Evaluation of stroke volume variations obtained with the pressure recording analytic method
Critical Care Medicine, 04/04/2012
Biais M et al. – Stroke volume variations obtained with a pressure recording analytic method cannot predict fluid responsiveness in intensive care unit patients under mechanical ventilation. Cardiac output measured by this device is not able to track changes in cardiac output induced by volume expansion.Methods
- Thirty-five mechanically ventilated patients with circulatory failure for whom the decision to give fluid was taken by the physician were included.
- Exclusion criteria were: Arrhythmia, tidal volume <8mL/kg, left ventricular ejection fraction<50%, right ventricular dysfunction, and heart rate/respiratory rate ratio <3.6.
- Fluid challenge with 500mL of saline over 15mins.
- Stroke volume variations and cardiac output obtained with a pressure recording analytic method, pulse pressure variations, and cardiac output estimated by echocardiography were recorded before and after volume expansion.
- Patients were defined as responders if stroke volume obtained using echocardiography increased by ≥15% after volume expansion.
- Nineteen patients responded to the fluid challenge.
- Median [interquartile range, 25% to 75%] stroke volume variation values at baseline were not different in responders and nonresponders (10% [8-16] vs. 14% [12-16]), whereas pulse pressure variations were significantly higher in responders (17% [13-19] vs. 7% [5-10]; p<.0001).
- A 12.6% stroke volume variations threshold discriminated between responders and nonresponders with a sensitivity of 63% (95% confidence interval 38% to 84%) and a specificity of 69% (95% confidence interval 41% to 89%).
- A 10% pulse pressure variation threshold discriminated between responders and nonresponders with a sensitivity of 89% (95% confidence interval 67% to 99%) and a specificity of 88% (95% confidence interval 62% to 98%).
- The area under the receiver operating characteristic curves was different between pulse pressure variations (0.95; 95% confidence interval 0.82-0.99) and stroke volume variations (0.60; 95% confidence interval 0.43-0.76); p<.0001).
- Volume expansion-induced changes in cardiac output measured using echocardiography or pressure recording analytic method were not correlated (r2=0.14; p>.05) and the concordance rate of the direction of change in cardiac output was 60%.