Prediction of fluid responsiveness in patients during cardiac surgery

被引:136
作者
Rex, S
Brose, S
Metzelder, S
Hüneke, R
Schälte, G
Autschbach, R
Rossaint, R
Buhre, W
机构
[1] Rhein Westfal TH Aachen, Dept Anaesthesiol, D-5100 Aachen, Germany
[2] Rhein Westfal TH Aachen, Dept Thorac & Cardiovasc Surg, D-5100 Aachen, Germany
关键词
fluid balance; lung; tidal volume; monitoring; functional haemodynamic; surgery; cardiovascular;
D O I
10.1093/bja/aeh280
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background. Left ventricular stroke volume variation (SVV) has been shown to be a predictor of fluid responsiveness in various subsets of patients. However, the accuracy and reliability of SVV are unproven in patients ventilated with low tidal volumes. Methods. Fourteen patients were studied immediately after coronary artery bypass grafting (CABG). All patients were mechanically ventilated in pressure-controlled mode [tidal volume 7.5 (1.2) ml kg(-1)]. In addition to standard haemodynamic monitoring, SVV was assessed by arterial pulse contour analysis. Left ventricular end-diastolic area index (LVEDAI) was determined by transoesophageal echocardiography. A transpulmonary thermodilution technique was used for measurement of cardiac index (CI), stroke volume index (SVI) and intrathoracic blood volume index (ITBI). All variables were assessed before and after a volume shift induced by tilting the patients from the anti-Trendelenburg (30degrees head up) to the Trendelenburg position (30degrees head down). Results. After the change in the Trendelenburg position, SVV decreased significantly, while CI, SVI, ITBI, LVEDAI, central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) increased significantly. Changes in SVI were significantly correlated to changes in SVV (r=0.70; P<0.0001) and to changes in LVEDAI, ITBI, CVP and PAOP. Only prechallenge values of SVV were predictive of changes in SVI after change from the anti-Trendelenburg to the Trendelenburg position. Conclusions. In patients after CABG surgery who were ventilated with low tidal volumes, SVV enabled prediction of fluid responsiveness and assessment of the haemodynamic effects of volume loading.
引用
收藏
页码:782 / 788
页数:7
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