Is dynamic arterial elastance a predictor of an increase in blood pressure after fluid administration in pediatric patients with hypotension? Reanalysis of prospective observational studies

• Published in: Pediatric anesthesia 2020-01, Vol.30 (1), p.34-42
• Main Authors: Lee, Ji‐Hyun, Kwon, Yea‐La, Na, Jung‐Hwan, Jang, Young‐Eun, Kim, Eun‐Hee, Kim, Hee‐Soo, Kim, Jin‐Tae, Vutskits, Laszlo
• Format: Article
• Language: English
• Subjects: Anesthesia; arterial pressure; Arterial Pressure - physiology; Blood Flow Velocity - physiology; Blood pressure; Blood Pressure - physiology; Child, Preschool; Confidence intervals; Doppler; echocardiography; Female; Flow velocity; Fluid Therapy - methods; Humans; Hypotension - physiopathology; hypotension; pediatrics; Infant; Infant, Newborn; Male; Observational studies; Pediatrics; Prospective Studies; Stroke Volume
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.13769

Background Dynamic arterial elastance (Eadyn) has been proposed to predict an increase in mean arterial pressure (MAP) after volume expansion in hypotensive adults. We aimed to evaluate the clinical usefulness of Eadyn as a predictor of arterial pressure response after fluid loading in pediatric patients with hypotension. Methods We re‐analyzed data of 63 hypotensive children (age, ≤5 years), collected from three previous prospective observational studies about fluid responsiveness. Pulse pressure variation (PPV), stroke volume variation (SVV), and respiratory variation in aortic blood flow velocity (ΔVpeak) were used to calculate Eadyn (PPV/SVV) and modified Eadyn (PPV/ΔVpeak). Preload‐dependent patients were defined as those with ΔVpeak ≥12% before fluid loading. Patients were classified as pressure responders, if their MAP increased ≥15% after fluid administration. Results Mean Eadyn (SD) was 1.06 (0.47) in pressure responders (n=39) and 0.99 (0.48) in nonresponders (n = 24) (mean difference, 0.08; 95% confidence interval [CI], −0.19‐0.34; P = .567). Additionally, mean modified Eadyn was 1.27 (0.64) in responders and 1.11 (0.43) in nonresponders (mean difference, 0.17; 95% CI, −0.13‐0.46; P = 0.269). Both Eadyn (AUC 0.506; 95% confidence interval [CI], 0.337 to 0.675; P = 0.948) and modified Eadyn (AUC 0.498; 95% CI, 0.328‐0.669; P = 0.983), as well as other dynamic variables, could not predict pressure responsiveness in children. Sub‐group analysis revealed similar findings in both in 39 preload‐dependent and hypotensive patients (26 pressure responders and 13 nonpressure responders). Conclusion Both Eadyn and modified Eadyn cannot predict whether blood pressure increases with fluid administration in pediatric patients with hypotension.