Abstract
Thoracic surgery using CO2 insufflation maintains closed-chest one-lung ventilation (OLV) that may provide the necessary heart–lung interaction for the dynamic indices to predict fluid responsiveness. We studied whether pulse pressure variation (PPV) and stroke volume variation (SVV) can predict fluid responsiveness during thoracoscopic surgery. Forty patients were enrolled in the study. OLV was performed with a tidal volume of 6 mL/kg at a positive end-expiratory pressure of 5 cm H2O, while CO2 was insufflated to the contralateral side at 8 mm Hg. Patients whose stroke volume index (SVI) increased ≥15% after fluid challenge (7 mL/kg) were defined as fluid responders. The predictive ability of PPV and SVV on fluid responsiveness was investigated using the area under the receiver-operator characteristic curve (AUROC), which was also assessed according to the right or left lateral decubitus position considering the intrathoracic location of the right-sided superior vena cava. AUROCs of PPV and SVV for predicting fluid responsiveness were 0.65 (95% confidence interval 0.47–0.83, p = 0.113) and 0.64 (95% confidence interval 0.45–0.82, p = 0.147), respectively. The AUROCs of indices did not exhibit any statistical significance according to position. Dynamic indices of preload cannot predict fluid responsiveness during one-lung ventilation with CO2 gas insufflation.
Highlights
Pulse pressure variation (PPV) and stroke volume variation (SVV) are widely used dynamic preload indices for fluid therapy and hemodynamic optimization under positive ventilation of general anesthesia [1]. These dynamic indices are dependent on the heart–lung interaction and, their reliability as predictors of fluid responsiveness has been shown to be inconsistent in one-lung ventilation (OLV) for thoracic surgery [2,3,4,5]
The present study results suggest that PPV and SVV obtained from the radial artery do r mL/kg) was performed with p-Value not predict fluid responsiveness when OLV
OLV with a tidal volume of 8 mL/kg and 25% stroke volume index (SVI) was used as a criterion for fluid responsiveness in surgery under thoracotomy and showed that the area under the receiver-operator characteristic curve (AUROC) was 0.90 (95% confidence interval, CI 0.809–0.991) [14]
Summary
Pulse pressure variation (PPV) and stroke volume variation (SVV) are widely used dynamic preload indices for fluid therapy and hemodynamic optimization under positive ventilation of general anesthesia [1] These dynamic indices are dependent on the heart–lung interaction and, their reliability as predictors of fluid responsiveness has been shown to be inconsistent in one-lung ventilation (OLV) for thoracic surgery [2,3,4,5]. Increased intrathoracic pressure in both thoracic cavities may exert a physical influence that can interfere with venous return even under OLV with low tidal volume [7], while maintaining closed-chest conditions These physiologic changes can theoretically provide the necessary heart–lung interaction that may allow the dynamic indices to predict fluid responsiveness, even during
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