scholarly journals Changes in stroke volume induced by lung recruitment maneuver can predict fluid responsiveness during intraoperative lung-protective ventilation in prone position

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ryota Watanabe ◽  
Koichi Suehiro ◽  
Akira Mukai ◽  
Katsuaki Tanaka ◽  
Tokuhiro Yamada ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Prone Position ◽  
Recruitment Maneuver ◽  
Protective Ventilation ◽  
Lung Recruitment ◽  
Lung Protective Ventilation ◽  
Future Research ◽  
Gray Zone ◽  
Clinical Trial Registry ◽  
Lung Recruitment Maneuver

Abstract Background The present study aimed to evaluate the reliability of hemodynamic changes induced by lung recruitment maneuver (LRM) in predicting stroke volume (SV) increase after fluid loading (FL) in prone position. Methods Thirty patients undergoing spine surgery in prone position were enrolled. Lung-protective ventilation (tidal volume, 6–7 mL/kg; positive end-expiratory pressure, 5 cmH2O) was provided to all patients. LRM (30 cmH2O for 30 s) was performed. Hemodynamic variables including mean arterial pressure (MAP), heart rate, SV, SV variation (SVV), and pulse pressure variation (PPV) were simultaneously recorded before, during, and at 5 min after LRM and after FL (250 mL in 10 min). Receiver operating characteristic curves were generated to evaluate the predictability of SVV, PPV, and SV decrease by LRM (ΔSVLRM) for SV responders (SV increase after FL > 10%). The gray zone approach was applied for ΔSVLRM. Results Areas under the curve (AUCs) for ΔSVLRM, SVV, and PPV to predict SV responders were 0.778 (95% confidence interval: 0.590–0.909), 0.563 (0.371–0.743), and 0.502 (0.315–0.689), respectively. The optimal threshold for ΔSVLRM was 30% (sensitivity, 92.3%; specificity, 70.6%). With the gray zone approach, the inconclusive values ranged 25 to 75% for ΔSVLRM (including 50% of enrolled patients). Conclusion In prone position, LRM-induced SV decrease predicted SV increase after FL with higher reliability than traditional dynamic indices. On the other hand, considering the relatively large gray zone in this study, future research is needed to further improve the clinical significance. Trial registration UMIN Clinical Trial Registry UMIN000027966. Registered 28th June 2017.

Changes in Stroke Volume Induced by Lung Recruitment Maneuver Predict Fluid Responsiveness in Mechanically Ventilated Patients in the Operating Room

2017 ◽  
Vol 126 (2) ◽  
pp. 260-267 ◽  
Author(s):  
Matthieu Biais ◽  
Romain Lanchon ◽  
Musa Sesay ◽  
Lisa Le Gall ◽  
Bruno Pereira ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Pulse Pressure ◽  
Volume Expansion ◽  
Recruitment Maneuver ◽  
Lung Recruitment ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Preload Responsiveness ◽  
Lung Recruitment Maneuver ◽  
Ventilated Patients

Abstract Background Lung recruitment maneuver induces a decrease in stroke volume, which is more pronounced in hypovolemic patients. The authors hypothesized that the magnitude of stroke volume reduction through lung recruitment maneuver could predict preload responsiveness. Methods Twenty-eight mechanically ventilated patients with low tidal volume during general anesthesia were included. Heart rate, mean arterial pressure, stroke volume, and pulse pressure variations were recorded before lung recruitment maneuver (application of continuous positive airway pressure of 30 cm H2O for 30 s), during lung recruitment maneuver when stroke volume reached its minimal value, and before and after volume expansion (250 ml saline, 0.9%, infused during 10 min). Patients were considered as responders to fluid administration if stroke volume increased greater than or equal to 10%. Results Sixteen patients were responders. Lung recruitment maneuver induced a significant decrease in mean arterial pressure and stroke volume in both responders and nonresponders. Changes in stroke volume induced by lung recruitment maneuver were correlated with those induced by volume expansion (r2 = 0.56; P < 0.0001). A 30% decrease in stroke volume during lung recruitment maneuver predicted fluid responsiveness with a sensitivity of 88% (95% CI, 62 to 98) and a specificity of 92% (95% CI, 62 to 99). Pulse pressure variations more than 6% before lung recruitment maneuver discriminated responders with a sensitivity of 69% (95% CI, 41 to 89) and a specificity of 75% (95% CI, 42 to 95). The area under receiver operating curves generated for changes in stroke volume induced by lung recruitment maneuver (0.96; 95% CI, 0.81 to 0.99) was significantly higher than that for pulse pressure variations (0.72; 95% CI, 0.52 to 0.88; P < 0.05). Conclusions The authors’ study suggests that the magnitude of stroke volume decrease during lung recruitment maneuver could predict preload responsiveness in mechanically ventilated patients in the operating room.

LUNG RECRUITMENT MANEUVER: OPEN VS. CLOSED CHEST.

2005 ◽  
Vol 33 ◽  
pp. A19
Author(s):  
jonas nielsen ◽  
E Nygard ◽  
J Tingleff ◽  
A Larsson
Keyword(s):  
Recruitment Maneuver ◽  
Lung Recruitment ◽  
Closed Chest ◽  
Lung Recruitment Maneuver

scholarly journals Stroke volume changes induced by a recruitment maneuver predict fluid responsiveness in patients with protective ventilation in the operating theater

Medicine ◽  
2016 ◽  
Vol 95 (28) ◽  
pp. e4259 ◽  
Author(s):  
Bruno De Broca ◽  
Jeremie Garnier ◽  
Marc-Olivier Fischer ◽  
Thomas Archange ◽  
Julien Marc ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Fluid Responsiveness ◽  
Recruitment Maneuver ◽  
Protective Ventilation ◽  
Volume Changes ◽  
Predict Fluid Responsiveness ◽  
Operating Theater

scholarly journals The tidal volume challenge improves the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation

2019 ◽  
Author(s):  
Joo-Hyun Jun ◽  
Rack Kyung Chung ◽  
Hee Jung Baik ◽  
Mi Hwa Chung ◽  
Joon-Sang Hyeon ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Stroke Volume ◽  
Tidal Volume ◽  
Fluid Responsiveness ◽  
Protective Ventilation ◽  
Volume Index ◽  
Lung Protective Ventilation ◽  
Predictive Capability ◽  
Robot Assisted ◽  
Trendelenburg Position

Abstract Background: The reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) is controversial under pneumoperitoneum. In addition, the usefulness of these indices is being called into question with the increasing adoption of lung-protective ventilation using low tidal volume (VT) in surgical patients. A recent study indicated that changes in PPV or SVV obtained by transiently increasing VT (VT challenge) accurately predicted fluid responsiveness even in critically ill patients receiving low VT. We evaluated whether the changes in PPV and SVV induced by a VT challenge predicted fluid responsiveness during pneumoperitoneum. Methods: We performed an interventional prospective study in patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position under lung-protective ventilation. PPV, SVV, and the stroke volume index (SVI) were measured at a VT of 6 mL/kg and 3 minutes after increasing the VT to 8 mL/kg. The VT was reduced to 6 mL/kg, and measurements were performed before and 5 minutes after volume expansion (infusing 6% hydroxyethyl starch 6 ml/kg over 10 minutes). Fluid responsiveness was defined as ≥ 15% increase in the SVI. Results: Twenty-four of the 38 patients enrolled in the study were responders. In the receiver operating characteristic curve analysis, an increase in PPV > 1% after the VT challenge showed excellent predictive capability for fluid responsiveness, with an area under the curve (AUC) of 0.95 [95% confidence interval (CI), 0.83–0.99, P < 0.0001; sensitivity 92%, specificity 86%]. An increase in SVV > 2% after the VT challenge predicted fluid responsiveness, but showed only fair predictive capability, with an AUC of 0.76 (95% CI, 0.60–0.89, P < 0.0006; sensitivity 46%, specificity 100%). The augmented values of PPV and SVV following VT challenge also showed the improved predictability of fluid responsiveness compared to PPV and SVV values (as measured by VT) of 6 ml/kg. Conclusions: The change in PPV following the VT challenge has excellent reliability in predicting fluid responsiveness in our surgical population. The change in SVV and augmented values of PPV and SVV following this test are also reliable.

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