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Tidal volume challenge to predict fluid responsiveness in the operating room

An observational study

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

European Journal of Anaesthesiology (EJA): August 2019 - Volume 36 - Issue 8 - p 583–591
doi: 10.1097/EJA.0000000000000998
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BACKGROUND Pulse pressure variation (PPV) and stroke volume variation (SVV) do not predict fluid responsiveness when using a protective ventilation strategy: the use of functional haemodynamic tests can be useful to overcome this limitation.

OBJECTIVES We tested the use of a tidal volume challenge (VTC), during 6 ml kg−1 [predicted body weight (PBW)] ventilation, and the end-expiratory occlusion test (EEOT) for prediction of fluid responsiveness.

DESIGN An interventional prospective study.

SETTING Supine elective neurosurgical patients.

INTERVENTIONS The study protocol was, first, the initial EEOT test was performed during baseline 6 ml kg−1 PBW ventilation; second, VTC was performed by increasing the VT up to 8 ml kg−1 PBW and PPV and SVV changes were recorded after 1 min; third, a second EEOT was performed during 8 ml kg−1 PBW ventilation; and VT was reduced back to 6 ml kg−1 PBW and a third EEOT was performed. Finally, a 250 ml fluid challenge was administered over 10 min to identify fluid responders (increase in stroke volume index ≥10%).

RESULTS In the 40 patients analysed, PPV and SVV values at baseline and EEOT performed at 6 ml kg−1 PBW did not predict fluid responsiveness. A 13.3% increase in PPV after VTC predicted fluid responsiveness with a sensitivity of 94.7% and a specificity of 76.1%, while a 12.1% increase in SVV after VTC predicted fluid responsiveness with a sensitivity of 78.9% and a specificity of 95.2%. After EEOT performed at 8 ml kg−1 PBW, a 3.6% increase in cardiac index predicted fluid responsiveness with a sensitivity of 89.4% and a specificity of 85.7%, while a 4.7% increase in stroke volume index (SVI) with a sensitivity of 89.4% and a specificity of 85.7%.

CONCLUSION The changes in PPV and SVV obtained after VTC are reliable and comparable to the changes in CI and SVI obtained after EEOT performed at 8 ml kg−1 PBW in predicting fluid responsiveness in neurosurgical patients.

TRIAL REGISTRATION ACTRN12618000351213.

From the Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas, Humanitas University, Milan (AM, MC), the Department of Anaesthesia and Intensive Care Medicine, Maggiore della Carità University Hospital, Novara (CM, GC, FG, LM, FDC), the Department of Anaesthesiology and Intensive Care, San Bortolo Hospital, Vicenza (SDR), and the Department of Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy (PN)

Correspondence to Antonio Messina, MD, PhD, Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas, Humanitas University, Via Alessandro Manzoni, 56, Rozzano – Milan 20089, Italy Tel: +392 8224 8282; e-mail: mess81rc@gmail.com

Published online 23 April 2019

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© 2019 European Society of Anaesthesiology