Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients.

Wolfgang Huber; Uli Mayr; Andreas Umgelter; Michael Franzen; Wolfgang Reindl; Roland M Schmid; Florian Eckel

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Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients.

Author: Wolfgang HUBER ¹ ; Uli MAYR ¹ ; Andreas UMGELTER ¹ ; Michael FRANZEN ² ; Wolfgang REINDL ³ ; Roland M SCHMID ¹ ; Florian ECKEL ⁴
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1. II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany.
2. Universitätsklinik für Innere Medizin I, Salzburger Landeskliniken, Universitätsklinikum Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria.
3. II. Medizinische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
4. Klinik für Innere Medizin, RoMed Klinik Bad Aibling, Harthauser Straße 16, D-83043 Bad Aibling, Germany.
Publication Type:Journal Article
Keywords: Hemodynamic monitoring; Preload; Fluid responsiveness; Stroke volume variation; Pulse pressure variation
MeSH: Adult; Aged; Analysis of Variance; Blood Pressure; Female; Fluid Therapy; Hemodynamics; Humans; Intensive Care Units; Liver Failure; physiopathology; therapy; Male; Middle Aged; Monitoring, Physiologic; methods; statistics & numerical data; Pancreatitis; physiopathology; therapy; Prospective Studies; Respiration, Artificial; Sepsis; physiopathology; therapy; Stroke Volume
From: Journal of Zhejiang University. Science. B 2018;19(7):515-524
CountryChina
Language:English
Abstract: BACKGROUND AND OBJECTIVE:Stroke volume variation (SVV) has high sensitivity and specificity in predicting fluid responsiveness. However, sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for their application. Several studies suggest a limited applicability of SVV in intensive care unit (ICU) patients. We hypothesized that the applicability of SVV might be different over time and within certain subgroups of ICU patients. Therefore, we analysed the prevalence of SR and CV in ICU patients during the first 24 h of PiCCO-monitoring (primary endpoint) and during the total ICU stay. We also investigated the applicability of SVV in the subgroups of patients with sepsis, cirrhosis, and acute pancreatitis.
METHODS:The prevalence of SR and CV was documented immediately before 1241 thermodilution measurements in 88 patients.
RESULTS:In all measurements, SVV was applicable in about 24%. However, the applicability of SVV was time-dependent: the prevalence of both SR and CV was higher during the first 24 h compared to measurements thereafter (36.1% vs. 21.9%; P<0.001). Within different subgroups, the applicability during the first 24 h of monitoring ranged between 0% in acute pancreatitis, 25.5% in liver failure, and 48.9% in patients without pancreatitis, liver failure, pneumonia or sepsis.
CONCLUSIONS:The applicability of SVV in a predominantly medical ICU is only about 25%-35%. The prevalence of both mandatory criteria decreases over time during the ICU stay. Furthermore, the applicability is particularly low in patients with acute pancreatitis and liver failure.