Prediction of Fluid Responsiveness by Stroke Volume Variation in Children Undergoing Fontan Operation

Background. Fontan operation is a palliative medical procedure performed on children with single-ventricle defects. As postoperative success of the procedure largely depends on the preload volume, it is necessary to maintain an appropriate pressure gradient between the systemic vein and the left atrium to ensure the effective volume of systemic circulation. However, there is a lack of effective indexes to evaluate fluid responsiveness in Fontan patients. Stroke volume variation (SVV) is a dynamic hemodynamic parameter based on cardiopulmonary interaction in mechanical ventilation. This study is aimed at validating the sensitivity and specificity of SVV and central venous pressure (CVP) in assessing the fluid responsiveness of Fontan patients. Method. Sixty-four children with single ventricle who underwent modified Fontan operation between May 2018 and January 2020 were included in this study. Patients were administered 10 ml·kg-1 albumin for fluid challenge within 10 min after cardiopulmonary bypass. Before and after fluid challenge, the invasive arterial pressure module was connected to MostCare™ equipment to collect the cardiac index (CI) and SVV dynamically in a time window of 30 s at a frequency of 1000 Hz. According to the range of CI change, patients with Δ CI ≥ 15 % were classified into the responder (R) group and those with Δ CI < 15 % into the nonresponder (NR) group. Using SVV and CVP as indicators, the receiver operating characteristic (ROC) curve of the patients was established, and the area under curve (AUC), diagnostic threshold, sensitivity, and specificity were calculated. Results. The SVV values were 16.28% (25th and 75th percentiles 14.17%-19.24%) and 13.68% (25th and 75th percentiles 12.90%-15.89%) before and after fluid challenge treatment in responders, respectively, and the values were 18.60 ± 1.83 mmHg before and 20.20 ± 2.39 mmHg for CVP after treatment. The AUC of SVV was 0.74 (95% confidence interval (CI) 0.54-0.94, P < 0.05 ), and the cutoff value was 16%, offering a sensitivity of 50% and a specificity of 91.7%. Meanwhile, the AUC of CVP was 0.70 (95% CI 0.50-0.92, P > 0.05 ), and the cutoff value was 19.5 mmHg, offering a sensitivity of 58% and a specificity of 76%. Conclusion. SVV exhibited a good predictive value for fluid responsiveness in pediatric Fontan patients. Appropriate fluid therapy according to SVV could improve the cardiac function of such patients. Trial registration. This study was registered in Chinese Clinical Trail Registry on Jan 26, 2018. Registration number is ChiCTR1800014654. Registry URL is http://www.chictr.org.cn/showproj.aspx?proj=25019. This observational prospective study was approved by the Local Ethics Committee of Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University (SCMCIRB-K2017035).

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Prediction of Volume Responsiveness by Stroke Volume Variation vs. Central Venous Pressure in Children Undergoing Fontan Operation

10.21203/rs.3.rs-22897/v1 ◽

2020 ◽

Author(s):

Yun'an Song ◽

Huiyan Hou ◽

Jie Bai ◽

Hongbin Gu

Keyword(s):

Stroke Volume ◽

Stroke Volume Variation ◽

Single Ventricle ◽

Fontan Operation ◽

Venous Pressure ◽

Central Venous ◽

Volume Responsiveness ◽

Before And After ◽

Fontan Patients ◽

Volume Challenge

Abstract Background: Fontan operation is a palliative medical procedure performed on children with single-ventricle defects. As postoperative success of the procedure largely depends on the preload volume, it is necessary to ensure the effective volume of systemic circulation by maintaining an appropriate pressure gradient between the systemic vein and the left atrium. However, there is a lack of effective indexes to evaluate volume responsiveness in Fontan patients. Stroke volume variation (SVV) is a dynamic hemodynamic parameter based on cardiopulmonary interaction in mechanical ventilation. This study is to validate the sensitivity and specificity of SVV vs. central venous pressure (CVP) in assessing volume responsiveness of Fontan patients.Method: 64 children were included in this prospective study with single-ventricle who underwent modified Fontan operation between May 2018 and January 2020. Patients were given 10ml·kg− 1 albumin for volume challenge within 10 min after CPB. Before and after volume challenge, the invasive arterial pressure module was connected to Mostcare™ equipment to collect SBP, MBP, DBP, SVV, CI and SVRI dynamically in a time window of 30 s at a frequency of 1000 Hz. According to the range of CI change, patients with ΔCI ≥ 15% were classified into response (R) group and patients with ΔCI < 15% into non-response (NR) group. Using SVV and CVP as indicators, the ROC of the patients was established, and the AUC, diagnostic threshold, sensitivity and specificity were calculated.Results: The 64 pediatric patients included with a mean age of 4.85 ± 1.20 years, a mean height of 98.00 ± 16.74 cm and a mean weight of 15.65 ± 5.37 kg. The SVV value was 17.15 ± 3.97% and 13.45 ± 2.45% before and after fluid challenge treatment vs. 18.60 ± 1.83 mmHg and 20.20 ± 2.39 mmHg for CVP in responders. The AUC of SVV was 0.74 (95% confidence interval [CI] 0.54–0.94, P < 0.05) and the cutoff value was 16%, offering a sensitivity of 50% and a specificity of 91.7% vs.0.70 (95% CI 0.50–0.92, P > 0.05), 19.5 mmHg, 58% and 76% for CVP.Conclusion: SVV exhibited a good predictive value for volume responsiveness in pediatric Fontan patients. Appropriate volume therapy according to SVV could improve the cardiac function of such patients.Trial registration: This research was registered in Chinese Clinical Trail Registry on Jan 26, 2018. Registration number is ChiCTR1800014654.Registry URL is http://www.chictr.org.cn/showproj.aspx?proj=25019. This observational prospective study was approved by the Local Ethics Committee of Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University (SCMCIRB-K2017035)

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Stroke volume variation is a good predictor of fluid responsiveness in cardiac surgery patients with implanted intra-arortic balloon pump

10.21203/rs.3.rs-668839/v1 ◽

2021 ◽

Author(s):

Rostislav Enev ◽

Filip Abedinov ◽

Neda Bakalova

Keyword(s):

Cardiac Surgery ◽

Stroke Volume ◽

Fluid Responsiveness ◽

Fluid Therapy ◽

Good Predictor ◽

Stroke Volume Variation ◽

Fluid Challenge ◽

Pulse Contour ◽

Important Variable ◽

Volume Variation

Abstract There is a vast body of evidence in favor of individualising fluid therapy using dynamic hemodynamic indices like stroke volume variation (SVV). Patients with implanted intra-aortic balloon pump (IABP) are excluded from this approach because of pulse contour artifacts caused by the pump. The aim of this work is to test whether SVV can be used for fluid responsiveness prediction in these patients. Materials and methods: Patients after cardiac surgery with implanted IABP were included in this study. SVV was measured after placing the IABP on standy mode for one minute. Cardiac output (CO) measurement was obtained via Swan-Ganz catheter before and after a 6 ml/kg fluid challenge. Fluid responsiveness was defined as increase of CO by at least 10%. Results: SVV above 8.5% showed a good correlation with fuid responsiveness. Sensitivity was 95 (95% CI 85 to 100) and specificity 82 (95% CI 72 to 92). SVV had an area under the ROC curve 0.91 (95% CI 0.81 to 1.0) Conclusion: SVV is a good predictor of fluid responsiveness in patients with IABP. SVV should not be excluded as a fluid therapy guide for these patients. Placing the pump on standby for one minute allows obtaining an accurate measurement of this important variable.

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Validitas Stroke Volume Variation dengan Ultrasonic Cardiac Output Monitor (USCOM) untuk Menilai Fluid Responsiveness

Sari Pediatri ◽

10.14238/sp17.5.2016.367-372 ◽

2016 ◽

Vol 17 (5) ◽

pp. 367

Author(s):

I Nyoman Budi Hartawan ◽

Antonius H Pudjiadi ◽

Abdul Latief ◽

Rismala Dewi ◽

Irene Yuniar

Keyword(s):

Intensive Care Unit ◽

Cardiac Output ◽

Stroke Volume ◽

Fluid Responsiveness ◽

Area Under Curve ◽

Stroke Volume Variation ◽

Fluid Challenge ◽

Pediatric Intensive Care ◽

Volume Variation ◽

Cardiac Output Monitor

Latar belakang. Stroke volume variation (SVV) adalah parameter hemodinamik untuk menilai fluid responsiveness. Pengukuran SVV dapat dilakukan dengan USCOM yang merupakan alat pemantauan hemodinamik non invasif berbasis ekokardiografi Doppler.Tujuan. Mengetahui nilai cut-off point (titik potong optimal) SVV dengan USCOM sebagai prediktor fluid responsiveness pada pasien dengan ventilasi mekanik.Metode. Penelitan dilaksanakan di Pediatric Intensive Care Unit (PICU) dan Unit Gawat Darurat (UGD) Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta. Penelitian ini merupakan uji diagnostik dengan menggunakan peningkatan stroke volume (SV) setelah challenge cairan ringer laktat 10 mL/kg berat badan selama 15 menit sebagai indek. Subyek penelitian adalah pasien dengan usia ≥1 bulan dan ≤18 tahun yang menggunakan ventilasi mekanik. Peningkatan nilai SV ≥10% disebut responder dan <10% disebut non responder. Pengukuran SV dengan USCOM dilakukan sebelum dan setelah fluid challenge, dan pengukuran SVV dilakukan sebelum challenge cairan.Hasil. Terdapat 32 subyek ikut serta dalam penelitian. Area under curve (AUC) subyek ventilasi mekanik adalah 76,6% (IK95%:60,1%-93,1%), p<0,05. Titik potong optimal SVV adalah 30%, dengan sensitivitas 72,7% dan spesisifitas 70%.Kesimpulan. Ultrasonic cardiac output monitor (USCOM) memiliki validitas yang baik untuk menilai SVV pada pasien dengan ventilasi mekanik.

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Stroke volume variation (SVV) and fluid responsiveness in major gynecological surgery evaluated with ClearSight

10.26226/morressier.57108e2cd462b80290b49ba6 ◽

2016 ◽

Author(s):

Dario Galante

Keyword(s):

Stroke Volume ◽

Fluid Responsiveness ◽

Stroke Volume Variation ◽

Gynecological Surgery ◽

Volume Variation

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Faculty Opinions recommendation of Accuracy of stroke volume variation compared with pleth variability index to predict fluid responsiveness in mechanically ventilated patients undergoing major surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.3515956.3213054 ◽

2010 ◽

Author(s):

Malachy Columb

Keyword(s):

Stroke Volume ◽

Fluid Responsiveness ◽

Stroke Volume Variation ◽

Major Surgery ◽

Pleth Variability Index ◽

Predict Fluid Responsiveness ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Variability Index ◽

Ventilated Patients

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Intraoperative Assessment of Fluid Responsiveness in Normotensive Dogs under Isoflurane Anaesthesia

Veterinary Sciences ◽

10.3390/vetsci8020026 ◽

2021 ◽

Vol 8 (2) ◽

pp. 26

Author(s):

Despoina Skouropoulou ◽

Luca Lacitignola ◽

Caterina Di Bella ◽

Marzia Stabile ◽

Claudia Acquafredda ◽

...

Keyword(s):

Fluid Responsiveness ◽

Systolic Pressure ◽

Fluid Challenge ◽

Pressure Variation ◽

Before And After ◽

Ringer’S Lactate ◽

Controlled Mechanical Ventilation ◽

Variability Index ◽

Plethysmographic Variability Index ◽

Volume Controlled

The aim of this study was to evaluate the incidence of fluid responsiveness (FR) to a fluid challenge (FC) in normotensive dogs under anaesthesia. The accuracy of pulse pressure variation (PPV), systolic pressure variation (SPV), stroke volume variation (SVV), and plethysmographic variability index (PVI) for predicting FR was also evaluated. Dogs were anaesthetised with methadone, propofol, and inhaled isoflurane in oxygen, under volume-controlled mechanical ventilation. FC was performed by the administration of 5 mL/kg of Ringer’s lactate within 5 min. Cardiac index (CI; L/min/m2), PPV, (%), SVV (%), SPV (%), and PVI (%) were registered before and after FC. Data were analysed with ANOVA and ROC tests (p < 0.05). Fluid responsiveness was defined as 15% increase in CI. Eighty dogs completed the study. Fifty (62.5%) were responders and 30 (37.5%) were nonresponders. The PPV, PVI, SPV, and SVV cut-off values (AUC, p) for discriminating responders from nonresponders were PPV >13.8% (0.979, <0.001), PVI >14% (0.956, <0.001), SPV >4.1% (0.793, <0.001), and SVV >14.7% (0.729, <0.001), respectively. Up to 62.5% of normotensive dogs under inhalant anaesthesia may be fluid responders. PPV and PVI have better diagnostic accuracy to predict FR, compared to SPV and SVV.

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