI 95% confidence intervalAUC Area under the curve; usually this applies to the receiver operating characteristic curve.AWMF Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (Association of the

Scientific Medical Societies in Germany)CVP Central venous pressureDGAI Deutsche Gesellschaft fur Anaesthesiologie und Intensivmedizin (German Society of Anaesthesiology

and Intensive Care Medicine)DO2 (I) Oxygen delivery indexDSG Deutsche Sepsis-Gesellschaft (German Sepsis Society)EMA European Medicines AgencyFTc corrected aortic flow timeGEDV (I) Global end-diastolic volume (index)GEF Global ejection fractionGoR Grade of RecommendationHES Hydroxyethyl starchITBV (I) Intra-thoracic blood volume (index)ITTV Intra-thoracic thermal volumeIVC inferior vena cavaIQR Interquartile rangekgBW kilograms of body weightLoE Level of EvidenceLVEDV (I) Left ventricular enddiastolic volume (index)NaCl Sodium chlorideOR Odds ratioPAOP Pulmonary artery occlusion pressurePLR Passive leg raisingPPVar Pulse pressure variationPTV Pulmonary thermal volumeROC Receiver Operating Characteristic (Curve)

ight European Society of Anaesthesiology. Unauthorized reproduction of this article is prohibited.

Eur J Anaesthesiol 2016; 33:134

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Intravascular volume therapy in adults 3

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