Document Detail

Accuracy of stroke volume variation compared with pleth variability index to predict fluid responsiveness in mechanically ventilated patients undergoing major surgery.
MedLine Citation:
PMID:  20035228     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVE: Accurate assessment of a patient's volume status is an important goal for an anaesthetist. However, most variables assessing fluid responsiveness are either invasive or technically challenging. This study was designed to compare the accuracy of arterial pressure-based stroke volume variation (SVV) and variations in the pulse oximeter plethysmographic waveform amplitude as evaluated with the noninvasive calculated pleth variability index (PVI) with central venous pressure to predict the response of stroke volume index (SVI) to volume replacement in patients undergoing major surgery. METHODS: We studied 20 patients scheduled for elective major abdominal surgery. After induction of anaesthesia, all haemodynamic variables were recorded immediately before (T1) and subsequent to volume replacement (T2) by infusion of 6% hydroxy-ethyl starch (HES) 130/0.4 (7 ml kg) at a rate of 1 ml kg min. RESULTS: The volume-induced increase in SVI was at least 15% in 15 patients (responders) and less than 15% in five patients (nonresponders). Baseline SVV correlated significantly with changes in SVI (DeltaSVI; r = 0.80; P < 0.001) as did baseline PVI (r = 0.61; P < 0.004), whereas baseline values of central venous pressure showed no correlation to DeltaSVI. There was no significant difference between the area under the receiver operating characteristic curve for SVV (0.993) and PVI (0.973). The best threshold values to predict fluid responsiveness were more than 11% for SVV and more than 9.5% for PVI. CONCLUSION: Although arterial pressure-derived SVV revealed the best correlation to volume-induced changes in SVI, the results of our study suggest that both variables, SVV and PVI, can serve as valid indicators of fluid responsiveness in mechanically ventilated patients undergoing major surgery.
Markus Zimmermann; Thomas Feibicke; Cornelius Keyl; Christopher Prasser; Stefan Moritz; Bernhard M Graf; Christoph Wiesenack
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  27     ISSN:  1365-2346     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-05     Completed Date:  2010-11-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  555-61     Citation Subset:  IM    
Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany.
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MeSH Terms
Blood Pressure / physiology
Fluid Therapy / methods*
Hemodynamics / drug effects,  physiology
Hetastarch / administration & dosage
Middle Aged
Monitoring, Intraoperative / methods*
Plasma Substitutes / administration & dosage
Plethysmography / methods*
ROC Curve
Respiration, Artificial / methods*
Respiratory Mechanics
Stroke Volume / physiology*
Surgical Procedures, Elective / methods
Reg. No./Substance:
0/Plasma Substitutes; 9005-27-0/Hetastarch

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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