Key result
Increases in radial artery pulse pressure ≥13% after fluid challenge predicted stroke volume increases ≥15% with a sensitivity of 0.82, specificity of 0.83, and an AUC of 0.90 (95% CI 0.81-0.96).
Why the study?
It was unknown whether changes in radial artery pulse pressure can predict changes in stroke volume after fluid challenge in patients following cardiac surgery.
Does the change in radial artery pulse pressure predict fluid responsiveness in mechanically ventilated hypotensive patients after cardiac surgery?
Observational (n=75)
Does the change in radial artery pulse pressure predict fluid responsiveness in mechanically ventilated hypotensive patients after cardiac surgery?
Effect estimate: AUC 0.90 (95% CI 0.81-0.96)
Changes in radial artery pulse pressure can accurately predict fluid responsiveness in mechanically ventilated hypotensive patients following cardiac surgery.
May aid radial pulse pressure monitoring for fluid responsiveness; hypothesis-generating and requires prospective validation.
Objective To evaluate whether the changes in the radial artery pulse pressure (rPP) can predict the changes in stroke volume (SV) after fluid challenge in patients after cardiac surgery. Methods This prospective observational study included 75 mechanical ventilated patients with hypotension after cardiac surgery, where all the patients involved underwent rPP and SV measurement after fluid challenges. Accordingly, the patients were divided into a volume responder group (increases in SV≥15%, n=45) and a non-responder group (increases in SV<15%, n=30). Then, heart rate (HR), blood pressure(BP), mean arterial pressure (MAP), central venous pressure (CVP), SV and stroke volume variation (SVV) were collected at baseline level and after fluid challenges respectively. The ability of the indices to predict fluid responsiveness, the area under the receiver operating characteristic curve (AUC), sensitivity and specificity for predicting fluid responsiveness were calculated. Results In the study, 60% of the patients were defined as fluid responders. BP, MAP, CVP, SV increased significantly in the volume responder group(P<0.05), while HR and SVV tended to decrease. Increases in rPP induced by fluid challenges (≥13%) indicated SV increases (≥15%) with a sensitivity of 0.82 and a specificity of 0.83. The AUC was 0.90 [95% confidence interval(CI) 0.81-0.96]. Conclusions The changes in rPP induced by fluid challenges can be used to predict the changes in SV in patients after cardiac surgery.
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Hou et al. (2019) conducted an observational in Hypotension after cardiac surgery (n=75). Changes in radial artery pulse pressure (rPP) was evaluated on Fluid responsiveness (increases in stroke volume ≥15%) (AUC 0.90, 95% CI 0.81-0.96). Increases in radial artery pulse pressure ≥13% after fluid challenge predicted stroke volume increases ≥15% with a sensitivity of 0.82, specificity of 0.83, and an AUC of 0.90 (95% CI 0.81-0.96).
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