- Poster presentation
- Open Access
Accuracy of stroke volume variation as a predictor of volume responsiveness in patients with raised intra-abdominal pressure
© Bauer et al. 2011
- Published: 1 March 2011
- Area Under Curve
- Fluid Responsiveness
- Stroke Volume Variation
- Fluid Bolus
Dynamic predictors of fluid responsiveness such as stroke volume variation (SVV) are gaining popularity. Intra-abdominal hypertension (IAH) affects heart-lung interactions and may invalidate SVV as a preload indicator, as indeed suggested in a recent animal study . We studied SVV in liver patients, who have a high incidence of raised intra-abdominal pressure (IAP).
Patients admitted to a specialist liver ICU with acute or decompensated chronic liver disease were studied. All were in shock and received controlled mechanical ventilation. Cardiac output monitoring via transpulmonary thermodilution (PiCCO; Pulsion Medical Systems) and pulmonary artery catheterisation (CCombo; Edwards Lifesciences) was performed. Measurements before and after a 300 ml colloid bolus (Voluven; Fresenius Kabi) were recorded; fluid responsiveness was defined as an increase in stroke volume (SV) >10%. IAP was monitored via a Foley manometer and patients were divided into two groups: none/mild versus clinically significant IAH, cut-off value 15 mmHg. Volume responsiveness according to SVV and severity of IAH was analysed via receiver operating characteristic. Demographic parameters are displayed as the median and range.
Twenty-three measurements were made in 18 patients (in five patients, two fluid boluses were given on separate days). Median age was 45 years (47), 11 were females. Diagnoses were acetaminophen-induced acute liver failure (ALF, n = 6), acute decompensation of alcoholic liver disease (n = 4), Budd-Chiari syndrome (n = 3), seronegative ALF (n = 2), post-transplant septic shock (n = 2) and leptospirosis (n = 1). The median SOFA score was 18 (12), nor-epinephrine dose 0.26 μg/kg/minute (1.25). Clinically significant IAH was present in 15 measurements (IAP 17 to 27). Ten fluid boluses resulted in an increase in SV >10%. As a whole SVV failed to predict fluid responsiveness (area under curve (AUC) 0.53, P = 0.82). The subgroup with IAP <15 showed a trend towards significance (AUC 0.91, P = 0.06). In the latter group a SVV of 13.5% had 75% sensitivity and specificity in predicting fluid responders.
SVV does not predict fluid responsiveness in patients with significant intra-abdominal hypertension. If IAP is mildly raised, higher cut-off levels for SVV may need to be considered.
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.