Original article
Stroke Volume Variation as a Predictor of Fluid Responsiveness in Patients Undergoing One-Lung Ventilation

https://doi.org/10.1053/j.jvca.2010.03.014Get rights and content

Objectives

To investigate the ability of stroke volume variation (SVV) calculated by the Vigileo-FloTrac system (Edwards Lifescience, Irvine, CA) to predict fluid responsiveness in patients undergoing one-lung ventilation (OLV).

Design

Prospective, observational study.

Setting

Clinical hospital.

Participants

Thirty patients scheduled for a pulmonary lobectomy requiring OLV for at least 1 hour under combined epidural/general anesthesia.

Interventions

After starting OLV, hydroxyethyl starch, 500 mL, was administered for 30 minutes.

Measurements and Main Results

Hemodynamic variables including heart rate, mean arterial pressure, cardiac index, stroke volume index (SVI), and SVV were measured before and after volume loading. SVV before volume loading was significantly correlated with the absolute changes in SVV (ΔSVV) and percentage changes in stroke volume index (ΔSVI) after volume loading (ΔSVV: p < 0.05, r = −0.893; ΔSVI: p < 0.05, r = 0.866). Of the 30 patients, 15 (50%) were responders to intravascular volume expansion (an increase in SVI ≥25%), and 15 (50%) were nonresponders (an increase in SVI <25%). The area under the ROC curve was 0.900 for SVV (95% confidence interval, 0.809-0.991), whereas the optimal threshold value of SVV to discriminate between responders and nonresponders was 10.5% (sensitivity: 82.4%, specificity: 92.3%).

Conclusions

The authors found that SVV measured by the Vigileo-FloTrac system was able to predict fluid responsiveness in patients undergoing surgery with OLV with acceptable levels of sensitivity and specificity.

Section snippets

Methods

This study was approved by the Clinical Research Ethics Committee of the authors' hospital, and written informed consent was obtained from all patients before surgery. The patients were classified as American Society of Anesthesiologists risk I or II and scheduled for a pulmonary lobectomy under thoracoscopy requiring OLV for at least 1 hour with combined epidural/general anesthesia from April to July 2009. Exclusion criteria were risk of hepatic/renal/cardiac dysfunction and severe obesity

Results

A total of 30 patients were included in the study. All lobectomies were performed under thoracoscopy in the same way, and 18 patients (60%) had right-sided operations. There were no cases with massive blood loss (>50 mL) or requiring the administration of vasoactive agents during volume loading. Table 1 shows data representing the hemodynamic variables at time points T1 and T2. Except for HR, all hemodynamic variables changed significantly (p < 0.05) after volume loading (between T1 and T2).

Discussion

Several studies have reported that systolic pressure variation and pulse pressure variation are valuable indicators of fluid responsiveness during mechanical ventilation, whereas CVP and PCWP have been found to be of little help for that prediction.14, 15, 16, 17, 18 However, the major limitations of most current dynamic indicators are their inability to be automatically and continuously monitored.19

The Vigileo-FloTrac system allows for automatic and continuous monitoring of SVV, which is

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