Tidal volume challenge to predict fluid responsiveness in the operating room

Messina, Antonio; Montagnini, Claudia; Cammarota, Gianmaria; Rosa, Silvia De; Giuliani, Fabiana; Muratore, Lara; Corte, Francesco Della; Navalesi, Paolo; Cecconi, Maurizio

doi:10.1097/eja.0000000000000998

Cited by 55 publications

(58 citation statements)

References 40 publications

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“…However, the cut-off values of ΔPPV 6–8 and ΔSVV 6–8 in our study and in the study of Messina et al [20] were lower than those reported by Myatra et al [19]. There are several possible explanations for this discrepancy.…”

Section: Discussioncontrasting

confidence: 90%

“…Our study demonstrated that a V T challenge improved the predictive power of PPV and SVV values, even in patients with elevated IAP. Because PPV and SVV values are augmented in fluid responders, but not in non-responders, the absolute changes in the PPV and SVV values induced by increased V T could also be used to predict fluid responsiveness, which is consistent with studies of Myatra et al [19] and Messina et al [20].…”

Section: Discussionsupporting

confidence: 82%

“…The extent of airway pressure transmission to the pleural space is inversely proportional to chest wall compliace (C cw ) and proportional to lung compliance (C L ) [33, 34]. Messina et al described that their cut-off values was lower because Myatra et al enrolled critically ill patients in the ICU with reduced C cw reported at 30%, while they enrolled healthy surgical patients [20, 35]. As pneumoperitoneum has been known to decreases C cw [36], higher cut-off values could be expected in our study population.…”

Section: Discussionmentioning

confidence: 99%

“…They demonstrated that the absolute changes of PPV and SVV values induced by V T challenge, as well as their augmented values, predicted fluid responsiveness with high sensitivity and specificity, even in critically ill patients receiving low V T [19]. This test also validated in predicting fluid responsiveness in surgical patients receiving low V T [20].…”

Section: Introductionmentioning

confidence: 99%

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The tidal volume challenge improves the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation

et al. 2019

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Background: The reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) is controversial under pneumoperitoneum. In addition, the usefulness of these indices is being called into question with the increasing adoption of lung-protective ventilation using low tidal volume (V T) in surgical patients. A recent study indicated that changes in PPV or SVV obtained by transiently increasing V T (V T challenge) accurately predicted fluid responsiveness even in critically ill patients receiving low V T. We evaluated whether the changes in PPV and SVV induced by a V T challenge predicted fluid responsiveness during pneumoperitoneum. Methods: We performed an interventional prospective study in patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position under lung-protective ventilation. PPV, SVV, and the stroke volume index (SVI) were measured at a V T of 6 mL/kg and 3 min after increasing the V T to 8 mL/kg. The V T was reduced to 6 mL/kg, and measurements were performed before and 5 min after volume expansion (infusing 6% hydroxyethyl starch 6 ml/kg over 10 min). Fluid responsiveness was defined as ≥15% increase in the SVI. Results: Twenty-four of the 38 patients enrolled in the study were responders. In the receiver operating characteristic curve analysis, an increase in PPV > 1% after the V T challenge showed excellent predictive capability for fluid responsiveness, with an area under the curve (AUC) of 0.95 [95% confidence interval (CI), 0.83-0.99, P < 0.0001; sensitivity 92%, specificity 86%]. An increase in SVV > 2% after the V T challenge predicted fluid responsiveness, but showed only fair predictive capability, with an AUC of 0.76 (95% CI, 0.60-0.89, P < 0.0006; sensitivity 46%, specificity 100%). The augmented values of PPV and SVV following V T challenge also showed the improved predictability of fluid responsiveness compared to PPV and SVV values (as measured by V T) of 6 ml/kg. Conclusions: The change in PPV following the V T challenge has excellent reliability in predicting fluid responsiveness in our surgical population. The change in SVV and augmented values of PPV and SVV following this test are also reliable. Trial registration: This trial was registered with Clinicaltrials.gov, NCT03467711, 10th March 2018.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The tidal volume challenge improves the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation

et al. 2019

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“…Most studies investigating EEOT under low-tidal volume ventilation derive from an intensive care setting and cannot be directly transmitted to surgery [65,67]. Only one study involving neurosurgical patients directly compared the effects of low-to regular-tidal volume ventilation on the accuracy of EEOT, and showed a very low predictive value of EEOT under low-tidal volume ventilation (AUC of the change of cardiac index 0.53 [95% CI: 0.35-0.71]) [68]. Guinot et al [66] published the only study showing a low predictive value of EEOT for fluid responsiveness under sufficient tidal volumes (of 8.2 ml/kg) in a heterogeneous study of surgical patients.…”

Section: End-expiratory Occlusion Test (Eeot)mentioning

confidence: 99%

Management of perioperative volume therapy – monitoring and pitfalls

Sander

Schneck

Habicher

2020

Korean J Anesthesiol

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Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery, including the risk factors of the surgical procedure and those of the patient. There have been substantial developments over the last few decades regarding the risk of anesthesia. In the early days of anesthesia, the risk of the anesthetic procedure itself was high and led to a number of fatalities [1,2]. This has changed dramatically, and these days anesthesia-related deaths are extremely low. Such advances are likely related to drug advancements, an improved understanding of physiology, and better monitoring and management. However, death after surgery, including the whole perioperative process, has not substantially declined. The risk of death during the 30 days following surgery is 1,000 times more likely than during surgery itself [3]. According to recent data, death within 30 days of surgery is the third leading cause of death in the United States of America, behind cardiac diseases and malignancy [4]. Some recent studies have assessed this risk in detail. According to Weiser et al. [5], it is estimated that more than 310 million surgical procedures are performed worldwide. The exact complication rate and risk of death after these procedures are largely unknown. However, it is estimated that depending on the type of surgery and patient's comorbidities that about 30-40% of patients develop complications, of which up to 20% are severe and possibly life-threatening [6-8]. Besides, the mortality risk of surgery is not precisely known. It has been estimated that between 3 and 12 million patients die worldwide after surgery. The European Surgical Outcome study evaluated this in detail in a seven-day cohort study that included 46,539 patients from 498 European centers. Patients were followed for up to 60 days after their surgical procedure. Of this cohort, 1,855 patients died while in hospital, giving an in-hospital mortality rate of 4.7%. Additionally, the study Over 300 million surgical procedures are performed every year worldwide. Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery and aim to reduce the risk of complications. Perioperative hemodynamic and volume management can help to improve outcomes in perioperative patients. There has been ongoing discussion about goal-directed therapy. However, there is a consensus that fluid overload and severe fluid depletion in the perioperative period are harmful and can lead to adverse outcomes. This article provides an overview of how to evaluate the fluid responsiveness of patients, details which parameters could be used, and what limitations should be noted.

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Anesthetic Concerns in Advanced Age Undergoing Emergency Surgery

Wahlen

Gasperi

2021

Emergency General Surgery in Geriatrics

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Tidal volume challenge to predict fluid responsiveness in the operating room

Cited by 55 publications

References 40 publications

The tidal volume challenge improves the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation

The tidal volume challenge improves the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation

Management of perioperative volume therapy – monitoring and pitfalls

Anesthetic Concerns in Advanced Age Undergoing Emergency Surgery

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