Prediction of Fluid Responsiveness by the Effect of the Lung Recruitment Maneuver on the Perfusion Index in Mechanically Ventilated Patients During Surgery

Abstract

IntroductionExcessive or inadequate fluid administration during perioperative period affects outcomes. Adjustment of volume expansion (VE) by performing fluid responsiveness (FR) test plays an important role in optimizing fluid infusion. Since changes in stroke volume (SV) during lung recruitment maneuver (LRM) can predict FR, and peripheral perfusion index (PI) is related to SV; therefore, we hypothesized that the changes in PI during LRM (ΔPILRM) could predict FR during perioperative period.MethodsPatients who were scheduled for elective non-laparoscopic surgery under general anesthesia with a mechanical ventilator and who required VE (250 mL of crystalloid solution infusion over 10 min) were included. Before VE, LRM was performed by a continuous positive airway pressure of 30 cm H2O for 30 sec; hemodynamic variables with their changes (PI, obtained by pulse oximetry; and ΔPILRM, calculated by using [(PI before LRM—PI after LRM)/PI before LRM]*100) were obtained before and after LRM. After SV (measured by esophageal doppler) and PI had returned to the baseline values, VE was infused, and the values of these variables were recorded again, before and after VE. Fluid responders (Fluid-Res) were defined by an increase in SV ≥10% after VE. Receiver operating characteristic curves of the baseline values and ΔPILRM were constructed and reported as areas under the curve (AUC) with 95% confidence intervals, to predict FR.ResultsOf 32 mechanically ventilated adult patients included, 13 (41%) were in the Fluid-Res group. Before VE and LRM, there were no differences in the mean arterial pressure (MAP), heart rate, SV, and PI between patients in the Fluid-Res and fluid non-responders (Fluid-NonRes) groups. After LRM, SV, MAP, and, PI decreased in both groups, ΔPILRM was greater in the Fluid-Res group than in Fluid-NonRes group (55.2 ± 17.8% vs. 35.3 ± 17.3%, p < 0.001, respectively). After VE, only SV and cardiac index increased in the Fluid-Res group. ΔPILRM had the highest AUC [0.81 (0.66–0.97)] to predict FR with a cut-off value of 40% (sensitivity 92.3%, specificity 73.7%).ConclusionsΔPILRM can be applied to predict FR in mechanical ventilated patients during the perioperative period.

Best Respiratory Compliance Following a Recruitment Maneuver Allows Hemodynamically Stability During Laparoscopic Surgery: a Secondary Analysis of a Randomized Controlled Trial

“…Importantly, we also noted that this hemodynamic inhibition was transient, with parameters returning to baseline levels shortly after the intervention. These ndings are consistent with previous research highlighting the hemodynamic challenges associated with RMs 8, 19,20 . Meanwhile, the absence of a requirement for vasopressor medications, such as phenylephrine, during the procedures suggests clinically stable hemodynamics, as assessed per anesthesiologists.…”

The Hemodynamic Changes Induced by Lung Recruitment Maneuver to Predict Fluid Responsiveness in Children during One Lung Ventilation—A Prospective Observational Study

“…The ratio of patients who did respond (fluid responder) vs. those who did not respond to fluid expansion (non-responder) assessed by the changes of SV and MAP following VE were assumed to be 1:2 according to the results of the previous study [ 12 ]. With α error of 0.05, power of 0.8, and the null hypothesis of an AUC of 0.5 [ 13 ], and a potential dropout of 10%, 34 patients were finally enrolled in this study.…”

“…Secondly, 3 response classes (negative, inconclusive, and positive) were used to calculate the gray zone of ΔSV LRM , and ΔMAP LRM ; the range of inconclusive responses were cutoff values with a sensitivity and a specificity of <90% [ 9 , 10 ]. The larger range calculated between the two steps was the gray zone [ 13 ]. A p value < 0.05 was considered to be statistically significant.…”