Volume 17 Supplement 2

33rd International Symposium on Intensive Care and Emergency Medicine

Open Access

Looking for the inflexion point of the Frank-Starling curve

  • HD Aya1,
  • M Geisen1,
  • C Ebm1,
  • N Fletcher1,
  • M Grounds1,
  • A Rhodes1 and
  • M Cecconi1
Critical Care201317(Suppl 2):P206

DOI: 10.1186/cc12144

Published: 19 March 2013

Introduction

Fluid responsiveness is defined based on an arbitrary increase of cardiac output (CO) or stroke volume (SV) of 10 to 15%. We hypothesise that the variation of heart efficiency (Eh) and the slope (S) defined by the relative increase of CO over the relative increase of mean filling pressure (Pmsa) can be used as alternative definitions of fluid responsiveness.

Methods

Patients admitted to the ICU were monitored with a calibrated LiDCOplus (LiDCO, UK) and Navigator (Applied Physiology, Australia) to estimate Pmsa and Eh (Pmsa -central venous pressure/Pmsa). A 250 ml fluid challenge was performed over 5 minutes. Categorical data were compared by Pearson chi-square test. Correlation was assessed by Kappa test. The inflexion point of S to define responders was obtained by ROC curve analysis.

Results

A total of 104 fluid challenges were observed in 40 patients. ROC curve analysis reveals an area under the curve of 0.93 (95% CI = 0.85 to 1, P < 0.001). The best cutoff or the slope was 0.76 (sensitivity 0.92, specificity 0.93). The proportions of responders identified by the ΔEh (Table 1) and by the slope method (Table 2) are smaller compared with the relative increase of SV method. Significant correlation was found between both methods and the ΔSV (ΔEh κ = 0.54, P < 0.001; S κ = 0.55, P < 0.001). See Figure 1
https://static-content.springer.com/image/art%3A10.1186%2Fcc12144/MediaObjects/13054_2013_Article_1301_Fig1_HTML.jpg
Figure 1

.

Table 1

Distribution of events according to ΔSV and ΔEh

 

Response by ΔSV ≥10%

Response by ΔEh ≥0

P value

Nonresponder

62 (59.6%)

76 (73.1%)

<0.001

Responder

42 (40.4%)

28 (26.9%)

<0.001

Table 2

Distribution of events according to ΔSV and the slope (S)

 

Response by ΔSV ≥10%

Response by S ≥0

P value

Nonresponder

62 (59.6%)

75 (72.1%)

<0.001

Responder

42 (40.4%)

29 (27.9%)

<0.001

Conclusion

Moderate agreement is observed between new and current definitions of fluid responsiveness.

Authors’ Affiliations

(1)
St George's Healthcare NHS Trust

References

  1. Michard F, et al.: Chest. 2002, 121: 2000. 10.1378/chest.121.6.2000View ArticlePubMedGoogle Scholar

Copyright

© Aya et al.; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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