Predicting fluid responsiveness in patients undergoing cardiac surgery: functional haemodynamic parameters including the Respiratory Systolic Variation Test and static preload indicators
Department of Anesthesiology and Intensive Care, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
* Corresponding author. E-mail: preisman{at}netvision.net.il
Background. Prediction of the response of the left ventricular stroke volume to fluid administration remains an unsolved clinical problem. We compared the predictive performance of various haemodynamic parameters in the perioperative period in patients undergoing coronary artery bypass surgery. These parameters included static indicators of cardiac preload and functional parameters, derived from the arterial pressure waveform analysis. These included the systolic pressure variation (SPV) and its delta down component (dDown), pulse pressure variation (PPV), stroke volume variation (SVV), and a new parameter, termed the respiratory systolic variation test (RSVT), which is a measure of the slope of the lowest systolic pressure values during a standardized manoeuvre consisting of three successive incremental pressure-controlled breaths.
Methods. Eighteen patients were included into this prospective observational study. Seventy volume loading steps (VLS), each consisting of 250 ml of colloid administration were performed before surgery and after the closure of the chest. The response to each VLS was considered as a positive (increase in stroke volume more than 15%) or non-response. Receiver operating characteristic curves were plotted for each parameter to evaluate its predictive value.
Results. All functional parameters predicted fluid responsiveness better than the intrathoracic blood volume and the left ventricular end-diastolic area. Parameters with the best predictive ability were the RSVT and PPV.
Conclusions. Functional haemodynamic parameters are superior to static indicators of cardiac preload in predicting the response to fluid administration. The RSVT and PPV were the most accurate predictors of fluid responsiveness, although only the RSVT is independent of the settings of mechanical ventilation.
Presented in part at the Annual Meeting of American Society of Anesthesiologists, San Francisco, October 2003.
Declaration of interest. Azriel Perel, MD, is the inventor of the Respiratory Systolic Variation Test (US Patent # 5,769,082). He cooperates as an investigator with Draeger-Siemens in a clinical research project concerning the Respiratory Systolic Variation Test, and is a member of the medical advisory board of Pulsion Medical Systems, Munich, Germany.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. Derichard, E. Robin, B. Tavernier, M. Costecalde, M. Fleyfel, J. Onimus, G. Lebuffe, J.-P. Chambon, and B. Vallet Automated pulse pressure and stroke volume variations from radial artery: evaluation during major abdominal surgery Br. J. Anaesth., November 1, 2009; 103(5): 678 - 684. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Pestel, K. Fukui, V. Hartwich, P. M. Schumacher, A. Vogt, L. B. Hiltebrand, A. Kurz, Y. Fujita, D. Inderbitzin, and D. Leibundgut Automatic Algorithm for Monitoring Systolic Pressure Variation and Difference in Pulse Pressure Anesth. Analg., June 1, 2009; 108(6): 1823 - 1829. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R.-M. B.G.E. Breukers, R. J. Trof, R. B.P. de Wilde, P. C.M. van den Berg, J. W.R. Twisk, J. R.C. Jansen, and J. Groeneveld Relative value of pressures and volumes in assessing fluid responsiveness after valvular and coronary artery surgery Eur. J. Cardiothorac. Surg., January 1, 2009; 35(1): 62 - 68. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Muller, G. Louart, C. Bengler, P. Fabbro-Peray, J. Carr, J. Ripart, J.-E. de La Coussaye, and J.-Y. Lefrant The Intrathoracic Blood Volume Index as an Indicator of Fluid Responsiveness in Critically Ill Patients with Acute Circulatory Failure: A Comparison with Central Venous Pressure Anesth. Analg., August 1, 2008; 107(2): 607 - 613. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. E. Marik, M. Baram, and B. Vahid Does Central Venous Pressure Predict Fluid Responsiveness?: A Systematic Review of the Literature and the Tale of Seven Mares Chest, July 1, 2008; 134(1): 172 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Perel Automated Assessment of Fluid Responsiveness in Mechanically Ventilated Patients Anesth. Analg., April 1, 2008; 106(4): 1031 - 1033. [Full Text] [PDF]
|
|
|
|
|
|
J. O. Auler Jr., F. Galas, L. Hajjar, L. Santos, T. Carvalho, and F. Michard Online Monitoring of Pulse Pressure Variation to Guide Fluid Therapy After Cardiac Surgery Anesth. Analg., April 1, 2008; 106(4): 1201 - 1206. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Durairaj and G. A. Schmidt Fluid Therapy in Resuscitated Sepsis: Less Is More Chest, January 1, 2008; 133(1): 252 - 263. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Malhotra, M. Eikermann, and S. Magder Is Brachial Artery Peak Velocity Variation Ready for Prime Time? Chest, May 1, 2007; 131(5): 1279 - 1281. [Full Text] [PDF]
|
|
|
|
|
|
C. Runcie, B. Tavernier, H. Solus-Biguenet, M. Fleyfel, and B. Vallet Predicting fluid responsiveness in theatre Br. J. Anaesth., April 1, 2007; 98(4): 545 - 547. [Full Text] [PDF]
|
|
|
|
|
|
H. Solus-Biguenet, M. Fleyfel, B. Tavernier, E. Kipnis, J. Onimus, E. Robin, G. Lebuffe, C. Decoene, F. R. Pruvot, and B. Vallet Non-invasive prediction of fluid responsiveness during major hepatic surgery Br. J. Anaesth., December 1, 2006; 97(6): 808 - 816. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Mekontso-Dessap, L. Tual, M. Kirsch, G. D'Honneur, D. Loisance, L. Brochard, and J.-L. Teboul B-type natriuretic peptide to assess haemodynamic status after cardiac surgery Br. J. Anaesth., December 1, 2006; 97(6): 777 - 782. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Respiratory Systolic Variation Test to predict fluid responsiveness Br. J. Anaesth., July 1, 2006; 97(1): 118 - 118. [Full Text] [PDF]
|
|
E-letters:
Read all E-letters
- Is it Wise to Use Pressure Control-Derived Parameters to Predict Fluid Responsiveness?
- Frédéric Michard, et al.
- British Journal of Anaesthesia, 14 Dec 2005 [Full text]
- Yes but...
- Nevil P Hutchinson, et al.
- British Journal of Anaesthesia, 26 Jan 2006 [Full text]