Key result
PPV and SVV from three monitors showed moderate predictive value for fluid responsiveness (AUROC 0.71-0.76), whereas their decreases after fluid challenge were better markers (AUROC 0.82-0.93).
Why the study?
Dynamic indices of fluid responsiveness differ among hemodynamic monitors using proprietary algorithms and vary over short periods.
Do pulse pressure variation and stroke volume variation measured by different monitors accurately predict fluid responsiveness in high-risk surgical patients?
Observational (n=20)
Do pulse pressure variation and stroke volume variation measured by different monitors accurately predict fluid responsiveness in high-risk surgical patients?
Effect estimate: AUROC 0.71-0.76
Changes in pulse pressure and stroke volume variations after a fluid challenge are more reliable and device-independent markers of fluid responsiveness than baseline values in high-risk surgical patients.
Inter-monitor variability in PPV/SVV may affect fluid decisions; leaves open need for standardized validation in larger trials.
Introduction: Dynamic indices of fluid responsiveness (FR) such as pulse pressure variation (PPV) and stroke volume variation (SVV) differ among hemodynamic monitors, which use proprietary algorithms, and vary even over a short period of time. We aimed to compare the baseline values, fluctuation and predictive value for FR of PPV and SVV measured by three minimally invasive monitors. Patients and methods: Twenty patients undergoing high-risk abdominal surgery were included and 45 fluid challenges were analysed. The patients were simultaneously monitored using Carescape B650, LiDCO Rapid and FloTrac/Vigileo system. Cardiac output (CO), PPV and SVV were recorded before and after the fluid challenge of 500 ml of balanced crystalloid solution. An increase in CO ≥ 15 % defined fluid responders. Concurrently recorded arterial waveform was used for offline calculation of PPV. Results: Mean baseline values of the indices ranged between 8.6 % and 13.4 %. LiDCO showed higher fluctuation of indices compared to the other monitors. Area under the receiver operating characteristic curve (AUROC) ranged from 0.71 to 0.76 with optimal cut-off value between 7.5 % and 13.9 %. AUROC increased for all indices when FR was defined as an increase in stroke volume. Furthermore, a decrease in PPV or SVV after fluid challenge (ΔPPV, ΔSVV) proved a better marker of FR (AUROC 0.82-0.93) than baseline values with a uniform threshold of approximately -3%. Conclusions: Although a significant range of baselines variations and optimal cut-off values was observed, the predictive value of PPV and SVV from all the monitors was only moderate and comparable. Nevertheless, ΔPPV and ΔSVV appear to be a reliable and device-independent markers of FR.
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Cenková et al. (2024) conducted an observational in High-risk abdominal surgery (n=20). Carescape B650, LiDCO Rapid and FloTrac/Vigileo systems was evaluated on Predictive value for fluid responsiveness (increase in cardiac output ≥ 15%) (AUROC 0.71-0.76). PPV and SVV from three monitors showed moderate predictive value for fluid responsiveness (AUROC 0.71-0.76), whereas their decreases after fluid challenge were better markers (AUROC 0.82-0.93).
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