Novel parameters for predicting fluid responsiveness during the mini fluid challenge: ability of cardiac power index
Taner Abdullah, Hürü Ceren Gökduman, İşbara Alp Enişte, Ayşe Gülşah Atasever, Achmet Ali, Funda Gümüş Özcan
Department of Anesthesiology, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkiye
Giriş: Absolute or percentage change of stroke volume index (MFC-ΔSVI and MFC-ΔSVI%, respectively) are the two most frequently used variables during the mini fluid challenge (MFC). However, up to 20% of the patients remain in the gray zone of these variables. This study aims to compare the MFC-ΔSVI% and cardiac power index change percentage due to mini fluid challenge (MFC-ΔCPI%) with the baseline values of pulse pressure variation and stroke volume variation (PPV and SVV) in terms of their abilities to predict fluid responsiveness in patients undergoing major abdominal surgery.
Gereç ve Yöntem: SVI, CPI, SVV, PPV, arterial elastance (Ea), dP/dtmax and cardiac cycle efficiency (CCE) were recorded before 100mL isotonic saline was infused over one minute (MFC), One minute after MFC was completed, and three minutes after additional 400mL of isotonic saline was infused within 10 minutes to complete 500mL of fluid loading (FL). Patients whose SVI increased more than 15% after the FL were defined as fluid responders.
Bulgular: Sixty-seven patients completed the study. Thirty-five patients (52%) were responders. The areas under the receiver operating characteristics curves generated to predict fluid responsiveness for MFC-ΔSVI% and MFC-ΔCPI% (0.94; 95% CI: 0.86-0.99 and 0.89; 95% CI: 0.79-0.95, respectively) were significantly higher than those for SVV and PPV (0.63; 95% CI: 0.50-0.75 and 0.55; 95% CI: 0.42-0.67, respectively) (p<0.001 for all comparisons). The best cut-off values for MFC-ΔSVI% and MFC-ΔCPI% were 6.67 and 5.3, respectively. The gray zone analysis revealed that the MFC-ΔSVI% values of 12 patients were in the gray zone. Of the 12, 7 patients’ MFC-ΔCPI% values were outside of the gray zone.
Tartışma ve Sonuç: Fluid responsiveness can be predicted more accurately by using MFC-ΔSVI% and MFC-ΔCPI% than by using SVV and PPV. Additionally, concomitant use of MFC-ΔSVI% and MFC-ΔCPI% is recommended as this approach diminishes the number of the patients in the gray zone.
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