Predicting fluid responsiveness in patients undergoing cardiac surgery: functional haemodynamic parameters including the Respiratory Systolic Variation Test and static preload indicators.
TLDR
Functional haemodynamic parameters are superior to static indicators of cardiac preload in predicting the response to fluid administration and the RSVT and PPV were the most accurate predictors of fluid responsiveness.Abstract:
Background Prediction of the response of the left ventricular stroke volume to fluid administration remains an unsolved clinical problem. We compared the predictive performance of various haemodynamic parameters in the perioperative period in patients undergoing coronary artery bypass surgery. These parameters included static indicators of cardiac preload and functional parameters, derived from the arterial pressure waveform analysis. These included the systolic pressure variation (SPV) and its delta down component (dDown), pulse pressure variation (PPV), stroke volume variation (SVV), and a new parameter, termed the respiratory systolic variation test (RSVT), which is a measure of the slope of the lowest systolic pressure values during a standardized manoeuvre consisting of three successive incremental pressure-controlled breaths. Methods Eighteen patients were included into this prospective observational study. Seventy volume loading steps (VLS), each consisting of 250 ml of colloid administration were performed before surgery and after the closure of the chest. The response to each VLS was considered as a positive (increase in stroke volume more than 15%) or non-response. Receiver operating characteristic curves were plotted for each parameter to evaluate its predictive value. Results All functional parameters predicted fluid responsiveness better than the intrathoracic blood volume and the left ventricular end-diastolic area. Parameters with the best predictive ability were the RSVT and PPV. Conclusions Functional haemodynamic parameters are superior to static indicators of cardiac preload in predicting the response to fluid administration. The RSVT and PPV were the most accurate predictors of fluid responsiveness, although only the RSVT is independent of the settings of mechanical ventilation.read more
Citations
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Does Central Venous Pressure Predict Fluid Responsiveness?: A Systematic Review of the Literature and the Tale of Seven Mares
TL;DR: A systematic review of the literature demonstrated a very poor relationship between CVP and blood volume as well as the inability of CVP/DeltaCVP to predict the hemodynamic response to a fluid challenge.
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Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature.
TL;DR: Dynamic changes of arterial waveform-derived variables during mechanical ventilation are highly accurate in predicting volume responsiveness in critically ill patients with an accuracy greater than that of traditional static indices of volume responsiveness.
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Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense.
Paul E. Marik,Rodrigo Cavallazzi +1 more
TL;DR: There are no data to support the widespread practice of using central venous pressure to guide fluid therapy, and this approach to fluid resuscitation should be abandoned.
Journal ArticleDOI
Hemodynamic parameters to guide fluid therapy
TL;DR: A number of dynamic tests of volume responsiveness have been reported, which dynamically monitor the change in stroke volume after a maneuver that increases or decreases venous return (preload) and challenges the patients' Frank-Starling curve.
Journal ArticleDOI
Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge
David Osman,Christophe Ridel,Patrick Ray,Xavier Monnet,Nadia Anguel,Christian Richard,Jean-Louis Teboul +6 more
TL;DR: It is demonstrated that cardiac filling pressures are poor predictors of fluid responsiveness in septic patients and their use as targets for volume resuscitation must be discouraged, at least after the early phase of sepsis has concluded.
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