Dynamic Indices for the Prediction of Fluid Responsiveness in Laparoscopic Urologic Surgery under General Anaesthesia: An Interventional Study
DOI:
https://doi.org/10.31584/jhsmr.2022915Keywords:
dynamic indices, predict fluid responsiveness, urologic surgeryAbstract
Objective: This study aims to evaluate the ability of stroke volume variation (SVV), pulse pressure variation (PPV), and change in PVV and SVV after tidal volume challenge testing (∆PPV and ∆SVV) aiming to predict fluid responsiveness in patients undergoing laparoscopic urologic surgery.
Material and Methods: A prospective interventional study was performed with 23 patients undergoing urologic surgery while they were placed in Trendelenburg positions. A Vigileo/FloTrac system was used for the analysis. Hemodynamic data such as: arterial pressure (MAP), heart rate (HR), peak airway pressure (PIP), stroke volume (SV), cardiac output (CO), SVV, and PPV were recorded at the tidal volume settings of 8 mL/kg and 12 mL/kg before, and after a fluid challenge (FC). Fluid responsiveness was defined as an increase in SV(ΔSV) ≥15.0%.
Results: After tidal volume challenge tests, there were significant increases in PIP in both groups. PPV increased only in the responders, as opposed to SVV, which increased significantly only in non-responders after tidal volume challenge test. After fluid challenge, PVV and SVV decreased gradually and significantly in both groups. The area under the ROC curves of patients undergoing laparoscopic urologic surgery was 0.872 (95% CI: 0.57-0.96) for ∆PPV, this change was the highest compared to other parameters. The threshold of the ∆PPV of patients undergoing laparoscopic urologic surgery was 4% with a sensitivity at 0.75 and specificity at 0.93.
Conclusion: Change in PPV after the tidal volume challenge test from 8 mL/kg to 12 mL/kg can be used as an effective indicator to monitor fluid responsiveness in regards to patients undergoing urologic surgery.
References
Michard F. Changes in arterial pressure during mechanical ventilation. Anesthesiology 2005;103:419-28; quiz 449. doi: 10.1097/00000542-200508000-00026.
Kim HK, Pinsky MR. Effect of tidal volume, sampling duration, and cardiac contractility on pulse pressure and stroke volume variation during positive-pressure ventilation. Crit Care Med 2008;36:2858-62. doi: 10.1097/CCM.0b013e3181865aea.
De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med 2005;31:517-23. doi: 10.1007/s00134-005-2586-4.
Grabowski JE, Talamini MA. Physiological effects of pneumo peritoneum. J Gastrointest Surg 2009;13:1009-16. doi: 10.1007/ s11605-008-0662-0.
Vistisen ST, Koefoed-Nielsen J, Larsson A. Should dynamic parameters for prediction of fluid responsiveness be indexed to the tidal volume? Acta Anaesthesiol Scand 2010;54:191-8. doi: 10.1111/j.1399-6576.2009.02114.x.
Hong DM, Lee JM, Seo JH, Min JJ, Jeon Y, Bahk JH. Pulse pressure variation to predict fluid responsiveness in spontaneously breathing patients: tidal vs forced inspiratory breathing. Anaesthesia 2014;69:717-22. doi: 10.1111/anae. 12678.
Min JJ, Gil NS, Lee JH, Ryu DK, Kim CS, Lee SM. Predictor of fluid responsiveness in the ”grey zone”: augmented pulse pressure variation through a temporary increase in tidal volume. Br J Anaesth 2017;119:50-6. doi: 10.1093/bja/aex074.
Monge García MI, Gil Cano A, Díaz Monrové JC. Arterial pressure changes during the valsalva maneuver to predict fluid responsiveness in spontaneously breathing patients. Intensive Care Med 2009;35:77-84. doi: 10.1007/s00134-008-1295-1.
Biais M, Ehrmann S, Mari A, Conte B, Mahjoub Y, Desebbe O, et al. Clinical relevance of pulse pressure variations for predicting fluid responsiveness in mechanically ventilated intensive care unit patients: the grey zone approach. Crit Care 2014;18:587. doi: 10.1186/s13054-014-0587-9.
Cannesson M, Le Manach Y, Hofer CK, Goarin JP, Lehot JJ, Vallet B, et al. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a ”gray zone” approach. Anesthesiology 2011;115:231-41. doi: 10.1097/ALN.0b013e318225b80a.
Chin JH, Lee EH, Hwang GS. Prediction of fluid responsiveness using dynamic preload indices in patients undergoing robot-assisted surgery with pneumoperitoneum in the Trendelenburg position. Anaesth Intensive Care 2013;41:515-22. doi: 10.1177/ 0310057X1304100413.
Zlicar M, Novak-Jankovic V, Blagus R, Cecconi M. Predictive values of pulse pressure variation and stroke volume variation for fluid responsiveness in patients with pneumoperitoneum. J Clin Monit Comput 2018;32:825-32. doi: 10.1007/s10877-017- 0081-4.
Høiseth LØ, Hoff IE, Myre K, Landsverk SA, Kirkebøen KA. Dynamic variables of fluid responsiveness during pneumoperitoneum and laparoscopic surgery. Acta Anaesthesiol Scand 2012;56:777-86. doi: 10.1111/j.1399-6576.2011.02641.x.
Díaz F, Erranz B, Donoso A, Salomon T, Cruces P. Influence of tidal volume on pulse pressure variation and stroke volume variation during experimental intra-abdominal hypertension. BMC Anesthesiol 2015;15:127. doi: 10.1186/s12871-015-0105-x.
Liu X, Fu Q, Mi W, Liu H, Zhang H, Wang P. Pulse pressure variation and stroke volume variation predict fluid responsiveness in mechanically ventilated patients experiencing intra-abdominal hypertension. BioSci Trends 2013;7:101-8. doi: 10.5582/bst.2013.v7.2.101.
Sanders DS, Carter MJ, Goodchap RJ, Cross SS, Gleeson DC, Lobo AJ. Prospective validation of the Rockall risk scoring system for upper GI hemorrhage in subgroups of patients with varices and peptic ulcers. Am J Gastroenterol 2002;97:630-5. doi: 10.1111/j.1572-0241.2002.05541.x.
Zuckerman R, Gold M, Jenkins P, Rauscher LA, Jones M, Heneghan S. The effects of pneumoperitoneum and patient position on hemodynamics during laparoscopic cholecystectomy. Surg Endosc 2001;15:562-5. doi: 10.1007/s004640080065.
Perkins NJ, Schisterman EF. The inconsistency of ”optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol 2006;163:670-5. doi: 10.1093/aje/kwj063.
Mahjoub Y, Touzeau J, Airapetian N, Lorne E, Hijazi M, Zogheib E, et al. The passive leg-raising maneuver cannot accurately predict fluid responsiveness in patients with intra-abdominal hypertension. Crit Care Med 2010;38:1824-9. doi: 10.1097/ CCM.0b013e3181eb3c21.
Renner J, Gruenewald M, Quaden R, Hanss R, Meybohm P, Steinfath M, et al. Influence of increased intra-abdominal pressure on fluid responsiveness predicted by pulse pressure variation and stroke volume variation in a porcine model. Crit Care Med 2009;37:650-8. doi: 10.1097/CCM.0b013e3181959864.
Jun JH, Chung RK, Baik HJ, Chung MH, Hyeon JS, Lee YG, et al. The tidal volume challenge improves the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation. BMC Anesthesiol 2019;19:142. doi: 10.1186/s12871-019-0807-6.
Robotham JL, Wise RA, Bromberger-Barnea B. Effects of changes in abdominal pressure on left ventricular performance and regional blood flow. Crit Care Med 1985;13:803-9. doi: 10.1097/00003246-198510000-00006.
Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators, Cavalcanti AB, Suzumura ÉA, Laranjeira LN, Paisani DM, Damiani LP, et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA 2017;318:1335-45. doi: 10.1001/jama.2017.14171, PMID 28973363.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
