Dynamic variables to predict fluid responsiveness in young children

Background The evidence that dynamic variables predict fluid responsiveness in young children is limited by conflicting research results. Methods Sixty patients, 1–3 years of age, undergoing major neurosurgery, received 10 mL/kg of Ringer's solution over 10 min after anesthesia induction. Respiratory variation in aortic blood flow peak velocity (∆Vpeak), plethysmographic variability index (PVI), FloTrac/Vigileo‐derived stroke volume variation (SVV), dynamic arterial elastance (Eadyn), and pulse pressure variation (PPV) were measured before and following fluid loading. An increase in the cardiac index (CI) of ≥10% following fluid loading identified fluid “responders.” Results Twenty‐six patients (43.3%) were fluid responders. Baseline ∆Vpeak was an excellent predictor of a CI increase following fluid loading with an area under the receiver operating characteristic curve (AUROC) of 0.982 (p < 0.001). The PVI showed fair diagnostic accuracy for CI‐fluid responsiveness (AUROC 0.775, p < 0.001). Baseline ∆Vpeak and PVI cutoff values were 9.6% and 15%, respectively. PPV, SVV, and Eadyn were not predictors or were poor predictors for CI‐fluid responsiveness (AUROC 0.669, 0.653, and 0.533, respectively). Conclusion Volume‐based PVI and ∆Vpeak showed acceptable reliability for fluid responsiveness prediction in young children undergoing major neurosurgery, whereas pressure‐based SVV using FloTrac/Vigileo, Eadyn, and PPV did not.