Abstract
BackgroundThe present study aimed to evaluate the reliability of hemodynamic changes induced by lung recruitment maneuver (LRM) in predicting stroke volume (SV) increase after fluid loading (FL) in prone position.MethodsThirty patients undergoing spine surgery in prone position were enrolled. Lung-protective ventilation (tidal volume, 6–7 mL/kg; positive end-expiratory pressure, 5 cmH2O) was provided to all patients. LRM (30 cmH2O for 30 s) was performed. Hemodynamic variables including mean arterial pressure (MAP), heart rate, SV, SV variation (SVV), and pulse pressure variation (PPV) were simultaneously recorded before, during, and at 5 min after LRM and after FL (250 mL in 10 min). Receiver operating characteristic curves were generated to evaluate the predictability of SVV, PPV, and SV decrease by LRM (ΔSVLRM) for SV responders (SV increase after FL > 10%). The gray zone approach was applied for ΔSVLRM.ResultsAreas under the curve (AUCs) for ΔSVLRM, SVV, and PPV to predict SV responders were 0.778 (95% confidence interval: 0.590–0.909), 0.563 (0.371–0.743), and 0.502 (0.315–0.689), respectively. The optimal threshold for ΔSVLRM was 30% (sensitivity, 92.3%; specificity, 70.6%). With the gray zone approach, the inconclusive values ranged 25 to 75% for ΔSVLRM (including 50% of enrolled patients).ConclusionIn prone position, LRM-induced SV decrease predicted SV increase after FL with higher reliability than traditional dynamic indices. On the other hand, considering the relatively large gray zone in this study, future research is needed to further improve the clinical significance.Trial registrationUMIN Clinical Trial Registry UMIN000027966. Registered 28th June 2017.
Highlights
The present study aimed to evaluate the reliability of hemodynamic changes induced by lung recruitment maneuver (LRM) in predicting stroke volume (SV) increase after fluid loading (FL) in prone position
When the patients were turned to the prone position, both of stroke volume variation (SVV) and pulse pressure variation (PPV) significantly increased, while SV significantly decreased (T0 vs before recruitment maneuver in prone position (T1))
LRM induced a significant decrease in mean arterial pressure (MAP) and SV in both groups (T1 vs at the end of recruitment maneuver (T2))
Summary
The present study aimed to evaluate the reliability of hemodynamic changes induced by lung recruitment maneuver (LRM) in predicting stroke volume (SV) increase after fluid loading (FL) in prone position. Lung-protective ventilation, defined as lower tidal volume (6–7 mL/kg) and positive end-expiratory pressure (PEEP) (5–10 cm H2O), is becoming a standard of care for surgical patients and can improve the outcomes of postoperative patients [11, 12]. In this situation, the usefulness of dynamic indices in predicting fluid responsiveness is limited, reducing their applicability in daily clinical practice [13]. Lung-protective ventilation is commonly used in prone position; under this condition, the usefulness of dynamic indices is limited, as described in a previous report [16]
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