Variation of left ventricular outflow tract velocity and global end-diastolic volume index reliably predict fluid responsiveness in cardiac surgery patients

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• 作者：Ole Broch ; MD^a ; ^{broch@anaesthesie.uni-kiel.de} ; Jochen Renner ; PhD^a ; Matthias Gruenewald ; MD^a ; Patrick Meybohm ; PhD^a ; Jan H&ouml ; cker ; MD^a ; Jan Sch&ouml ; ttler ; MD^b ; Markus Steinfath ; MD PhD^a ; Berthold Bein ; MD PhD^a
• 关键词：Velocity time integral ; Global end-diastolic volume index ; Stroke volume variation ; Pulse pressure variation ; Fluid responsiveness ; Preload ; Monitoring
• 刊名：Journal of Critical Care
• 出版年：2012
• 期刊代码：167_08839441
• 类别：med
• 出版时间：June, 2012
• 卷：27
• 期：3
• 页码：325.e7-325.e13
• 文件大小：189 K

摘要

Purpose

The ability of the global end-diastolic volume index (GEDVI) and respiratory variations in left ventricular outflow tract velocity (螖VTI_LVOT) for prediction of fluid responsiveness is still under debate. The aim of the present study was to challenge the predictive power of GEDVI and 螖VTI_LVOT compared with pulse pressure variation (PPV) and stroke volume variation (SVV) in a large patient population.

Material and Methods

Ninety-two patients were studied before coronary artery surgery. Each patient was monitored with central venous pressure (CVP), the PiCCO system (Pulsion Medical Systems, Munich, Germany), and transesophageal echocardiography. Responders were defined as those who increased their stroke volume index by greater than 15%(螖SVI_TPTD >15%) during passive leg raising.

Results

Central venous pressure showed no significant correlation with 螖SVI_TPTD (r = 鈭?.06, P = .58), in contrast to PPV (r = 0.71, P < .0001), SVV (r = 0.61, P < .0001), GEDVI (r = 鈭?.54, P < .0001), and 螖VTI_LVOT (r = 0.54, P < .0001). The best area under the receiver operating characteristic curve (AUC) predicting 螖SVI_TPTD greater than 15%was found for PPV (AUC, 0.82; P < .0001) and SVV (AUC, 0.77; P < .0001), followed by 螖VTI_LVOT (AUC, 0.74; P < .0001) and GEDVI (AUC, 0.71; P = .0006), whereas CVP was not able to predict fluid responsiveness (AUC, 0.58; P = .18).

Conclusions

In contrast to CVP, GEDVI and 螖VTI_LVOT reliably predicted fluid responsiveness under closed-chest conditions. Pulse pressure variation and SVV showed the highest accuracy.