Ability of Short Time Low PEEP Challenge and Mini Fluid Challenge to Predict Fluid Responsiveness During Pancreaticoduodenectomy
Taner Abdullah, Hürü Ceren Gökduman, İşbara Alp Enişte, Onur Sarban, Achmet Ali, Funda Gümüş Özcan
University of Health Sciences İstanbul Başakşehir Çam and Sakura City Hospital Department of Anesthesiology and Reanimation
Giriş: The mini-fluid challenge (MFC) and the short-time low PEEP challenge (SLPC) are two of the functional hemodynamic tests that can be used for predicting fluid responsiveness in surgical patients. However, SLPC has not been assessed in patients undergoing abdominal surgery and there is no study comparing these two tests during laparotomy.
Gereç ve Yöntem: All patients received a standard hemodynamic management. The study protocol evaluated the percentage change in stroke volume index following the application of additional 5 cmH2O PEEP for 30 seconds (SVIΔ%-SLPC) and the infusion of 100 mL crystalloid over one minute (SVIΔ%-MFC). Challenges that resulted in an increase more than 15% in SVI after the 500ml of fluid loading over 10 minutes were classified as positive challenges (PC). Areas under the receiver operating characteristics curves (ROCAUCs) were used for the comparison of the methods.
Bulgular: Thirty-three patients completed the study with 94 successful challenges. Fifty-five (58,5%) of them were PCs. The ROCAUC of SVIΔ%-MFC was observed to be significantly higher than that of SVIΔ%-SLPC (0.97 vs 0.64, p < 0.001). The best cut-off value for SVIΔ%-MFC was 5,6%. If we had stopped the bolus fluid administration when SVIΔ%-MFC ≤ 5% was observed (lower limit of the gray zone) we would have cancelled or postponed the FL in 35 (89.7%) of 39 negative challenges. The amount of fluid deferred would have corresponded to up to 40% of the total fluid given, while the average ratio of the fluid deferred would have been equal to 13,3% in the study group.
Tartışma ve Sonuç: SVIΔ%-MFC could predict fluid responsiveness with a high diagnostic performance and better than SVIΔ%-SLPC in patients undergoing open pancreatoduodenectomy. Additionally, the use of SVIΔ%-MFC throughout the surgery as a part of GDHM protocol has the potential to defer up to 40% of the total fluid given.
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