[Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Baskıdaki Makaleler: TARD-29577

Reliability of passive leg raising, stroke volume variation and pulse pressure variation to predict fluid responsiveness during weaning from mechanical ventilation after cardiac surgery: a prospective, observational study

Christoph Karl Hofer1, Martin Geisen1, Sonja Hartnack2, Omer Dzemali3, Michael Thomas Ganter4, Andreas Zollinger1
1Institute of Anaesthesiology and Intensive Care Medicine, Triemli Hospital Zurich, Switzerland
2Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Switzerland
3Division of Cardiac Surgery, Triemli City Hospital Zurich, Switzerland
4Institute of Anaesthesiology, Kantonsspital Winterthur, Switzerland

Objective: During assisted ventilation and spontaneous breathing, functional hemodynamic parameters like stroke volume variation (SVV) and pulse pressure variation (PPV) are of limited value to predict fluid responsiveness and the passive leg raising (PLR) maneuver has been advocated as surrogate method. We aimed to study the predictive value of SVV, PPV and PLR for fluid responsiveness during weaning from mechanical ventilation after cardiac surgery.
Methods: Hemodynamic variables and fluid responsiveness were assessed in 34 patients. Upon arrival in the ICU, measurements were done during continuous mandatory ventilation (CMV), spontaneous breathing with pressure support (PSV) and after extubation (SPONT). Prediction of a positive fluid responsiveness (defined as stroke volume increase >15% after fluid administration) was tested by calculation of the specific receiver operating characteristic (ROC) curves.
Results: A significant increase in stroke volumes was observed during CMV, PSV and SPONT after fluid administration. There were 19 fluid responders (55.9%) during CMV, 22 (64.7%) and 13 (40.6%) during PSV and SPONT, respectively. The predictive value for a positive fluid responsiveness (area under the ROC curve) for SVV was 0.88, 0.70 and 0.56, for PPV 0.83, 0.69 and 0.48, for PLR 0.72, 0.74 and 0.70 during CMV, PSV and SPONT, respectively.
Conclusion: During mechanical ventilation, adequate prediction of fluid responsiveness using SVV and PPV was observed. However, during spontaneous breathing, reliability of SVV and PPV was poor. In this period, PLR as a surrogate was able to better predict fluid responsiveness than SVV or PPV, but less reliable than previously reported.

Keywords: Stroke volume variation, Pulse pressure variation, passive leg raising, functional hemodynamic parameter, pulse contour analysis

Sorumlu Yazar: Christoph Karl Hofer, Switzerland

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