Key result
Stroke volume variation predicted fluid responsiveness in patients undergoing airway pressure release ventilation better than central venous pressure (AUC 0.793 vs 0.442; P<0.05).
Why the study?
Does stroke volume variation predict fluid responsiveness better than central venous pressure in patients undergoing airway pressure release ventilation?
Observational (n=80)
No
Does stroke volume variation predict fluid responsiveness better than central venous pressure in patients undergoing airway pressure release ventilation?
Stroke volume variation is a reliable predictor of fluid responsiveness in mechanically ventilated patients on APRV, outperforming central venous pressure.
This is the authors' abstract. We don't add key points for this paper.
We investigated the effectiveness of stroke volume variation (SVV) shown by the Vigileo-FloTrac™ system (Edwards Lifesciences, Irvine, CA) to predict fluid responsiveness in patients undergoing airway pressure release ventilation (APRV). All 80 patients mechanically ventilated in the intensive care unit of our hospital from April to November 2010 were included in this study. After starting APRV, Ringer's lactate solution was administered for 30 minutes. Haemodynamic variables including heart rate, mean arterial pressure, cardiac index (CI), stroke volume index (SVI) and SVV were measured before and after volume loading. SVV before volume loading was significantly correlated with absolute change in SVV (ΔSVV) and percentage change in stroke volume index (ΔSVI) after volume loading (ΔSVV: P<0.05, r2=0.534; ΔSVI: P<0.05, r2=0.217). Of the 80 patients, 38 (47.5%) were responders to intravascular volume expansion (increase in CI≥15%) and 42 (52.5%) were non-responders (increase in CI<15%). Receiver operating characteristic (ROC) curves were generated for SVV and central venous pressure by varying the discriminating threshold of the variable and areas under the ROC curves were calculated. The areas under the ROC curves were 0.793 for SVV (95% confidence interval: 0.709-0.877) and 0.442 for central venous pressure (95% confidence interval: 0.336-0.549), which were significantly different (P<0.05). The optimal threshold value of SVV to discriminate between responders and nonresponders was 14% (sensitivity: 78.9%; specificity: 64.3%). We found that SVV was able to predict fluid responsiveness in patients undergoing APRV with acceptable levels of sensitivity and specificity.
Answers are grounded in this paper and cite their sources.
May guide fluid decisions in APRV; hypothesis-generating and requires prospective validation before practice change.
No takes yet. Share an insight, caveat, or question.
Suehiro et al. (2012) conducted an observational in Patients undergoing airway pressure release ventilation (n=80). Stroke volume variation (SVV) vs. Central venous pressure was evaluated on Fluid responsiveness (increase in cardiac index ≥15%) (AUC 0.793, 95% CI 0.709-0.877, p=<0.05). Stroke volume variation predicted fluid responsiveness in patients undergoing airway pressure release ventilation better than central venous pressure (AUC 0.793 vs 0.442; P<0.05).
Synapse has enriched 10 related papers. Consider them for comparative context: