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Prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters

BACKGROUND: Functional hemodynamic parameters such as stroke volume and pulse pressure variation (SVV and PPV) have been shown to be reliable predictors of fluid responsiveness in mechanically ventilated patients. Today, different minimally- and non-invasive hemodynamic monitoring systems measure fu...

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Autores principales: Ganter, Michael T., Geisen, Martin, Hartnack, Sonja, Dzemali, Omer, Hofer, Christoph K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964892/
https://www.ncbi.nlm.nih.gov/pubmed/29788919
http://dx.doi.org/10.1186/s12871-018-0520-x
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author Ganter, Michael T.
Geisen, Martin
Hartnack, Sonja
Dzemali, Omer
Hofer, Christoph K.
author_facet Ganter, Michael T.
Geisen, Martin
Hartnack, Sonja
Dzemali, Omer
Hofer, Christoph K.
author_sort Ganter, Michael T.
collection PubMed
description BACKGROUND: Functional hemodynamic parameters such as stroke volume and pulse pressure variation (SVV and PPV) have been shown to be reliable predictors of fluid responsiveness in mechanically ventilated patients. Today, different minimally- and non-invasive hemodynamic monitoring systems measure functional hemodynamic parameters. Although some of these parameters are described by the same name, they differ in their measurement technique and thus may provide different results. We aimed to test the performance of seven functional hemodynamic parameters simultaneously in the same clinical setting. METHODS: Hemodynamic measurements were done in 30 cardiac surgery patients that were mechanically ventilated. Before and after a standardized intravenous fluid bolus, hemodynamics were measured by the following monitoring systems: PiCCOplus (SVV(PiCCO), PPV(PiCCO)), LiDCO(rapid) (SVV(LiDCO), PPV(LiDCO)), FloTrac (SVV(FloTrac)), Philips Intellivue (PPV(Philips)) and Masimo pulse oximeter (pleth variability index, PVI). Prediction of fluid responsiveness was tested by calculation of receiver operating characteristic (ROC) curves including a gray zone approach and compared using Fisher’s Z-Test. RESULTS: Fluid administration resulted in an increase in cardiac output, while all functional hemodynamic parameters decreased. A wide range of areas under the ROC-curve (AUC’s) was observed: AUC-SVV(PiCCO) = 0.91, AUC-PPV(PiCCO) = 0.88, AUC-SVV(LiDCO) = 0.78, AUC-PPV(LiDCO) = 0.89, AUC-SVV(FloTrac) = 0.87, AUC-PPV(Philips) = 0.92 and AUC-PVI = 0.68. Optimal threshold values for prediction of fluid responsiveness ranged between 9.5 and 17.5%. Lowest threshold values were observed for SVV(LiDCO), highest for PVI. CONCLUSION: All functional hemodynamic parameters tested except for PVI showed that their use allows a reliable identification of potential fluid responders. PVI however, may not be suitable after cardiac surgery to predict fluid responsiveness. TRIAL REGISTRATION: NCT02571465, registered on October 7th, 2015 (retrospectively registered).
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spelling pubmed-59648922018-05-24 Prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters Ganter, Michael T. Geisen, Martin Hartnack, Sonja Dzemali, Omer Hofer, Christoph K. BMC Anesthesiol Research Article BACKGROUND: Functional hemodynamic parameters such as stroke volume and pulse pressure variation (SVV and PPV) have been shown to be reliable predictors of fluid responsiveness in mechanically ventilated patients. Today, different minimally- and non-invasive hemodynamic monitoring systems measure functional hemodynamic parameters. Although some of these parameters are described by the same name, they differ in their measurement technique and thus may provide different results. We aimed to test the performance of seven functional hemodynamic parameters simultaneously in the same clinical setting. METHODS: Hemodynamic measurements were done in 30 cardiac surgery patients that were mechanically ventilated. Before and after a standardized intravenous fluid bolus, hemodynamics were measured by the following monitoring systems: PiCCOplus (SVV(PiCCO), PPV(PiCCO)), LiDCO(rapid) (SVV(LiDCO), PPV(LiDCO)), FloTrac (SVV(FloTrac)), Philips Intellivue (PPV(Philips)) and Masimo pulse oximeter (pleth variability index, PVI). Prediction of fluid responsiveness was tested by calculation of receiver operating characteristic (ROC) curves including a gray zone approach and compared using Fisher’s Z-Test. RESULTS: Fluid administration resulted in an increase in cardiac output, while all functional hemodynamic parameters decreased. A wide range of areas under the ROC-curve (AUC’s) was observed: AUC-SVV(PiCCO) = 0.91, AUC-PPV(PiCCO) = 0.88, AUC-SVV(LiDCO) = 0.78, AUC-PPV(LiDCO) = 0.89, AUC-SVV(FloTrac) = 0.87, AUC-PPV(Philips) = 0.92 and AUC-PVI = 0.68. Optimal threshold values for prediction of fluid responsiveness ranged between 9.5 and 17.5%. Lowest threshold values were observed for SVV(LiDCO), highest for PVI. CONCLUSION: All functional hemodynamic parameters tested except for PVI showed that their use allows a reliable identification of potential fluid responders. PVI however, may not be suitable after cardiac surgery to predict fluid responsiveness. TRIAL REGISTRATION: NCT02571465, registered on October 7th, 2015 (retrospectively registered). BioMed Central 2018-05-22 /pmc/articles/PMC5964892/ /pubmed/29788919 http://dx.doi.org/10.1186/s12871-018-0520-x Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ganter, Michael T.
Geisen, Martin
Hartnack, Sonja
Dzemali, Omer
Hofer, Christoph K.
Prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters
title Prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters
title_full Prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters
title_fullStr Prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters
title_full_unstemmed Prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters
title_short Prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters
title_sort prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964892/
https://www.ncbi.nlm.nih.gov/pubmed/29788919
http://dx.doi.org/10.1186/s12871-018-0520-x
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