Ability of stroke volume variation measured by oesophageal Doppler monitoring to predict fluid responsiveness during surgery

作者：Guinot P G^*; de Broca B; Abou Arab O; Diouf M; Badoux L; Bernard E; Lorne E; Dupont H

来源：British Journal of Anaesthesia, 2013, 110(1): 28-33.

DOI：10.1093/bja/aes301

• anaesthesia
• cardiac output measurement
• Doppler ultrasonography
• intraoperative monitoring
• stroke volume

The objective of this study was to test whether non-invasive assessment of respiratory stroke volume variation (respSV) by oesophageal Doppler monitoring (ODM) can predict fluid responsiveness during surgery in a mixed population. The predictive value of respSV was evaluated using a grey zone approach.
Ninety patients monitored using ODM who required i.v. fluids to expand their circulating volume during surgery under general anaesthesia were studied. Patients with a preoperative arrhythmia, right ventricular failure, frequent ectopic beats, or breathing spontaneously were excluded. Haemodynamic variables and oesophageal Doppler indices [peak velocity (PV), stroke volume (SV), corrected flow time (FTc), cardiac output (CO), respSV, and respiratory variation of PV (respPV)] were measured before and after fluid expansion. Responders were defined by a 15 increase in SV after infusion of 500 ml crystalloid solution.
SV was increased by epsilon 15 after 500 ml crystalloid infusion in 53 (59) of the 90 patients. respSV predicted fluid responsiveness with an area under the receiver-operating characteristic (AUC) curve of 0.91 [95 confidence interval (95 CI): 0.850.97, P0.0001]. The optimal respSV cut-off was 14.4 (95 CI: 14.314.5). The grey zone approach identified 12 patients (14) with a range of respSV values between 14 and 15. FTc was not predictive of fluid responsiveness (AUC 0.49, 95 CI: 0.370.62, P0.84).
respSV predicted fluid responsiveness accurately during surgery over a respSV range between 14 and 15. In contrast, FTc did not predict fluid responsiveness.

• 出版日期2013-1