BJA Advance Access published online on October 12, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen277
Uncalibrated pulse contour-derived stroke volume variation predicts fluid responsiveness in mechanically ventilated patients undergoing liver transplantation
Service d’Anesthésie Réanimation 1, Hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
* Corresponding author. E-mail: francois.sztark{at}chu-bordeaux.fr
Background: Stroke volume variation (SVV) is able to predict adequately the individual response to fluid loading. Our objective was to assess whether the SVV measured by a new algorithm (VigileoTM; FlotracTM) can predict fluid responsiveness.
Methods: Forty mechanically ventilated patients undergoing liver transplantation, who needed volume expansion (VE), were included. VE was done with albumin (4%) 20 mlxBMI over 20 min. SVV, pulse pressure variation (PPV), central venous pressure (CVP), and pulmonary artery occlusion pressure (PAOP) were measured immediately before and after VE. Cardiac output (CO) measured by transthoracic echocardiography (CO-TTE) was used to define responder patients if CO increased by 15% or more after VE, or non-responder otherwise. CO obtained with the pulmonary artery catheter (CO-PAC) and with Vigileo (CO-Vigileo) were also recorded.
Results: Five patients were excluded. Seventeen patients were responders (Rs) and 18 were non-responders (NRs). Before VE (i) SVV and PPV were higher in Rs and (ii) CVP and PAOP were lower in Rs. Baseline SVV and PPV correlated with change in CO induced by VE (respectively, r2=0.72, P<0.0001; r2=0.84, P<0.0001). An SVV threshold of >10% discriminated Rs with a sensitivity of 94% and a specificity of 94%. After VE, the decrease in SVV was significantly correlated with the increase in CO (r2=0.51; P<0.0001). There was no difference between the area under the ROC curves of SVV and PPV. After VE, the change in CO-Vigileo was closely correlated with change in CO-TTE (r2=0.74, P<0.0001) and with change in CO-PAC (r2=0.77, P<0.0001).
Conclusions: The SVV obtained by the Vigileo system may be used as a predictor of fluid responsiveness in patients with circulatory failure after liver transplantation. CO-Vigileo is able to track the change in CO induced by VE.
Keywords: heart, cardiac output; liver, transplantation; measurement techniques, cardiac output; measurement techniques, Doppler echocardiography; monitoring, cardiopulmonary
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