Document Detail

Evaluation of stroke volume variation obtained by arterial pulse contour analysis to predict fluid responsiveness intraoperatively.
MedLine Citation:
PMID:  19628484     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Fluid management guided by oesophageal Doppler monitor has been reported to improve perioperative outcome. Stroke volume variation (SVV) is considered a reliable clinical predictor of fluid responsiveness. Consequently, the aim of the present trial was to evaluate the accuracy of SVV determined by arterial pulse contour (APCO) analysis, using the FloTrac/Vigileo system, to predict fluid responsiveness as measured by the oesophageal Doppler. METHODS: Patients undergoing major abdominal surgery received intraoperative fluid management guided by oesophageal Doppler monitoring. Fluid boluses of 250 ml each were administered in case of a decrease in corrected flow time (FTc) to <350 ms. Patients were connected to a monitoring device, obtaining SVV by APCO. Haemodynamic variables were recorded before and after fluid bolus application. Fluid responsiveness was defined as an increase in stroke volume index >10%. The ability of SVV to predict fluid responsiveness was assessed by calculation of the area under the receiver operating characteristic (ROC) curve. RESULTS: Twenty patients received 67 fluid boluses. Fifty-two of the 67 fluid boluses administered resulted in fluid responsiveness. SVV achieved an area under the ROC curve of 0.512 [confidence interval (CI) 0.32-0.70]. A cut-off point for fluid responsiveness was found for SVV > or =8.5% (sensitivity: 77%; specificity: 43%; positive predictive value: 84%; and negative predictive value: 33%). CONCLUSIONS: This prospective, interventional observer-blinded study demonstrates that SVV obtained by APCO, using the FloTrac/Vigileo system, is not a reliable predictor of fluid responsiveness in the setting of major abdominal surgery.
D Lahner; B Kabon; C Marschalek; A Chiari; G Pestel; A Kaider; E Fleischmann; H Hetz
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2009-07-23
Journal Detail:
Title:  British journal of anaesthesia     Volume:  103     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-14     Completed Date:  2009-09-03     Revised Date:  2009-11-17    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  346-51     Citation Subset:  IM    
Department of Anaesthesiology, General Intensive Care and Pain Control, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria.
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MeSH Terms
Abdomen / surgery
Echocardiography, Transesophageal
Epidemiologic Methods
Fluid Therapy / methods
Intraoperative Care / methods
Middle Aged
Monitoring, Intraoperative / methods*
Signal Processing, Computer-Assisted
Stroke Volume*
Comment In:
Br J Anaesth. 2009 Dec;103(6):896-7; author reply 897-9   [PMID:  19918025 ]

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