Predicting fluid responsiveness in mechanically ventilated children under general anaesthesia using dynamic parameters and transthoracic echocardiography

Neto, Edmundo Pereira de Souza; Grousson, S.; Duflo, Frédéric; Ducreux, Corinne; Joly, Hervé; Convert, J.; Mottolese, C; Dailler, Frédéric; Cannesson, Maxime

doi:10.1093/bja/aer090

Cited by 141 publications

(181 citation statements)

References 34 publications

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“…In contrast, Wajima et al 13 examined PVI in preoperative adults and reported no change in PVI or cardiac index after an infusion of 500 mL crystalloid. Pereira de Souza Neto et al 14 noted similar negative findings among intubated children before surgery.…”

Section: Resultsmentioning

confidence: 73%

Pleth Variability Index and Fluid Responsiveness of Hemodynamically Stable Patients After Cardiothoracic Surgery

Maughan¹,

Seigel²,

Napoli³

2015

American Journal of Critical Care

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Background Fluid responsiveness is a measure of preload dependence and is defined as an increase in cardiac output due to volume expansion. Recent publications have suggested that variation in amplitude of the pulse oximetry waveform may be predictive of fluid responsiveness. The pleth variability index (PVI) was developed as a noninvasive bedside measurement of this variation in the pulse oximetry waveform. Objectives To measure the discriminatory value of PVI for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution in patients after cardiothoracic surgery. Methods A prospective observational study of hemodynamically stable postoperative cardiac surgery patients with pulmonary artery catheters. A fingertip sensor was used to measure PVI. Vital signs, PVI, and cardiac index were measured before, during, and after passive leg raise. Fluid responsiveness was defined by increase in cardiac index of greater than 15% during passive leg raise. The discriminatory value of PVI was assessed by using the Wilcoxon method to measure the area under the receiver operating curve. Results In 13 months, 47 patients (24 receiving mechanical ventilation, 23 spontaneously breathing) were enrolled. Fluid responsiveness was noted in 42% of intubated patients and 48% of spontaneously breathing patients. PVI was not adequate to discriminate fluid responsiveness in intubated patients (area under curve, 0.63; P = .16) or spontaneously breathing patients (area under curve, 0.41; P = .75). Conclusions Among postoperative cardiac surgery patients, PVI is not reliable for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution, regardless of ventilatory status.

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Section: Resultsmentioning

confidence: 73%

Pleth Variability Index and Fluid Responsiveness of Hemodynamically Stable Patients After Cardiothoracic Surgery

Maughan¹,

Seigel²,

Napoli³

2015

American Journal of Critical Care

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“…The utility of this method of fluid challenging to determine fluid responsiveness has also been demonstrated in mechanically ventilated children in the postoperative period [40,41] (Fig. 17).…”

Section: Left Ventricular Outflow Tract (Lvot) Velocity Time Integralmentioning

confidence: 90%

Cardiac Ultrasonography in the critical care setting: a practical approach to asses cardiac function and preload for the “non-cardiologist”

Vermeiren¹,

Malbrain

Walpot³

2015

Anaesthesiol Intensive Ther

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Cardiac ultrasonography has become an indispensible tool in the management of hemodynamically unstable critically ill patients. Some consider it as the modern stethoscope. Echocardiography is non-invasive and safe while the modern portable devices allow to be used at the bedside in order to provide fast, specific and vital information regarding the hemodynamic status, as well as the function, structure and anatomy of the heart. In this review, we will give an overview of cardiac function in general followed by an assessment of left ventricular function using echocardiography with calculation of cardiac output, left ventricular ejection fraction (EF), fractional shortening, fractional area contraction, M mode EF, 2D planimetry and 3D volumetry. We will briefly discuss mitral annulus post systolic excursion (MAPSE), calculation of dP/dt, speckle tracking or eyeballing to estimate EF for the experienced user. In a following section, we will discuss how to assess cardiac preload and diastolic function in 4 simple steps. The first step is the assessment of systolic function. The next step assesses the left atrium. The third step evaluates the diastolic flow patterns and E/e' ratio. The final step integrates the information of the previous steps. Echocardiography is also the perfect tool to evaluate right ventricular function with tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging, together with inferior vena cava dimensions and systolic pulmonary artery pressure and right ventricular systolic pressure measurement. Finally, methods to assess fluid responsiveness with echocardiography are discussed with the inferior vena cava collapsibility index and the variation on left ventricle outflow tract peak velocity and velocity time integral. Cardiac ultrasonography is an indispensible tool for the critical care physician to assess cardiac preload, afterload and contractile function in hemodynamically unstable patients in order to fine-tune treatment with fluids, inotropes and/or vasopressors.

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“…All patients presented with an intracardiac shunt [5], which can lead to misinterpretation of dynamic indices of preload. Moreover, another study, not quoted in Yin and Ho's meta-analysis, concluded that PVI did not predict response to volume expansion in children [6]. The lack of accuracy of PVI in children could be explained by the changes in arterial, chest wall and lung compliance during childhood [6], and by the influence of age on vasomotor tone.…”

Section: A Replymentioning

confidence: 97%

Plethysmographic variability index: everywhere for everyone?

Desgranges¹,

Desebbe²

2012

Anaesthesia

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Predicting fluid responsiveness in mechanically ventilated children under general anaesthesia using dynamic parameters and transthoracic echocardiography

Abstract: In this study, ▵Vpeak was the most appropriate variable to predict fluid responsiveness.

Cited by 141 publications

References 34 publications

Pleth Variability Index and Fluid Responsiveness of Hemodynamically Stable Patients After Cardiothoracic Surgery

Pleth Variability Index and Fluid Responsiveness of Hemodynamically Stable Patients After Cardiothoracic Surgery

Cardiac Ultrasonography in the critical care setting: a practical approach to asses cardiac function and preload for the “non-cardiologist”

Plethysmographic variability index: everywhere for everyone?

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