Dynamic variables of fluid responsiveness during pneumoperitoneum and laparoscopic surgery

Background Few data exist on dynamic variables predicting fluid responsiveness during laparoscopic surgery. The aim of this study was to explore the effects of laparoscopy on four dynamic variables: respiratory variations in pulse pressure (?PP), stroke volume variation by Vigileo/FloTrac (SVV Vigileo), pleth variability index (PVI) and respiratory variations in pulse oximetry plethysmography waveform amplitude (?POP), and their relation to fluid challenges during laparoscopic surgery. Methods ?PP, SVV Vigileo, PVI and ?POP were studied in 20 adult patients before and during pneumoperitoneum (1012?mmHg). During ongoing laparoscopic surgery, relations between the dynamic variables and changes in stroke volume oesophageal Doppler, (SVOD) after fluid challenges (250?ml colloid) were evaluated. Results Pneumoperitoneum changed the dynamic variables as follows {mean [95% confidence interval (CI)]}: ?PP 0.5 (-1.3, 2.3)%, P?=?0.53; SVV Vigileo 0.6 (-1.3, 2.5)%, P?=?0.52; PVI 2.9 (0.4, 5.3)%, P?=?0.025. For ?POP, median difference (95% CI) was 2.5 (-0.15, 6.7)%, P?=?0.058. During laparoscopic surgery, areas under receiver operating characteristics curves (95% CI) were ?PP 0.53 (0.310.75), SVV Vigileo 0.74 (0.510.90), PVI 0.61 (0.380.81), ?POP 0.63 (0.400.82). Correlation coefficients (P-values) between changes in dynamic variables and changes in SVOD were ?PP r?=?-0.65, P?=?0.009; SVV Vigileo r?=?-0.73, P?=?0.002; PVI r?=?-0.22, P?=?0.44; ?POP r?=?-0.32, P?=?0.24. Conclusion ?PP and SVV Vigileo did not change as pneumoperitoneum was established, whereas PVI increased and ?POP tended to increase. All four dynamic variables predicted fluid responsiveness relatively poor during ongoing laparoscopic surgery. ?PP and SVV Vigileo tracked changes in stroke volume induced by fluid challenges during ongoing laparascopic surgery, whereas ?POP and PVI did not.