Accuracy of stroke volume variation compared with pleth variability index to predict fluid responsiveness in mechanically ventilated patients undergoing major surgery

Background and objective Accurate assessment of a patient's volume status is an important goal for an anaesthetist. However, most variables assessing fluid responsiveness are either invasive or technically challenging. This study was designed to compare the accuracy of arterial pressure-based stroke volume variation (SVV) and variations in the pulse oximeter plethysmographic waveform amplitude as evaluated with the noninvasive calculated pleth variability index (PVI) with central venous pressure to predict the response of stroke volume index (SVI) to volume replacement in patients undergoing major surgery. Methods We studied 20 patients scheduled for elective major abdominal surgery. After induction of anaesthesia, all haemodynamic variables were recorded immediately before (T1) and subsequent to volume replacement (T2) by infusion of 6% hydroxy-ethyl starch (HES) 130/0.4 (7 ml kg−1) at a rate of 1 ml kg−1 min−1. Results The volume-induced increase in SVI was at least 15% in 15 patients (responders) and less than 15% in five patients (nonresponders). Baseline SVV correlated significantly with changes in SVI (ΔSVI; r = 0.80; P < 0.001) as did baseline PVI (r = 0.61; P < 0.004), whereas baseline values of central venous pressure showed no correlation to ΔSVI. There was no significant difference between the area under the receiver operating characteristic curve for SVV (0.993) and PVI (0.973). The best threshold values to predict fluid responsiveness were more than 11% for SVV and more than 9.5% for PVI. Conclusion Although arterial pressure-derived SVV revealed the best correlation to volume-induced changes in SVI, the results of our study suggest that both variables, SVV and PVI, can serve as valid indicators of fluid responsiveness in mechanically ventilated patients undergoing major surgery.

[1]  L. Mathews,et al.  Cardiac output monitoring. , 2008, Annals of cardiac anaesthesia.

[2]  Clifford Kavinsky,et al.  Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects , 2004, Critical care medicine.

[3]  F. Michard,et al.  Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial , 2007, Critical care.

[4]  F. Sztark,et al.  Uncalibrated pulse contour-derived stroke volume variation predicts fluid responsiveness in mechanically ventilated patients undergoing liver transplantation. , 2008, British journal of anaesthesia.

[5]  C. Hofer,et al.  Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac™ and PiCCOplus™ system , 2008, Critical care.

[6]  B. Trabold,et al.  Evaluation of an improved algorithm for arterial pressure-based cardiac output assessment without external calibration , 2007, Intensive Care Medicine.

[7]  J. Bakker,et al.  Noninvasive monitoring of peripheral perfusion , 2005, Intensive Care Medicine.

[8]  J. Achard,et al.  Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients. , 2002, Chest.

[9]  J. Teboul,et al.  Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation , 2000, Critical care.

[10]  Michael Baram,et al.  Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. , 2008, Chest.

[11]  C. Keyl,et al.  Assessment of intrathoracic blood volume as an indicator of cardiac preload: single transpulmonary thermodilution technique versus assessment of pressure preload parameters derived from a pulmonary artery catheter. , 2001, Journal of cardiothoracic and vascular anesthesia.

[12]  J. Boldt,et al.  Cardiac output derived from arterial pressure waveform analysis in patients undergoing cardiac surgery: validity of a second generation device. , 2008, Anesthesia and analgesia.

[13]  M. Cannesson,et al.  The Ability of Stroke Volume Variations Obtained with Vigileo/FloTrac System to Monitor Fluid Responsiveness in Mechanically Ventilated Patients , 2009, Anesthesia and analgesia.

[14]  A. Perel.  Automated assessment of fluid responsiveness in mechanically ventilated patients. , 2008, Anesthesia and analgesia.

[15]  M. Cannesson,et al.  Ability of pleth variability index to detect hemodynamic changes induced by passive leg raising in spontaneously breathing volunteers , 2008, Critical care.

[16]  J. Hanley,et al.  A method of comparing the areas under receiver operating characteristic curves derived from the same cases. , 1983, Radiology.

[17]  J. Hisdal,et al.  Poor Agreement between Respiratory Variations in Pulse Oximetry Photoplethysmographic Waveform Amplitude and Pulse Pressure in Intensive Care Unit Patients , 2008, Anesthesiology.

[18]  C. Keyl,et al.  Assessment of fluid responsiveness in mechanically ventilated cardiac surgical patients , 2005, European journal of anaesthesiology.

[19]  Maxime Cannesson,et al.  Using ventilation-induced plethysmographic variations to optimize patient fluid status , 2008, Current opinion in anaesthesiology.

[20]  M. Cannesson,et al.  Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre. , 2008, British journal of anaesthesia.

[21]  Stroke volume variation obtained with FloTrac/Vigileo fails to predict fluid responsiveness in coronary artery bypass graft patients. , 2008, British journal of anaesthesia.

[22]  J. Boldt,et al.  Uncalibrated arterial pressure waveform analysis for less-invasive cardiac output determination in obese patients undergoing cardiac surgery. , 2009, British journal of anaesthesia.

[23]  Andreas Zollinger,et al.  Stroke volume and pulse pressure variation for prediction of fluid responsiveness in patients undergoing off-pump coronary artery bypass grafting. , 2005, Chest.

[24]  G. Manecke.  Edwards FloTrac™ sensor and Vigileo™ monitor: easy, accurate, reliable cardiac output assessment using the arterial pulse wave , 2005, Expert review of medical devices.

[25]  G. Langewouters,et al.  The pressure dependent dynamic elasticity of 35 thoracic and 16 abdominal human aortas in vitro described by a five component model. , 1985, Journal of biomechanics.

[26]  Maxime Cannesson,et al.  Does the Pleth Variability Index Indicate the Respiratory-Induced Variation in the Plethysmogram and Arterial Pressure Waveforms? , 2008, Anesthesia and analgesia.

[27]  A. Perel.  The value of functional hemodynamic parameters in hemodynamic monitoring of ventilated patients , 2003, Der Anaesthesist.