Ultrasonographic caval indices do not significantly contribute to predicting fluid responsiveness immediately after coronary artery bypass grafting when compared to passive leg raising

Cardiovascular Ultrasound

Research

Pawel Andruszkiewicz¹  Karol Wierzbicki²  Maciej Stapor³  Dorota Sobczyk⁴  Krzysztof Nycz⁵ 

[1] 2nd Department of Anaesthesiology and Intensive Care, Warsaw Medical University, Warsaw, Poland;Cardiovascular Surgery and Transplantology Department, Medical College, Jagiellonian University, Cracow, Poland;Department of Interventional Cardiology, John Paul II Hospital, Cracow, Poland;Department of Interventional Cardiology, John Paul II Hospital, Cracow, Poland;Emergency and Admission Department, John Paul II Hospital, Pradnicka 80, 31 202, Cracow, Poland;Emergency and Admission Department, John Paul II Hospital, Pradnicka 80, 31 202, Cracow, Poland;

关键词: Ultrasound-guided fluid therapy;    Coronary artery bypass grafting;    Inferior vena cava;    Caval index;    Fluid responsiveness;    Passive leg raising;    Fluid challenge;   

DOI  :  10.1186/s12947-016-0065-4

 received in 2016-03-16, accepted in 2016-06-01,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundAppropriate fluid management is one of the most important elements of early goal-directed therapy after cardiothoracic surgery. Reliable determination of fluid responsivenss remains the fundamental issue in volume therapy.The purpose of the study was to assess the usefulness of dynamic IVC-derived parameters (collapsibility index, distensibility index) in comparison to passive leg raising, in postoperative fluid management in mechanically ventilated patients with left ventricular ejection fraction ≥ 30 %, immediately after elective coronary artery bypass grafting.MethodsProspective observational case series study including 35 patients with LVEF ≥ 30 %, undergoingelective coronary artery bypass grafting was conducted. Transthoracic echocardiography, passive leg raising and intravenous administration of saline were performed in all study subjects. Dynamic parameters derived from ultrasonographic assessment of the IVC diameter (collapsibility index–CI and distensibility index–DI), cardiac outputResultsThere were 24 (68.57 %) responders in the study population. There were no statistical differences between the groups in relation to: clinical parameters, pre- and postoperative LVEF, fluid balance and CVP. Change in cardiac output after passive leg raising correlated significantly with that after the volume expansion (p=0.000, r=0.822). Dynamic IVC derivatives were slightly higher in fluid responders, however this trend did not reach statistical significance. None of the caval indices correlated with fluid responsiveness.ConclusionDynamic IVC-derived parameters do not predict fluid responsiveness in mechanically ventilated patients with preserved ejection fraction immediately after elective coronary artery bypass grafting. Passive leg raising is not inferior to volume expansion in differentiating between fluid responders and nonresponders. Immediate fluid challenge after CABG is safe and well tolerated.

【 授权许可】

CC BY   
© Sobczyk et al. 2016