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Stroke output variations calculated by esophageal Doppler is a reliable predictor of fluid response

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Abstract

Objective

Esophageal Doppler allows continuous monitoring of stroke volume index (SVI) and corrected flow time (FTc). We hypothesized that variations in stroke output index SOI (SVI/FTc) during volume expansion can predict the hemodynamic response to subsequent fluid loading better than the static values.

Design and setting

Prospective study in the intensive care unit of a university hospital.

Patients

Fifty-one patients with circulatory failure were monitored by esophageal Doppler.

Interventions

Patients who responded to a first fluid challenge received a second one. Patients who responded to both were classified as responders-responders, and those who did not respond to the second as responders-nonresponders. In these two groups we compared ΔSVI, ΔFTc, and ΔSOI during each fluid challenge and also static values at the end of each fluid challenge.

Measurements and results

After the first fluid challenge ΔSOI and ΔSVI were significantly higher in patients who responded to subsequent volume expansion than in patients who no longer responded. ROC curves showed that ΔSOI was a better predictor of fluid responsiveness than ΔSVI. During volume expansion a ΔSOI value of 11% discriminated between responders and nonresponders to subsequent volume expansion with a sensitivity of 91% and a specificity of 97%. There was no significant difference between the two groups for FTc value at the end of first fluid challenge.

Conclusions

Analysis of ΔSOI during fluid challenge predicts response to subsequent fluid challenge and FTc is not a reliable indicator of cardiac preload.

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References

  1. Dellinger RP, Carlet JM, Gerlach H, Ramsey G, Levy M (2004) Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–873

    Article  PubMed  Google Scholar 

  2. Arieff AI (1999) Fatal postoperative pulmonary edema: pathogenesis and literature review. Chest 115:1371–1377

    Article  PubMed  Google Scholar 

  3. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138

    PubMed  Google Scholar 

  4. Slama M, Masson H, Teboul JL, Arnould ML, Nait-Kaoudjt R, Colas B, Peltier M, Tribouilloy C, Susic D, Frohlich E, Andrejak M (2004) Monitoring of respiratory variations of aortic blood flow velocity using esophageal Doppler. Intensive Care Med 30:1182–1187

    PubMed  Google Scholar 

  5. Slama M, Masson H, Teboul JL, Arnout ML, Susic D, Frohlich E, Andrejak M (2002) Respiratory variations of aortic VTI: a new index of hypovolemia and fluid responsiveness. Am J Physiol Heart Circ Physiol 283:1729–1733

    Google Scholar 

  6. Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL (2001) Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 119:867–873

    Article  PubMed  Google Scholar 

  7. Reuter DA, Kirchner A, Felbinger TW, Weis FC, Kilger E, Lamm P, Goetz AE (2003) Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function. Crit Care Med 31:1399–1404

    Article  PubMed  Google Scholar 

  8. Reuter DA, Felbinger TW, Schmidt C, Kilger E, Goedje O, Lamm P, Goetz AE (2002) Volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med 28:392–398

    Article  PubMed  Google Scholar 

  9. Krishnamurthy B, McMurray TJ, McClean E (1997) The peri-operative use of the oesophageal Doppler monitor in patients undergoing coronary artery revascularisation. A comparison with the continuous cardiac output monitor. Anaesthesia 52:624–629

    Article  PubMed  Google Scholar 

  10. Leone D, Servillo G, De Robertis E, Rossano F, Tufano R (1998) Monitoring cardiac output: esophageal doppler vs thermodilution. Minerva Anestesiol 64:351–356

    PubMed  Google Scholar 

  11. Baillard C, Cohen Y, Fosse JP, Karoubi P, Hoang P, Cupa M (1999) Haemodynamic measurements (continuous cardiac output and systemic vascular resistance) in critically ill patients: transoesophageal Doppler versus continuous thermodilution. Anaesth Intensive Care 27:33–37

    PubMed  Google Scholar 

  12. Keyl C, Rodig G, Lemberger P, Hobbhahn J (1996) A comparison of the use of transoesophageal Doppler and thermodilution techniques for cardiac output determination. Eur J Anaesthesiol 13:136–142

    Article  PubMed  Google Scholar 

  13. Sinclair S, James S, Singer M (1997) Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ 315:909–912

    PubMed  Google Scholar 

  14. Conway DH, Mayall R, Abdul-Latif MS, Gilligan S, Tackaberry C (2002) Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Anaesthesia 57:845–849

    Article  PubMed  Google Scholar 

  15. Venn R, Steele A, Richardson P, Poloniecki J, Grounds M, Newman P (2002) Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth 88:65–71

    Article  PubMed  Google Scholar 

  16. Gan TJ, Soppitt A, Maroof M, El Moalem H, Robertson KM, Moretti E, Dwane P, Glass PS (2002) Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 97:820–826

    Article  PubMed  Google Scholar 

  17. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874

    PubMed  Google Scholar 

  18. Legall J, Lemeshow S, Saulnier F (1993) New Simplified Acute Physiology Score (SAPS II) based on a European/North American Multicenter Study. JAMA 270:2957–2963

    PubMed  Google Scholar 

  19. Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843

    PubMed  Google Scholar 

  20. Madan AK, UyBarreta VV, Aliabadi-Wahle S, Jesperson R, Hartz RS, Flint LM, Steinberg SM (1999) Esophageal Doppler ultrasound monitor versus pulmonary artery catheter in the hemodynamic management of critically ill surgical patients. J Trauma 46:607–611

    PubMed  Google Scholar 

  21. DiCorte CJ, Latham P, Greilich PE, Cooley MV, Grayburn PA, Jessen ME (2000) Esophageal Doppler monitor determinations of cardiac output and preload during cardiac operations. Ann Thorac Surg 69:1782–1786

    Article  PubMed  Google Scholar 

  22. Michard F, Teboul JL (2002) Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 121:2000–2008

    Article  PubMed  Google Scholar 

  23. Lefrant JY, Bruelle P, Aya AG, Saissi G, Dauzat M, de La Coussaye JE, Eledjam JJ (1998) Training is required to improve the reliability of esophageal Doppler to measure cardiac output in critically ill patients. Intensive Care Med 24:347–352

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Anesthesia and Intensive Care Unit Department, Purpan University Hospital, Place du Dr Baylac, TSA 40031, 31059, Toulouse Cedex 9, France

    Fabrice Vallée, Olivier Fourcade, Olivier De Soyres, Olivier Angles, Pascale Sanchez-Verlaan, Fabien Pillard, Nadia Smail, Michel Olivier, Michèle Genestal & Kamran Samii

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  1. Fabrice Vallée
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  2. Olivier Fourcade
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  3. Olivier De Soyres
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  4. Olivier Angles
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  5. Pascale Sanchez-Verlaan
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  6. Fabien Pillard
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  7. Nadia Smail
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  8. Michel Olivier
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  9. Michèle Genestal
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  10. Kamran Samii
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Correspondence to Olivier Fourcade.

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Vallée, F., Fourcade, O., De Soyres, O. et al. Stroke output variations calculated by esophageal Doppler is a reliable predictor of fluid response. Intensive Care Med 31, 1388–1393 (2005). https://doi.org/10.1007/s00134-005-2768-0

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  • DOI: https://doi.org/10.1007/s00134-005-2768-0

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