Stroke Volume Variation and Pulse Pressure Variation Are Not Useful for Predicting Fluid Responsiveness in Thoracic Surgery

Jeong, Dong Young; Ahn, Hyun Joo; Park, Jungchan; Yang, Mikyung; Kim, Jie Ae; Park, Joo Hyun

doi:10.1213/ane.0000000000002056

Cited by 52 publications

(44 citation statements)

References 36 publications

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“…After simultaneous recordings of the baseline data including the SVI, SVV, PPV, and PSV, lactated Ringer’s solution was administered as an IV bolus of 10 mL/kg over 15 minutes to assess fluid responsiveness. Dogs were considered fluid responsive if SVI measured immediately after completion of the fluid challenge increased by 10% or more after volume loading [ 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

Comparison of Noninvasive Dynamic Indices of Fluid Responsiveness Among Different Ventilation Modes in Dogs Recovering from Experimental Cardiac Surgery

et al. 2018

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BackgroundFluid resuscitation is a cornerstone of minimizing morbidity and mortality in critically ill patients, but the techniques for predicting fluid responsiveness is still a matter of debate. In this study, we aimed to evaluate the utility of noninvasive stroke volume variation (SVV), pulse pressure variation (PPV), and systolic pressure variation (SPV) as a dynamic predictor for assessing fluid responsiveness during different ventilation modes in anaesthetized, intubated dogs recovering from cardiac surgery.Material/MethodsThirty-six adult Beagle dogs undergoing experimental surgery for isolated right ventricular failure were monitored for SVV, PPV, and SPV simultaneously using electrical velocimetry device. The relationships between each indicator and SVI before and after volume loading were compared in 3 ventilatory modes: assist control (A/C), synchronized intermittent mandatory ventilation (SIMV), and continuous positive airway pressure (CPAP). Responders were defined as those whose stroke volume index increased by ≥10%.ResultsIn all of the indices, the baseline values were greater in responders than in nonresponders (P<0.01) under A/C and SIMV. Receiver operating curve analysis confirmed the best predictive value during A/C [area under the curve (AUC): SVV, 0.90; PPV, 0.88; SPV, 0.85; P<0.05] followed by SIMV (AUC: SVV, 0.86; PPV, 0.83; CPAP, 0.80; P<0.05), with their sensitivities and specificities of ≥7 5%. By contrast, no statistically significance detected in any parameter during CPAP (AUC: SVV, 0.71; PPV, 0.66; CPAP, 0.65; P>0.05).ConclusionsSVV, PPV, and SVV are all useful to predict cardiac response to fluid loading in dogs during A/C and SIMV, while their reliabilities during CPAP are poor.

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Section: Methodsmentioning

confidence: 99%

Comparison of Noninvasive Dynamic Indices of Fluid Responsiveness Among Different Ventilation Modes in Dogs Recovering from Experimental Cardiac Surgery

et al. 2018

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“…Goal-directed fluid therapy (GDFT) based on the variations of pulse pressure and stroke volume 25 , or based on stroke volume or cardiac output itself 26 may be considered for thoracic surgery instead of fixed fluid infusion. However, the variations of pulse pressure and stroke volume are relatively inaccurate in thoracic surgery due to open chest, one lung ventilation, low tidal volume, etc 25 . Another shortcoming of GDFT is the possibility of fluid overload.…”

Section: Discussionmentioning

confidence: 99%

Restrictive intraoperative fluid management was associated with higher incidence of composite complications compared to less restrictive strategies in open thoracotomy: A retrospective cohort study

Kim

Ahn

et al. 2020

Sci Rep

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Restrictive fluid management has been recommended for thoracic surgery. However, specific guidelines are lacking, and there is always concern regarding impairment of renal perfusion with a restrictive policy. The objective of this study was to find the net intraoperative fluid infusion rate which shows the lowest incidence of composite complications (either pulmonary complications or acute kidney injury) in open thoracotomy. We hypothesized that a certain range of infusion rate would decrease the composite complications within postoperative 30 days. All patients (n = 1,031) who underwent open thoracotomy at a tertiary care university hospital were included in this retrospective study. The time frame of fluid monitoring was from the start of operation to postoperative 24 hours. The cutoff value of the intraoperative net fluid amount was 4-5 ml. kg −1 .h −1 according to the minimum p-value method, thus, patients were divided into Low (≤3 ml.kg −1 .h −1), Cutoff (4-5 ml.kg −1 .h −1) and High (≥6 ml.kg −1 .h −1) groups. The Cutoff group showed the lowest composite complication rate (19%, 12%, and 13% in the Low, Cutoff, and High groups, respectively, P = 0.0283; Low vs. Cutoff, P = 0.0324, Bonferroni correction). Acute respiratory distress syndrome occurred least frequently in the Cutoff group (7%, 3%, and 6% for the Low, Cutoff, and High groups, respectively, P = 0.0467; Low vs. Cutoff, P = 0.0432, Bonferroni correction). In multivariable analysis, intraoperative net fluid infusion rate was associated with composite complications, and the Cutoff group decreased risk (odds ratio 0.54, 95% confidence interval: 0.35-0.81, P = 0.0035). In conclusion, maintaining intraoperative net fluid infusion at 4-5 ml.kg −1 .h −1 was associated with better results in open thoracotomy, in terms of composite complications, compared to more restrictive fluid management. Postoperative pulmonary complications are the leading cause of morbidity, mortality, and prolonged hospital stay after thoracic surgery 1. Fluid overload is one of the major risk factors 2-4 and is receiving significant attention as a preventable risk factor. Therefore, fluid restriction is usually recommended during and after thoracic surgery 2-6. Despite the well-known risk of fluid overload, few studies have provided a guideline for intraoperative fluid management. Some experts insist on extreme restriction, and even zero fluid balance, for thoracic surgery 5. However, evidence for the efficacy of zero balance only exists in the context of intensive care units (ICUs) 7. Guidelines for ICU patients may not be applicable to patients undergoing a major operation because of anesthesia-induced vasodilation, increased insensible loss from the open thoracic cavity, surgical trauma induced fluid shift, and hemodynamic instability related to surgery. In addition to the lack of solid evidence, impairment of perfusion of major organs, especially the kidney, is another major concern with restrictive fluid management.

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“…Zhang et al found that a stroke volume variation threshold of greater than 15.5% had sensitivity and specificity, between 84.6% and 92.9%, suggesting that the Vigileo/FloTrac can be used to guide fluid therapy in the operating room. However, in thoracic surgery, the stroke volume variation is not a useful indicator of fluid responsiveness . The threshold value of the stroke volume variation for predicting fluid responsiveness may change when positive end‐expiratory pressure is applied.…”

Section: Discussionmentioning

confidence: 99%

“…However, in thoracic surgery, the stroke volume variation is not a useful indicator of fluid responsiveness. 19 The threshold value of the stroke volume variation for predicting fluid responsiveness may change when positive endexpiratory pressure is applied. We also observed a decrease in the SVC variation in response to the fluid challenge.…”

Section: Discussionmentioning

confidence: 99%

Transesophageal Echocardiographic Measurements of the Superior Vena Cava for Predicting Fluid Responsiveness in Patients Undergoing Invasive Positive Pressure Ventilation

Cheng

Yang

Zhu

et al. 2018

J of Ultrasound Medicine

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Objectives Preoperative fasting, water deprivation, and intraoperative fluid loss and redistribution result in hypovolemia in patients undergoing surgery. Some findings have indicated that the superior vena cava (SVC) diameter and variation, as determined by transesophageal echocardiography during surgery, do not reflect central venous pressure effectively. This study aimed to compare and correlate the SVC diameter and variation with the stroke volume variation for predicting fluid responsiveness in patients undergoing invasive positive pressure ventilation. Methods Thirty‐six patients scheduled for elective gastrointestinal surgery under general anesthesia with invasive positive pressure ventilation were included in this study. After anesthesia induction, the stroke volume variation, SVC diameter, mean arterial pressure, central venous pressure, and pulse were recorded, and measurements after fluid challenge were recorded as well. The SVC variation was calculated before and after the fluid challenge. Results After the fluid challenge, the SVC diameter markedly increased, whereas the SVC variation and stroke volume variation significantly decreased (P < .05). The optimal cutoff value for the SVC variation was 21.1%, and the area under the curve (AUC) from a receiver operating characteristic curve analysis was 0.849. The optimal cutoff value for the minimal SVC diameter was 1.135 cm, and that AUC was 0.929. In addition, the optimal cutoff value for the maximal SVC diameter was 1.480 cm, and the AUC was 0.862. Conclusions The minimal SVC diameter may be an effective indicator for predicting fluid responsiveness in patients undergoing invasive positive pressure ventilation.

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Stroke Volume Variation and Pulse Pressure Variation Are Not Useful for Predicting Fluid Responsiveness in Thoracic Surgery

Abstract: Dynamic preload indicators are not useful for predicting fluid responsiveness in VATS or open thoracic surgery.

Cited by 52 publications

References 36 publications

Comparison of Noninvasive Dynamic Indices of Fluid Responsiveness Among Different Ventilation Modes in Dogs Recovering from Experimental Cardiac Surgery

Comparison of Noninvasive Dynamic Indices of Fluid Responsiveness Among Different Ventilation Modes in Dogs Recovering from Experimental Cardiac Surgery

Restrictive intraoperative fluid management was associated with higher incidence of composite complications compared to less restrictive strategies in open thoracotomy: A retrospective cohort study

Transesophageal Echocardiographic Measurements of the Superior Vena Cava for Predicting Fluid Responsiveness in Patients Undergoing Invasive Positive Pressure Ventilation

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