Key result
Stroke volume variation measured with the intra-aortic balloon pump on standby for one minute accurately predicted fluid responsiveness with an area under the ROC curve of 0.91.
Why the study?
Patients with an implanted IABP are typically excluded from SVV-guided fluid therapy due to pulse contour artifacts caused by the pump.
Does stroke volume variation measured during a one-minute IABP standby predict fluid responsiveness in cardiac surgery patients with an implanted IABP?
Observational (n=30)
No
Does stroke volume variation measured during a one-minute IABP standby predict fluid responsiveness in cardiac surgery patients with an implanted IABP?
Effect estimate: AUC 0.91 (95% CI 0.81-1.0)
p-value: p=0.0002
Measuring stroke volume variation by placing an intra-aortic balloon pump on standby for one minute accurately predicts fluid responsiveness in postoperative cardiac surgery patients.
May inform fluid assessment via brief IABP pause post-cardiac surgery; hypothesis-generating and requires prospective validation before practice change.
There is a vast body of evidence in favour of individualising fluid therapy using dynamic hemodynamic indices like stroke volume variation (SVV). Patients with implanted intra-aortic balloon pump (IABP) are excluded from this approach because of pulse contour artifacts caused by the pump. The aim of this work is to test whether SVV can be used for fluid responsiveness prediction in these patients. Patients after cardiac surgery with implanted IABP were included in this study. SVV was measured after placing the IABP on standby mode for one minute. Cardiac output (CO) measurement was obtained via Swan-Ganz catheter before and after a 6 ml/kg fluid challenge. Fluid responsiveness was defined as increase of CO by at least 10%. SVV above 8.5% showed a good correlation with fluid responsiveness. Sensitivity was 95 (95% CI 85 to 100) and specificity 82 (95% CI 72 to 92). SVV had an area under the ROC curve 0.91 (95% CI 0.81 to 1.0) SVV is a good predictor of fluid responsiveness in patients with IABP. SVV should not be excluded as a fluid therapy guide for these patients. Placing the pump on standby for one minute allows obtaining an accurate measurement of this important variable.
No takes yet. Share an insight, caveat, or question.
Enev et al. (2023) conducted an observational in Low cardiac output syndrome after cardiac surgery with implanted IABP (n=30). Stroke volume variation (SVV) measurement was evaluated on Prediction of fluid responsiveness (increase in cardiac output ≥ 10%) (AUC 0.91, 95% CI 0.81-1.0, p=0.0002). Stroke volume variation measured with the intra-aortic balloon pump on standby for one minute accurately predicted fluid responsiveness with an area under the ROC curve of 0.91.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: