Comparison of an automated respiratory systolic variation test with dynamic preload indicators to predict fluid responsiveness after major surgery
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Comparison of an automated respiratory systolic variation test with dynamic preload indicators to predict fluid responsiveness after major surgery. / Trepte, C J C; Eichhorn, V; Haas, S A; Stahl, K; Schmid, F; Nitzschke, R; Goetz, A E; Reuter, D A.
In: BRIT J ANAESTH, Vol. 111, No. 5, 01.11.2013, p. 736-42.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Comparison of an automated respiratory systolic variation test with dynamic preload indicators to predict fluid responsiveness after major surgery
AU - Trepte, C J C
AU - Eichhorn, V
AU - Haas, S A
AU - Stahl, K
AU - Schmid, F
AU - Nitzschke, R
AU - Goetz, A E
AU - Reuter, D A
PY - 2013/11/1
Y1 - 2013/11/1
N2 - BACKGROUND: Predicting the response of cardiac output to volume administration remains an ongoing clinical challenge. The objective of our study was to compare the ability to predict volume responsiveness of various functional measures of cardiac preload. These included pulse pressure variation (PPV), stroke volume variation (SVV), and the recently launched automated respiratory systolic variation test (RSVT) in patients after major surgery.METHODS: In this prospective study, 24 mechanically ventilated patients after major surgery were enrolled. Three consecutive volume loading steps consisting of 300 ml 6% hydroxyethylstarch 130/0.4 were performed and cardiac index (CI) was assessed by transpulmonary thermodilution. Volume responsiveness was considered as positive if CI increased by >10%.RESULTS: In total 72 volume loading steps were analysed, of which 41 showed a positive volume response. Receiver operating characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.70 for PPV, 0.72 for SVV and 0.77 for RSVT. Areas under the curves of all variables did not differ significantly from each other (P>0.05). Suggested cut-off values were 9.9% for SVV, 10.1% for PPV, and 19.7° for RSVT as calculated by the Youden Index.CONCLUSION: In predicting fluid responsiveness the new automated RSVT appears to be as accurate as established dynamic indicators of preload PPV and SVV in patients after major surgery. The automated RSVT is clinically easy to use and may be useful in guiding fluid therapy in ventilated patients.
AB - BACKGROUND: Predicting the response of cardiac output to volume administration remains an ongoing clinical challenge. The objective of our study was to compare the ability to predict volume responsiveness of various functional measures of cardiac preload. These included pulse pressure variation (PPV), stroke volume variation (SVV), and the recently launched automated respiratory systolic variation test (RSVT) in patients after major surgery.METHODS: In this prospective study, 24 mechanically ventilated patients after major surgery were enrolled. Three consecutive volume loading steps consisting of 300 ml 6% hydroxyethylstarch 130/0.4 were performed and cardiac index (CI) was assessed by transpulmonary thermodilution. Volume responsiveness was considered as positive if CI increased by >10%.RESULTS: In total 72 volume loading steps were analysed, of which 41 showed a positive volume response. Receiver operating characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.70 for PPV, 0.72 for SVV and 0.77 for RSVT. Areas under the curves of all variables did not differ significantly from each other (P>0.05). Suggested cut-off values were 9.9% for SVV, 10.1% for PPV, and 19.7° for RSVT as calculated by the Youden Index.CONCLUSION: In predicting fluid responsiveness the new automated RSVT appears to be as accurate as established dynamic indicators of preload PPV and SVV in patients after major surgery. The automated RSVT is clinically easy to use and may be useful in guiding fluid therapy in ventilated patients.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Airway Resistance
KW - Algorithms
KW - Anesthesia, General
KW - Arterial Pressure
KW - Automation
KW - Blood Pressure
KW - Cardiac Output
KW - Female
KW - Fluid Therapy
KW - Humans
KW - Male
KW - Middle Aged
KW - Monitoring, Physiologic
KW - Postoperative Care
KW - Postoperative Period
KW - Predictive Value of Tests
KW - Prospective Studies
KW - ROC Curve
KW - Respiratory Mechanics
KW - Stroke Volume
KW - Thermodilution
KW - Young Adult
U2 - 10.1093/bja/aet204
DO - 10.1093/bja/aet204
M3 - SCORING: Journal article
C2 - 23811425
VL - 111
SP - 736
EP - 742
JO - BRIT J ANAESTH
JF - BRIT J ANAESTH
SN - 0007-0912
IS - 5
ER -