Key result
Fluid boluses during abdominal surgery link SVV reductions to linear increases in SVI.
Why the study?
Does stroke volume variation correlate with stroke volume changes following fluid bolus infusion in patients undergoing major abdominal surgery?
Observational (n=83)
Does stroke volume variation correlate with stroke volume changes following fluid bolus infusion in patients undergoing major abdominal surgery?
In patients undergoing major abdominal surgery, SVV changes following fluid bolus infusion significantly contribute to fluid responsiveness, with a linear relationship observed in the SVV range of 9%-20%.
SVV may aid fluid responsiveness assessment during abdominal surgery; leaves open whether SVV-guided boluses improve outcomes in prospective trials.
Objective: Changes in stroke volume after fluid bolus infusion (i.e., fluid responsiveness) during major abdominal surgery is affected by painful stimuli, anesthetics and inconsistent increases in cardiac preload following each round of fluid infusion. This study aimed to assess the relationship between stroke volume variation (SVV) and stroke volume during major abdominal surgery using arterial pulse contour analysis by removing data of stroke volume affected by these factors. Methods: Eighty-three patients who underwent major abdominal surgery received 8 ml/kg boluses of either Ringer’s acetate or 6% hydroxyethyl starch 70/0.5 solution over the course of 30 minutes. Stroke volume index (SVI) and SVV were obtained using the FloTracTM/VigileoTM system (Version 3.02). Patients were classified according to values of absolute changes of SVV (ΔSVV, %) and relative changes of SVI (ΔSVI, %) following fluid bolus infusion. For each patient, ΔSVI was linearly regressed against SVV at different time points during the 60 minute period after initiation of bolus infusion. The relationship between SVV and ΔSVI was examined using the angle (radian) of the slope of ΔSVI against SVV. Results: Following fluid bolus infusion, SVI increased in 43% of patients due to an increase in cardiac preload (i.e., SVV decrease), and 33% of patients showed false SVI responses (ΔSVV 0). Angle values for SVV-ΔSVI in 50 patients were consistent in the SVV range of 9%-20% (i.e., 1.2); a 4% decrease in SVV resulted in a 10% increase in SVI. Conclusions: One-third of patients undergoing major abdominal surgery showed false responses for SVI following fluid bolus infusion. After excluding false responses for SVI, the relationship between SVV and ΔSVI during major abdominal surgery was almost linear in the SVV range of 9%-20%, suggesting that SVV changes following fluid bolus infusion significantly contribute to fluid responsiveness.
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Sugi et al. (2016) conducted an observational in Major abdominal surgery (n=83). Fluid bolus infusion (Ringer's acetate or 6% hydroxyethyl starch) was evaluated on Relationship between stroke volume variation (SVV) and relative changes of stroke volume index (ΔSVI). During major abdominal surgery, the relationship between SVV and ΔSVI following fluid bolus infusion was almost linear in the SVV range of 9%-20%, where a 4% decrease in SVV yielded a 10% SVI increase.
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