Key result
The accuracy of respiratory variation of stroke volume to predict fluid responsiveness was significantly higher with a 500-mL fluid challenge (AUC 0.94) than with a 250-mL fluid challenge (AUC 0.79).
Why the study?
Does a 500 mL fluid challenge improve the predictability of respiratory variation of stroke volume for fluid responsiveness compared to a 250 mL fluid challenge in mechanically ventilated surgical patients?
Observational (n=128)
No
Does a 500 mL fluid challenge improve the predictability of respiratory variation of stroke volume for fluid responsiveness compared to a 250 mL fluid challenge in mechanically ventilated surgical patients?
Absolute Event Rate: 0.94% vs 0.79%
p-value: p=<0.05
In mechanically ventilated surgical patients, a 500 mL fluid challenge provides significantly better accuracy for predicting fluid responsiveness using respiratory variation of stroke volume compared to a 250 mL challenge.
May affect ΔrespSV reliability with varying FC volumes; leaves open optimal thresholds for fluid responsiveness in the OR.
This study was designed to assess the association between volume of fluid challenge (FC) and predictability of respiratory variation of stroke volume (ΔrespSV) in the operating theater.Patients undergoing intermediate/high-risk surgery and monitored by esophageal Doppler monitoring (EDM) were prospectively included. All patients were under general anesthesia and mechanically ventilated. Exclusion criteria were frequent ectopic beats or preoperative arrhythmia, right ventricular failure, and spontaneous breathing. Hemodynamic parameters and esophageal Doppler indices (SV, cardiac output, ΔrespSV) were collected before, after infusion of 250 mL, and after infusion of 500 mL of crystalloid solution. Responders were defined by a >15% increase of stroke volume after FC at each step.After infusion of a 250 mL FC, 41 patients (32%) were classified as fluid responders (R250). After infusion of a 500 mL FC, 80 patients (63%) were classified as fluid responders (R500). The predictability of ΔrespSV was fair with an area under the curve (AUC) of 0.79 (95% CI 0.71-0.86, P < .001) to predict fluid responsiveness with a 250 mL FC. With an AUC of 0.94 (95% CI 0.88-0.97, P < .0001), ΔrespSV presented an excellent ability to predict fluid responsiveness with a 500-mL FC.Predictability of ΔrespSV changed with the volume of fluid infused to assess fluid responsiveness. The accuracy of ΔrespSV was higher with 500 mL than with 250 mL. Bedside studies evaluating the predictability of dynamic preload indices should define fluid responsiveness as a >15% increase of SV in response to a 500-mL FC.
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Guinot et al. (2018) conducted an observational in Patients undergoing intermediate/high-risk surgery requiring volume expansion (n=128). 500 mL fluid challenge vs. 250 mL fluid challenge was evaluated on Area under the curve (AUC) of respiratory variation of stroke volume (DrespSV) to predict fluid responsiveness (p=<0.05). The accuracy of respiratory variation of stroke volume to predict fluid responsiveness was significantly higher with a 500-mL fluid challenge (AUC 0.94) than with a 250-mL fluid challenge (AUC 0.79).
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