January 1, 2014BioScience TrendsOpen Access

Stroke volume variation fail to predict fluid responsiveness in patients undergoing pulmonary lobectomy with one-lung ventilation using thoracotomy

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Patients undergoing pulmonary lobectomy with one-lung ventilation (OLV) using thoracotomy (n=30). Intervention: Stroke volume variation (SVV) monitoring vs. Central venous pressure (CVP). Primary outcome: Area under the ROC curve for predicting fluid responsiveness (increase in CI ≥ 10% after volume expansion) (AUC 0.507, 95% CI 0.294-0.720).

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Key result

Stroke volume variation via Vigileo-FloTrac fails to predict fluid responsiveness during one-lung ventilation.

AUC 0.507
95% CI 0.294-0.720
n=30

Why the study?

Does stroke volume variation predict fluid responsiveness in patients undergoing pulmonary lobectomy with one-lung ventilation via thoracotomy?

Study Design

Type

Observational (n=30)

Multicenter

Structured PICO

Does stroke volume variation predict fluid responsiveness in patients undergoing pulmonary lobectomy with one-lung ventilation via thoracotomy?

Population

30 adult patients with lung cancer undergoing pulmonary lobectomy with one-lung ventilation after thoracotomy, evaluated for fluid responsiveness.

Exposure

Volume expansion with 8 mL/kg of 6% hydroxyethyl starch infused over 30 minutes during one-lung ventilation.

Comparator

Baseline hemodynamic measurements (before volume expansion) and comparison between fluid responders and non-responders.

Outcome

Fluid responsiveness, defined as an increase in cardiac index (CI) ≥ 10% after volume expansion.surrogate

Main Result

Effect estimate: AUC 0.507 (95% CI 0.294-0.720)

Absolute Event Rate: 0.507% vs 0.556%

Stroke volume variation measured by the Vigileo-FloTrac system fails to predict fluid responsiveness in patients undergoing pulmonary lobectomy with one-lung ventilation via thoracotomy.

Limitations

Cardiac output was measured with the Vigileo-FloTrac system rather than a calibrated thermodilution monitor.
Shunt fraction was not estimated, preventing conclusions about its contribution to SVV.
Did not compare different ventilation strategies (e.g., lung-protective vs conventional) to see if they yielded different results.
Cardiac output was measured with the Vigileo-FloTrac system rather than the clinical standard calibrated thermodilution method.
Shunt fraction was not estimated, preventing conclusions on whether less shunt fraction contributes to a larger SVV that can predict fluid responsiveness.
Did not compare different ventilation strategies (e.g., lung-protective vs. conventional) to see if they would yield different results.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Caution against using Vigileo-FloTrac SVV to guide fluids in one-lung ventilation lobectomy; leaves open validation of alternative predictors in thoracic surgery.

Cite This Study

Fu et al. (2014) conducted an observational in Patients undergoing pulmonary lobectomy with one-lung ventilation (OLV) using thoracotomy (n=30). Stroke volume variation (SVV) monitoring vs. Central venous pressure (CVP) was evaluated on Area under the ROC curve for predicting fluid responsiveness (increase in CI ≥ 10% after volume expansion) (AUC 0.507, 95% CI 0.294-0.720). Stroke volume variation measured by the Vigileo-FloTrac system failed to predict fluid responsiveness (AUC 0.507) in patients undergoing pulmonary lobectomy with one-lung ventilation after thoracotomy.

synapsesocial.com/papers/6aa4309d971540f143c80d11 https://doi.org/10.5582/bst.8.59

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Implication

Caution against using Vigileo-FloTrac SVV to guide fluids in one-lung ventilation lobectomy; leaves open validation of alternative predictors in thoracic surgery.

Stroke volume variation fail to predict fluid responsiveness in patients undergoing pulmonary lobectomy with one-lung ventilation using thoracotomy

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Stroke volume variation fail to predict fluid responsiveness in patients undergoing pulmonary lobectomy with one-lung ventilation using thoracotomy

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider