Positive end-expiratory pressure-induced increase in external jugular venous pressure does not predict fluid responsiveness in laparoscopic prostatectomy
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Dynamic change in central venous pressure (CVP) was associated with fluid responsiveness. External jugular venous pressure (EJVP) may reliably estimate CVP and have the advantages of being less invasive. We investigated whether increase in EJVP induced by positive end-expiratory pressure (PEEP) could be a reliable predictor of fluid responsiveness in patients undergoing robot-assisted laparoscopic prostatectomy (RALP).
Fifty patients who underwent RALP with steep Trendelenburg position were enrolled. PEEP of 10 cmH2O was applied for 5 min and then 300 ml of colloid was administered. EJVP, stroke volume variation (SVV), and cardiac index calculated by pulse contour method were measured before and after the PEEP challenge and colloid administration. Increase in cardiac index > 10% was used to define the fluid responsiveness.
Twenty-six patients were fluid responders. Neither the increase in EJVP after the initial PEEP nor SVV was significantly different between responders and non-responders. They were not significantly correlated with an increase in cardiac index. The areas under the receiver operating characteristic curve (AUC) of these two variables were not significantly greater than 0.5. However, a post hoc analysis revealed that AUC of a decrease in EJVP after removal of PEEP was significantly greater than 0.50.
Our study results suggested that SVV and increase in EJVP after applying PEEP were not accurate predictors of fluid responsiveness during RALP. Further studies are required to find an adequate preload index in robot-assisted urologic surgery with steep Trendelenburg position.
KeywordsLaparoscopy Robot surgery Cardiac output Central venous pressure Fluid responsiveness
This study did not receive any external fund.
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest.
- 2.Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119:507–15.CrossRefPubMedGoogle Scholar
- 12.Chin JH, Kim WJ, Choi JH, Han YA, Kim SO, Choi WJ. Unreliable tracking ability of the third-generation FloTrac/Vigileo system for changes in stroke volume after fluid administration in patients with high systemic vascular resistance during laparoscopic surgery. PLoS One. 2015;10:e0142125.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Kawazoe Y, Nakashima T, Iseri T, Yonetani C, Ueda K, Fujimoto Y, Kato S. The impact of inspiratory pressure on stroke volume variation and the evaluation of indexing stroke volume variation to inspiratory pressure under various preload conditions in experimental animals. J Anesth. 2015;29:515–21.CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Seo H, Kong YG, Jin SJ, Chin JH, Kim HY, Lee YK, Hwang JH, Kim YK. Dynamic arterial elastance in predicting arterial pressure increase after fluid challenge during robot-assisted laparoscopic prostatectomy: a prospective observational study. Medicine (Baltimore). 2015;94:e1794.CrossRefGoogle Scholar
- 30.Duperret S, Lhuillier F, Piriou V, Vivier E, Metton O, Branche P, Annat G, Bendjelid K, Viale JP. Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs. Intensive Care Med. 2007;33:163–71.CrossRefPubMedGoogle Scholar
- 36.Shojaee M, Sabzghabaei A, Alimohammadi H, Derakhshanfar H, Amini A, Esmailzadeh B. Effect of positive end-expiratory pressure on central venous pressure in patients under mechanical ventilation. Emerg (Tehran). 2017;5:e1.Google Scholar
- 40.Maddali MM, Waje ND, Sathiya PM. Authentication of radial versus femoral arterial pressure waveform-derived cardiac output with transesophageal echocardiography-derived cardiac output measurements in patients undergoing on-pump coronary bypass surgery. J Cardiothorac Vasc Anesth. 2017;31:1183–9.CrossRefPubMedGoogle Scholar