Neither dynamic, static, nor volumetric variables can accurately predict fluid responsiveness early after abdominothoracic esophagectomy

Perioperative Medicine

Toshihito Tsubo¹  Toshinori Kasai¹  Junichi Saito¹  Hirobumi Okawa¹  Eiji Hashiba¹  Hironori Ishihara¹ 

[1] Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki-Shi 036-8562, Japan

关键词: Stroke volume variation;    Intrathoracic blood volume;    Glucose;    Fluid responsiveness;    Esophagectomy;    Cardiac preload;   

Others  :  816445
DOI  :  10.1186/2047-0525-2-3

 received in 2012-08-15, accepted in 2013-02-08,  发布年份 2013

【 摘 要 】

Background

Hypotension is common in the early postoperative stages after abdominothoracic esophagectomy for esophageal cancer. We examined the ability of stroke volume variation (SVV), pulse pressure variation (PPV), central venous pressure (CVP), intrathoracic blood volume (ITBV), and initial distribution volume of glucose (IDVG) to predict fluid responsiveness soon after esophagectomy under mechanical ventilation (tidal volume >8 mL/kg) without spontaneous respiratory activity.

Methods

Forty-three consecutive non-arrhythmic patients undergoing abdominothoracic esophagectomy were studied. SVV, PPV, cardiac index (CI), and indexed ITBV (ITBVI) were postoperatively measured by single transpulmonary thermodilution (PiCCO system) after patient admission to the intensive care unit (ICU) on the operative day. Indexed IDVG (IDVGI) was then determined using the incremental plasma glucose concentration 3 min after the intravenous administration of 5 g glucose. Fluid responsiveness was defined by an increase in CI >15% compared with pre-loading CI following fluid volume loading with 250 mL of 10% low molecular weight dextran.

Results

Twenty-three patients were responsive to fluids while 20 were not. The area under the receiver-operating characteristic (ROC) curve was the highest for CVP (0.690) and the lowest for ITBVI (0.584), but there was no statistical difference between tested variables. Pre-loading IDVGI (r = −0.523, P <0.001), SVV (r = 0.348, P = 0.026) and CVP (r = −0.307, P = 0.046), but not PPV or ITBVI, were correlated with a percentage increase in CI after fluid volume loading.

Conclusions

These results suggest that none of the tested variables can accurately predict fluid responsiveness early after abdominothoracic esophagectomy.

【 授权许可】

   
2013 Ishihara et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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