Key result
Protective one-lung ventilation reduces SVV and PPV accuracy for predicting fluid responsiveness versus conventional ventilation.
Why the study?
The ability of stroke volume variation and pulse pressure variation to predict fluid responsiveness during protective one-lung ventilation was uncertain.
Do stroke volume variation and pulse pressure variation predict fluid responsiveness in patients undergoing protective one-lung ventilation?
RCT (n=45)
Random numbers with odd/even mantissa
No
Do stroke volume variation and pulse pressure variation predict fluid responsiveness in patients undergoing protective one-lung ventilation?
Absolute Event Rate: 0.767% vs 0.885%
SVV and PPV can predict fluid responsiveness during protective one-lung ventilation, but their predictive accuracy is weaker compared to conventional ventilation.
SVV and PPV retain predictive value for fluid responsiveness in one-lung ventilation; extends validation to protective thoracic settings with noted accuracy limits.
In order to investigate whether the hemodynamic indices, including stroke volume variation (SVV) and pulse pressure variation (PPV) could predict fluid responsiveness in patients undergoing protective one-lung ventilation. 60 patients scheduled for a combined thoracoscopic and laparoscopic esophagectomy were enrolled and randomized into two groups. The patients in the protective group (Group P) were ventilated with a tidal volume of 6 mL/kg, an inspired oxygen fraction (FiO2) of 80%, and a positive end expiratory pressure (PEEP) of 5 cm H2O. Patients in the conventional group (Group C) were ventilated with a tidal volume of 8 mL/kg and a FiO2 of 100%. Dynamic variables were collected before and after fluid loading (7 mL/kg hydroxyethyl starch 6%, 0.4 mL/kg/min). Patients whose stroke volume index (SVI) increased by more than 15% were defined as responders. Data collected from 45 patients were finally analyzed. Twelve of 24 patients in Group P and 10 of 21 patients in Group C were responders. SVV and PPV significantly changed after the fluid loading. The receive operating characteristic (ROC) analysis showed that the thresholds for SVV and PPV to discriminate responders were 8.5% for each, with a sensitivity of 66.7% (SVV) and 75% (PPV) and a specificity of 50% (SVV) and 83.3% (PPV) in Group P. However, the thresholds for SVV and PPV were 8.5% and 7.5% with a sensitivity of 80% (SVV) and 90% (PPV) and a specificity of 70% (SVV) and 80% (PPV) in Group C. We found SVV and PPV could predict fluid responsiveness in protective one-lung ventilation, but the accuracy and ability of SVV and PPV were weak compared with the role they played in a conventional ventilation strategy.
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Fu et al. (2015) conducted an RCT in Esophageal carcinoma requiring one-lung ventilation (n=45). Protective one-lung ventilation vs. Conventional one-lung ventilation (tidal volume 8 mL/kg, FiO2 100% without PEEP) was evaluated on ROC AUC of stroke volume variation (SVV) for predicting fluid responsiveness. Stroke volume variation and pulse pressure variation could predict fluid responsiveness during protective one-lung ventilation, but their predictive accuracy was weaker compared to conventional ventilation.
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