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Predictive values of pulse pressure variation and stroke volume variation for fluid responsiveness in patients with pneumoperitoneum

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Abstract

Animal studies suggest that dynamic predictors remain useful in patients with pneumoperitoneum, but human data is conflicting. Our aim was to determine predictive values of pulse pressure variation (PPV) and stroke volume variation (SVV) in patients with pneumoperitoneum using LiDCORapid™ haemodynamic monitor. Standardised fluid challenges of colloid were administered to patients undergoing laparoscopic procedures, one fluid challenge per patient. Intra-abdominal pressure was automatically held at 12 mmHg. Fluid responsiveness was defined as an increase in nominal stroke index (nSI) ≥ 10%. Linear regression was used to assess the ability of PPV and SVV to track the changes of nSI and logistic regression and area under the receiver operating curve (AUROC) to assess the predictive value of PPV and SVV for fluid responsiveness. Threshold values for PPV and SVV were obtained using the “gray zone” approach. A p < 0.05 was considered as statistically significant. 56 patients were included in analysis. 41 patients (73%) responded to fluids. Both PPV and SVV tracked changes in nSI (Spearman correlation coefficients 0.34 for PPV and 0.53 for SVV). Odds ratio for fluid responsiveness for PPV was 1.163 (95% CI 1.01–1.34) and for SVV 1.341 (95% CI 1.10–1.63). PPV achieved an AUROC of 0.674 (95% CI 0.518–0.830) and SVV 0.80 (95% CI 0.668–0.932). The gray zone of PPV ranged between 6.5 and 20.5% and that of SVV between 7.5 and 13%. During pneumoperitoneum, as measured by LiDCORapid™, PPV and SVV can predict fluid responsiveness, however their sensitivity is lower than the one reported in conditions without pneumoperitoneum. Trial registry number: (with the Australian New Zealand Clinical Trials Registry): ACTRN12612000456853.

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Acknowledgements

Authors would like to thank Lea Andjelkovic MD, for her help in patient recruitment and critical suggestions.

Funding

This work was supported by the research fund of the University Medical Centre Ljubljana (20140007).

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Authors and Affiliations

  1. Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, Ljubljana, Slovenia

    Marko Zlicar & Vesna Novak-Jankovic

  2. Institute for Biostatistics and Medical Informatics, Medical Faculty, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia

    Rok Blagus

  3. Adult Critical Care, St. George’s Healthcare NHS Trust, London, SW170QT, UK

    Maurizio Cecconi

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  1. Marko Zlicar
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  2. Vesna Novak-Jankovic
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Contributions

MZ study design, patient recruitment, data collection and writing the first draft of the manuscript, final approval; VNJ study design, revision, final approval; RB data analysis, drafting, final approval and MC original idea, study design, revision, final approval.

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Correspondence to Marko Zlicar.

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Conflict of interest

MZ has acted as a lecturer for Edwards Lifesciences. VNJ has no interests to declare. RB has no interests to declare. MC acts as a consultant for Edwards Lifesciences, LiDCO, Masimo, Cheetah and Directed Systems.

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

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Informed consent was obtained from all individual participants included in the study.

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Zlicar, M., Novak-Jankovic, V., Blagus, R. et al. Predictive values of pulse pressure variation and stroke volume variation for fluid responsiveness in patients with pneumoperitoneum. J Clin Monit Comput 32, 825–832 (2018). https://doi.org/10.1007/s10877-017-0081-4

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  • DOI: https://doi.org/10.1007/s10877-017-0081-4

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