Impact of deep breathing on predictability of stroke volume variation in spontaneous breathing patients

Abstract

Background This study investigated the ability of stroke volume variation (SVV) during deep breathing to discriminate fluid responders among spontaneously breathing patients. Methods Thirty patients undergoing general anaesthesia were enrolled and assessed before anaesthetic induction. Haemodynamic variables, including stroke volume (SV) and SVV, were measured using the ClearSight system during normal breathing. After these measurements, each patient was required to maintain deep breathing (6 breaths min−1) and haemodynamic variables were recorded. Then, the table was adjusted to the Trendelenburg position (15°) for 2 minutes, and haemodynamic variables were measured. Receiver operating characteristic curves were created for SVV during normal and deep breathing, and the difference in SVV between normal and deep breathing (ΔSVV) to discriminate fluid responders (SV increase >10% after changing position). The correlation between SV increase and ΔSVV was examined using Pearson's correlation coefficient. The grey zone approach was used to assess the inconclusive range of the haemodynamic variables. Results Receiver operating characteristic curve analysis indicated that ΔSVV showed good reliability in predicting fluid responsiveness (AUC: 0.850; 95% CI: 0.672‐0.953; threshold: 4%, sensitivity: 75.0%, specificity: 88.9%], while SVV during normal breathing did not (AUC: 0.579; 95% CI: 0.386‐0.756)]. Although SVV during deep breathing exhibited acceptable predictability (AUC: 0.778; 95% CI: 0.589‐0.908), the sensitivity was not good (58.3%). With the grey zone approach, the inconclusive range of ΔSVV was small with the range of 1.4%‐4.2% (23% of patients). Conclusion Deep breathing could improve the reliability of dynamic indices in spontaneously breathing patients. Trial registration UMIN‐CTR, identifer: UMIN000027970. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000032040

Differences in Hemodynamic Response to Passive Leg Raising Tests during the Day in Healthy Individuals: The Question of Normovolemia

“…Deep and standardized breathing and measurement of IVC diameter 4 cm caudal to the IVC-right atrial junction improved the accuracy of the IVC collapsibility index to discriminate fluid responders (AUC 0.89-0.98) [40,41]. Forced [42] deep inspiratory breathing [43] or paced breathing with additional expiratory resistance [44] also demonstrated the improved predictive utility of PPV or SVV for detecting a fluid response during spontaneous breathing (AUC 0.85-0.91). However, these alternatives have not been fully investigated in healthy subjects.…”

Diagnostic Efficacy of Carotid Ultrasound for Predicting the Risk of Perioperative Hypotension or Fluid Responsiveness: A Meta-Analysis

“…Although PPV and SVV are conventional hemodynamic parameters widely used to evaluate fluid responsiveness in patients [ 38 , 39 , 40 ], their utilizations require invasive arterial catheterization, which may not be feasible in all clinical scenarios. In addition, despite the accuracy of these two methods in predicting fluid responsiveness in mechanically ventilated patients who receive a controlled tidal volume ventilation [ 41 , 42 ], their reliability may be compromised in patients who are not mechanically ventilated or those with spontaneous breathing. Moreover, the presence of arrhythmias or irregular cardiac cycles can significantly influence the precision of these parameters, thereby diminishing their reliability as perioperative hemodynamic indicators [ 43 ].…”