Extravascular Lung Water Does Not Increase in Hypovolemic Patients after a Fluid-Loading Protocol Guided by the Stroke Volume Variation

Carlos Ferrando,Gerardo Aguilar,F Javier Belda

doi:10.1155/2012/437659

Abstract

Introduction. Circulatory failure secondary to hypovolemia is a common situation in critical care patients. Volume replacement is the first option for the treatment of hypovolemia. A possible complication of volume loading is pulmonary edema, quantified at the bedside by the measurement of extravascular lung water index (ELWI). ELWI predicts progression to acute lung injury (ALI) in patients with risk factors for developing it. The aim of this study was to assess whether fluid loading guided by the stroke volume variation (SVV), in patients presumed to be hypovolemic, increased ELWI or not. Methods. Prospective study of 17 consecutive postoperative, fully mechanically ventilated patients diagnosed with circulatory failure secondary to presumed hypovolemia were included. Cardiac index (CI), ELWI, SVV, and global end-diastolic volume index (GEDI) were determined using the transpulmonary thermodilution technique during the first 12 hours after fluid loading. Volume replacement was done with a strict hemodynamic protocol. Results. Fluid loading produced a significant increase in CI and a decrease in SVV. ELWI did not increase. No correlation was found between the amount of fluids administered and the change in ELWI. Conclusion. Fluid loading guided by SVV in hypovolemic and fully mechanically ventilated patients in sinus rhythm does not increase ELWI.

Highlights

Circulatory failure secondary to hypovolemia is a common situation in critical care patients
There was a nonsignificant increase in the volumetric dynamic parameter, stroke volume index SVI (P = 0.168) and the static parameters global end-diastolic volume index (GEDI) (P = 0.456) and central venous pressure (CVP) (P = 0.151) and the contractility parameter cardiac function index (CFI) (P = 0.706)
We have demonstrated in postoperative patients that individualized fluid therapy guided by a dynamic parameter (SVV), increases cardiac index (CI) but does not increase pulmonary edema, as quantified by extravascular lung water

Summary

Introduction

Circulatory failure secondary to hypovolemia is a common situation in critical care patients. Many papers have shown that in patients in sinus rhythm during controlled mechanical ventilation the dynamic parameters (SVV; pulse pressure variation: PPV) predict more accurately fluid responsiveness than the static parameters (intrathoracic blood volume index: ITBI; central venous pressure: CVP) [3,4,5,6,7,8,9,10,11,12,13,14,15] These papers used different protocols for fluid loading which differed in the quantity, the type of fluid, and even the duration of the administration

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