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Prediction of fluid responsiveness using lung recruitment manoeuvre in paediatric patients receiving lung-protective ventilation: A prospective observational study.

Abstract：

BACKGROUND:Pressure-based dynamic variables are poor predictors of fluid responsiveness in children, and their predictability is expected to reduce further during lung-protective ventilation with a low tidal volume. OBJECTIVE:We hypothesised that lung recruitment manoeuvre (LRM)-induced changes in dynamic variables improve their ability to predict fluid responsiveness in children. DESIGN:Prospective observational study. SETTING:Tertiary care children's hospital, single-centre study performed from June 2017 to May 2019. PATIENTS:We included patients less than 7 years of age undergoing cardiac surgery. Neonates and patients with pulmonary hypertension, significant dysrhythmia, ventricular ejection fraction of less than 30% or pulmonary disease were excluded. INTERVENTION:All patients were provided with lung-protective volume-controlled ventilation (tidal volume 6 ml kg, positive end-expiratory pressure 6 cmH2O). A LRM was applied with a continuous inspiratory pressure of 25 cmH2O for 20 s. MAIN OUTCOME MEASURE:The ability of dynamic variables to predict fluid responsiveness was evaluated by the area under the receiver operating characteristic curve [area under the curve (AUC)]. Fluid responsiveness was defined as an increase in the cardiac index by more than 15% with crystalloid administration (10 ml kg). RESULTS:Thirty patients were included in the final analysis, of whom 19 were responders. The baseline pleth variability index (PVI) (AUC 0.794, 95% confidence interval 0.608 to 0.919, P < 0.001) and LRM-induced PVI (AUC 0.711, 95% confidence interval 0.517 to 0.861, P = 0.026) could predict fluid responsiveness. The respiratory variation of pulse oximetry photoplethysmographic waveform and pulse pressure variation did not predict fluid responsiveness regardless of the LRM. CONCLUSION:The PVI is effective in predicting fluid responsiveness in paediatric patients with lung-protective ventilation regardless of a LRM. However, the LRM did not improve the ability of the other dynamic variables to predict fluid responsiveness in these patients. CLINICAL TRIAL REGISTRATION:www.clinicaltrials.gov identifier: NCT03184961.

journal_name

Eur J Anaesthesiol

journal_title

European journal of anaesthesiology

authors

Kim EH,Lee JH,Jang YE,Ji SH,Kim HS,Cho SA,Kim JT

doi

10.1097/EJA.0000000000001387

subject

Has Abstract

pub_date

2020-11-11 00:00:00

eissn

0265-0215

issn

1365-2346

pub_type

杂志文章

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Prediction of fluid responsiveness using lung recruitment manoeuvre in paediatric patients receiving lung-protective ventilation: A prospective observational study.