Abstract
IntroductionStroke volume variation (SVV) has repeatedly been shown to be a reliable predictor of fluid responsiveness. Various devices allow automated clinical assessment of SVV. The aim of the present study was to compare prediction of fluid responsiveness using SVV, as determined by the FloTrac™/Vigileo™ system and the PiCCOplus™ system.MethodsIn patients who had undergone elective cardiac surgery, SVVFloTrac was determined via radial FloTrac sensor, and SVVPiCCO and pulse pressure variation were assessed via a femoral PiCCO catheter. Stroke volume was assessed by transpulmonary thermodilution. All variables were recorded before and after a volume shift induced by a change in body positioning (from 30° head-up position to 30° head-down position). Pearson correlation, t-test, and Bland-Altman analysis were performed. Area under the curve was determined by plotting receiver operating characteristic curves for changes in stroke volume in excess of 25%. P < 0.05 was considered statistically significant.ResultsBody positioning resulted in a significant increase in stroke volume; SVVFloTrac and SVVPiCCO decreased significantly. Correlations of SVVFloTrac and SVVPiCCO with change in stroke volume were similar. There was no significant difference between the areas under the curve for SVVFloTrac and SVVPiCCO; the optimal threshold values given by the receiver operating characteristic curves were 9.6% for SVVFloTrac (sensitivity 91% and specificity 83%) and 12.1% for SVVPiCCO (sensitivity 87% and specificity 76%). There was a clinically acceptable agreement and strong correlation between SVVFloTrac and SVVPiCCO.ConclusionSVVs assessed using the FloTrac™/Vigileo™ and the PiCCOplus™ systems exhibited similar performances in terms of predicting fluid responsiveness. In comparison with SVVPiCCO, SVVFloTrac has a lower threshold value.
Highlights
Stroke volume variation (SVV) has repeatedly been shown to be a reliable predictor of fluid responsiveness
Change in body position from 30° head-up to 30° head-down resulted in significantly increased stroke volume (SV), global end-diastolic volume (GEDV) and central venous pressure (CVP), whereas SVVFloTrac, SVVPiCCO and pulse pressure variation (PPV) significantly decreased (Table 1 and Figure 1)
stroke volume variation (SVV) as assessed using the modified FloTracTM/VigileoTM and the PiCCOplusTM systems were comparable predictors of SV changes related to a fluid shift manoeuvre in patients who had undergone off-pump coronary artery bypass grafting
Summary
Stroke volume variation (SVV) has repeatedly been shown to be a reliable predictor of fluid responsiveness. Fluid administration in critically ill patients is typically performed to increase cardiac preload, followed by a raise in cardiac output. Studies conducted during the past few years have shown that about 50% of critically ill patients do not exhibit the desired effect (they are not fluid responsive) [1]. Pressure preload variables (central venous pressure and pulmonary capillary wedge pressure), which continue to be used, often fail to provide reliable information regarding cardiac preload [2] and are incapable of predicting cardiac response to fluid therapy [3]. As an alternative to these static variables, a dynamic approach may be used in the form of preload monitoring to guide fluid therapy.
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