Accuracy of dynamic preload variables for predicting fluid responsiveness in patients with pediatric liver cirrhosis: A prospective study

Abstract

Background We have previously reported that dynamic preload variables predicted fluid responsiveness in adult patients with liver cirrhosis. However, pediatric patients with cirrhosis may present with unique hemodynamic characteristics, and therefore, the predictive accuracy of these variables in such patients must be clarified. Aims To investigate the accuracy of dynamic preload variables for predicting fluid responsiveness in pediatric patients with cirrhosis. Methods A total of 27 pediatric patients with cirrhosis undergoing orthotopic liver transplantation were enrolled in this study. Patients’ pulse pressure variation, stroke volume variation, stroke volume index, and central venous pressure were measured using the calibrated pulse contour cardiac output system. The plethysmographic variability index was measured using a Masimo Radical 7 co‐oximeter. During the hepatic dissection phase of the surgery, repeated intraoperative fluid challenges with 10 mL kg−1 of crystalloid within 15 minutes were administered. Fluid responsiveness was defined as an increase in stroke volume index of ≥15% after fluid challenge. Results A total of 61 fluid challenges were administered resulting in 15 fluid responders and 46 fluid nonresponders. Fluid challenge induced significant decreases in all three dynamic preload variables but not in the fluid nonresponders. However, the area under the receiver operating characteristic curves for pulse pressure variation, stroke volume variation, plethysmographic variability index, and central venous pressure for predicting fluid responsiveness were 0.67 (95% confidence interval: 0.52‐0.82; P = .0255), 0.68 (95% confidence interval: 0.54‐0.83; P = .0140), 0.56 (95% confidence interval: 0.40‐0.71; P = .4724), and 0.57 (95% confidence interval: 0.40‐0.74; P = .4192), respectively. Conclusions Dynamic preload variables do not predict fluid responsiveness in pediatric patients with liver cirrhosis.

Response to Han et al

“…We appreciate the insightful comments of Dr Han and colleagues regarding our report in which we demonstrate that dynamic preload variables do not predict fluid responsiveness in pediatric patients with liver cirrhosis 1 . We agree that applying a protective ventilation setting may influence the accuracy of dynamic preload variables.…”

Intraoperative fluid administration volumes during pediatric liver transplantation and postoperative outcomes: A multicenter analysis

“…However, the area under the receiver operating characteristic curves demonstrated only mild to moderate predictive ability for pulse pressure variation and stroke volume variation (0.67 and 0.68, respectively), and poor predictive ability for plethysmographic variability index (0.56). They also tested central venous pressure which similarly had a poor predictive ability with an area under the receiver operating characteristic curve test statistic of 0.57 22 . Larger, preferably multicenter studies are needed to further test the predictive ability of these dynamic preload variables to guide fluid resuscitation.…”

Perfusion index: Physical principles, physiological meanings and clinical implications in anaesthesia and critical care

“…PVI could also be an accurate tool to predict fluid responsiveness in children under mechanical ventilation in the operating theatre [73]. Nevertheless, results are conflicting among the studies performed in children and further studies are required to confirm the accuracy of PVI to predict fluid responsiveness in the paediatric population [73][74][75].…”