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Efficacy of functional hemodynamic parameters in predicting fluid responsiveness with pulse power analysis in surgical patients.
MedLine Citation:
PMID:  22534733     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: In this study we quantify the ability of dynamic cardiovascular parameters measured by the PulseCOTM algorithm of the LiDCO™plus monitor to predict the response to a fluid challenge in post-operative patients.
METHODS: Surgical patients, admitted to the Intensive Care Unit from the operating theatre were monitored with the LiDCO™plus system. A number of static and dynamic cardiovascular measurements were recorded before and after a fluid challenge. Receiver Operator Characteristic (ROC) curve analysis was used to identify the baseline values, with optimum sensitivity and specificity, to predict responsiveness to a fluid challenge.
RESULTS: Thirty-one patients were enrolled, and received protocol-based fluid challenges. Twelve (38%) responded by demonstrating an increase in stroke volume of >15%. Heart rate (HR) and central venous pressure (CVP) were not statistically different between responders and non-responders. Mean arterial pressure (mAP), systolic pressure variation (SPV), pulse pressure variation (PPV) and stroke volume variation (SVV) were statistically different between responders and non-responders. Parameters with a ROC area under the curve (AUC) significantly >0.5 included SPV 0.70 (0.52-0.88) P=0.046, PPV 0.87 (0.76-0.99) P<0.0002 and SVV 0.84 (0.71-0.96) P=0.0005. The best cut-off values (sensitivity and specificity) to predict fluid were SPV >9 mmHg (73%, 76%), PPV >13% (83%, 74%) and SVV >12.5% (75%, 83%). ROC analysis did not show the AUC to be significantly >0.5 for HR, mAP and CVP CONCLUSION:Dynamic indices measured by PulseCO™ (LiDCO) have a high sensitivity and specificity in predicting fluid responsiveness in sedated and mechanically ventilated patients. A cut-off value for PPV of 13% is the most sensitive and specific indicator of fluid responsiveness.
M Cecconi; G Monti; M A Hamilton; M Puntis; D Dawson; M L Tuccillo; G Della Rocca; R Grounds; A Rhodes
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Minerva anestesiologica     Volume:  78     ISSN:  1827-1596     ISO Abbreviation:  Minerva Anestesiol     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375272     Medline TA:  Minerva Anestesiol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  527-33     Citation Subset:  IM    
Department of General Intensive Care, St George's Healthcare NHS Trust, London, UK -
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