Abstract
BackgroundHypotension is common in the early postoperative stages after abdominothoracic esophagectomy for esophageal cancer. We examined the ability of stroke volume variation (SVV), pulse pressure variation (PPV), central venous pressure (CVP), intrathoracic blood volume (ITBV), and initial distribution volume of glucose (IDVG) to predict fluid responsiveness soon after esophagectomy under mechanical ventilation (tidal volume >8 mL/kg) without spontaneous respiratory activity.MethodsForty-three consecutive non-arrhythmic patients undergoing abdominothoracic esophagectomy were studied. SVV, PPV, cardiac index (CI), and indexed ITBV (ITBVI) were postoperatively measured by single transpulmonary thermodilution (PiCCO system) after patient admission to the intensive care unit (ICU) on the operative day. Indexed IDVG (IDVGI) was then determined using the incremental plasma glucose concentration 3 min after the intravenous administration of 5 g glucose. Fluid responsiveness was defined by an increase in CI >15% compared with pre-loading CI following fluid volume loading with 250 mL of 10% low molecular weight dextran.ResultsTwenty-three patients were responsive to fluids while 20 were not. The area under the receiver-operating characteristic (ROC) curve was the highest for CVP (0.690) and the lowest for ITBVI (0.584), but there was no statistical difference between tested variables. Pre-loading IDVGI (r = −0.523, P <0.001), SVV (r = 0.348, P = 0.026) and CVP (r = −0.307, P = 0.046), but not PPV or ITBVI, were correlated with a percentage increase in CI after fluid volume loading.ConclusionsThese results suggest that none of the tested variables can accurately predict fluid responsiveness early after abdominothoracic esophagectomy.
Highlights
Hypotension is common in the early postoperative stages after abdominothoracic esophagectomy for esophageal cancer
We previously reported that initial distribution volume of glucose (IDVG), rather than intrathoracic blood volume (ITBV) or central venous pressure (CVP), is closely correlated with cardiac output (CO) during hypotension and subsequent fluid volume loading early after esophagectomy [8]
This study aimed to evaluate the ability of currently available preload variables such as stroke volume variation (SVV), pulse pressure variation (PPV), CVP, and ITBV as well as IDVG to predict fluid responsiveness early after admission to the intensive care unit (ICU) following abdominothoracic esophagectomy
Summary
Hypotension is common in the early postoperative stages after abdominothoracic esophagectomy for esophageal cancer. We examined the ability of stroke volume variation (SVV), pulse pressure variation (PPV), central venous pressure (CVP), intrathoracic blood volume (ITBV), and initial distribution volume of glucose (IDVG) to predict fluid responsiveness soon after esophagectomy under mechanical ventilation (tidal volume >8 mL/kg) without spontaneous respiratory activity. Only one study has measured SVV after esophagectomy, suggesting that SVV is clinically relevant as a guide of fluid volume management [7]. As this measurement was made in the presence of spontaneous respiratory activity (pressure support ventilation), it would be of limited use in evaluating fluid responsiveness. We hypothesized that studies into fluid responsiveness would be of limited value during such hemodynamically unstable states
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