The predictability of dynamic preload indices depends on the volume of fluid challenge A prospective observational study in the operating theater - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Medicine Année : 2018

The predictability of dynamic preload indices depends on the volume of fluid challenge A prospective observational study in the operating theater

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Résumé

This study was designed to assess the association between volume of fluid challenge (FC) and predictability of respiratory variation of stroke volume (Delta respSV) in the operating theater. Patients undergoing intermediate/high-risk surgery and monitored by esophageal Doppler monitoring (EDM) were prospectively included. All patients were under general anesthesia and mechanically ventilated. Exclusion criteria were frequent ectopic beats or preoperative arrhythmia, right ventricular failure, and spontaneous breathing. Hemodynamic parameters and esophageal Doppler indices (SV, cardiac output, Delta respSV) were collected before, after infusion of 250 mL, and after infusion of 500mL of crystalloid solution. Responders were defined by a >15% increase of stroke volume after FC at each step. After infusion of a 250 mL FC, 41 patients (32%) were classified as fluid responders (R250). After infusion of a 500 mL FC, 80 patients (63%) were classified as fluid responders (R500). The predictability of Delta respSV was fair with an area under the curve (AUC) of 0.79 (95% CI 0.71-0.86, P<.001) to predict fluid responsiveness with a 250 mL FC. With an AUC of 0.94 (95% CI 0.88-0.97, P<.0001), Delta respSV presented an excellent ability to predict fluid responsiveness with a 500-mL FC. Predictability of Delta respSV changed with the volume of fluid infused to assess fluid responsiveness. The accuracy of Delta respSV was higher with 500 mL than with 250 mL. Bedside studies evaluating the predictability of dynamic preload indices should define fluid responsiveness as a >15% increase of SV in response to a 500-mL FC.

Dates et versions

hal-03577392 , version 1 (16-02-2022)

Identifiants

Citer

Pierre-Gregoire Guinot, Julien Marc, Bruno De Broca, Thomas Archange, Stephane Bar, et al.. The predictability of dynamic preload indices depends on the volume of fluid challenge A prospective observational study in the operating theater. Medicine, 2018, 97 (42), ⟨10.1097/MD.0000000000012848⟩. ⟨hal-03577392⟩
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