Variation of left ventricular outflow tract velocity and global end-diastolic volume index reliably predict fluid responsiveness in cardiac surgery patients.

Abstract:

PURPOSE:The ability of the global end-diastolic volume index (GEDVI) and respiratory variations in left ventricular outflow tract velocity (ΔVTI(LVOT)) for prediction of fluid responsiveness is still under debate. The aim of the present study was to challenge the predictive power of GEDVI and ΔVTI(LVOT) compared with pulse pressure variation (PPV) and stroke volume variation (SVV) in a large patient population. MATERIAL AND METHODS:Ninety-two patients were studied before coronary artery surgery. Each patient was monitored with central venous pressure (CVP), the PiCCO system (Pulsion Medical Systems, Munich, Germany), and transesophageal echocardiography. Responders were defined as those who increased their stroke volume index by greater than 15% (ΔSVI(TPTD) >15%) during passive leg raising. RESULTS:Central venous pressure showed no significant correlation with ΔSVI(TPTD) (r = -0.06, P = .58), in contrast to PPV (r = 0.71, P < .0001), SVV (r = 0.61, P < .0001), GEDVI (r = -0.54, P < .0001), and ΔVTI(LVOT) (r = 0.54, P < .0001). The best area under the receiver operating characteristic curve (AUC) predicting ΔSVI(TPTD) greater than 15% was found for PPV (AUC, 0.82; P < .0001) and SVV (AUC, 0.77; P < .0001), followed by ΔVTI(LVOT) (AUC, 0.74; P < .0001) and GEDVI (AUC, 0.71; P = .0006), whereas CVP was not able to predict fluid responsiveness (AUC, 0.58; P = .18). CONCLUSIONS:In contrast to CVP, GEDVI and ΔVTI(LVOT) reliably predicted fluid responsiveness under closed-chest conditions. Pulse pressure variation and SVV showed the highest accuracy.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Broch O,Renner J,Gruenewald M,Meybohm P,Höcker J,Schöttler J,Steinfath M,Bein B

doi

10.1016/j.jcrc.2011.07.073

subject

Has Abstract

pub_date

2012-06-01 00:00:00

pages

325.e7-13

issue

3

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(11)00366-2

journal_volume

27

pub_type

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