Comparison of stroke volume and fluid responsiveness measurements in commonly used technologies for goal-directed therapy

• Published in: Journal of clinical anesthesia 2013-09, Vol.25 (6), p.466-474
• Main Authors: Davies, Simon J., MB ChB, FRCA, Minhas, Simran, MB ChB, FRCA, Wilson, R. Jonathan T., MB ChB, FRCA, Yates, David, MB ChB, FRCA, Howell, Simon J., MD, FRCA
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia & Perioperative Care; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac output; Echocardiography, Doppler - methods; Echocardiography, Transesophageal - methods; Fluid optimization; Fluid Therapy - methods; Gastrointestinal surgery; Heart rate; Hemodynamics - physiology; Humans; Intraoperative Care - methods; Medical sciences; Methods; Middle Aged; Monitoring; Monitoring, Intraoperative - methods; Pain Medicine; Preload responsiveness; Prospective Studies; Pulmonary arteries; Pulse contour analysis; Reproducibility of Results; Signal Processing, Computer-Assisted; Stroke; Stroke Volume - physiology
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2013.04.010

Abstract Study Objective To compare stroke volume (SV) and preload responsiveness measurements from different technologies with the esophageal Doppler monitor (EDM). Design Prospective measurement study. Setting Operating room. Patients 20 ASA physical status 3 patients undergoing vascular, major urological, and bariatric surgery. Interventions Subjects received fluids using a standard Doppler protocol of 250 mL of colloid administered until SV no longer increased by > 10%, and again when the measured SV decreased by 10%. Measurements Simultaneous readings of SV, stroke volume variation (SVV) and pulse pressure variation (PPV) from the LiDCOrapid, and SVV from the FloTrac/Vigileo were compared with EDM measurements. The pleth variability index (PVI) also was recorded. Main Results No correlation was seen in percentage SV change as measured by either the LiDCOrapid (r=0.05, P = 0.616) or FloTrac (r=0.09, P = 0.363) systems compared with the EDM. Correlation was present between the LiDCOrapid and FloTrac (r=0.515, P < 0.0001). Percentage error compared with the EDM was 81% for the FloTrac and 90% for the LiDCOrapid. SVV as measured by LiDCOrapid differed for fluid responders and nonresponders (10% vs 7%; P = 0.021). Receiver operator curve analysis to predict a 10% increase in SV from the measured variables showed an area under the curve of 0.57 (95% CI 0.43-0.72) for SVVFloTrac , 0.64 (95% CI 0.52-0.78) for SVVLiDCO , 0.61 (95% CI 0.46 -0.76) for PPV, and 0.59 (95% CI 0.46 -0.71) for PVI. Conclusions Stroke volume as measured by the FloTrac and LiDCOrapid systems does not correlate with the esphageal Doppler, has poor concordance, and a clinically unacceptable percentage error. The predictive value of the fluid responsiveness parameters is low, with only SVV measured by the LiDCOrapid having clinical utility.