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Applicability of stroke volume variation in patients of a general intensive care unit: a longitudinal observational study

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Abstract

Sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for the applicability of respiratory changes of the arterial curve such as stroke volume variation (SVV) to predict fluid-responsiveness. Furthermore, several secondary limitations including tidal volumes <8 mL/kg and SVV-values within the “gray zone” of 9–13% impair prediction of fluid-responsiveness by SVV. Therefore, we investigated the prevalence of these four conditions in general ICU-patients. This longitudinal observational study analyzed a prospectively maintained haemodynamic database including 4801 transpulmonary thermodilution and pulse contour analysis measurements of 278 patients (APACHE-II 21.0 ± 7.4). The main underlying diseases were cirrhosis (32%), sepsis (28%), and ARDS (17%). The prevalence of SR and CV was only 19.4% (54/278) in the first measurements (primary endpoint), 18.8% (902/4801) in all measurements and 26.5% (9/34) in measurements with MAP < 65 mmHg and CI < 2.5 L/min/m2 and vasopressor therapy. In 69.1% (192/278) of the first measurements and in 65.9% (3165/4801) of all measurements the patients had SR but did not have CV. In 1.8% (5/278) of the first measurements and in 2.5% (119/4801) of all measurements the patients had CV but lacked SR. In 9.7% (27/278) of the first measurements and in 12.8% (615/4801) of all measurements the patients did neither have SR nor CV. Only 20 of 278 (7.2%) of the first measurements and 8.2% of all measurements fulfilled both major criteria (CV, SR) and both minor criteria for the applicability of SVV. The applicability of SVV in ICU-patients is limited due to the absence of mandatory criteria during the majority of measurements.

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Author notes

  1. Bernd Saugel

    Present address: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

Authors and Affiliations

  1. II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany

    Sebastian Mair, Julia Tschirdewahn, Simon Götz, Johanna Frank, Veit Phillip, Benedikt Henschel, Caroline Schultheiss, Ulrich Mayr, Sebastian Noe, Matthias Treiber, Roland M. Schmid & Wolfgang Huber

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  1. Sebastian Mair
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Correspondence to Wolfgang Huber.

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Conflict of interest

Wolfgang Huber and Bernd Saugel collaborate with Pulsion Medical Systems SE (Feldkirchen, Germany) as members of the Medical Advisory Board and have received refunds for travel expenses and honoraria for giving lectures from Pulsion Medical Systems SE, Feldkirchen, Germany. All other authors have no conflict of interest to disclose.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Due to the type of the study the Ethics Committee waived the need for formal consent.

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Mair, S., Tschirdewahn, J., Götz, S. et al. Applicability of stroke volume variation in patients of a general intensive care unit: a longitudinal observational study. J Clin Monit Comput 31, 1177–1187 (2017). https://doi.org/10.1007/s10877-016-9951-4

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