Assessing fluid responsiveness in patients undergoing abdominal major surgery: a comparison of the respiratory systolic variation test and other indices

Introduction

Fluid responsiveness can be predicted by respiratory-induced changes in arterial blood pressure. In this study we compare the predictive performance of various haemodynamic parameters, including the respiratory systolic variation test (RSVT), pulse pressure variation (DPP) and stroke volume variation (SVV), in 18 patients undergoing abdominal major surgery.

Methods

Eighteen patients, ASA I–II, were undergoing pancreatic surgery (whipple resection). The heart rate (HR) central venous pressure (CVP), arterial pressure (AP), cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume index (SVI), SVV, DPP and RSVT were measured before and after a volume load of 7 ml/kg hydroxyethylstarch. (CO, CI, SV, SVI and SVV were displayed by the Edwards Vigileo monitor with FloTrac sensor.) Receiving-operating characteristic (ROC) curves were plotted for each parameter to evaluate its predicting value. In addition, correlation between the baseline value of haemodynamic parameters RSVT, DPP, SVV and change in SVI after volume administration was made.

Results

DPP, SVV and RSVT demonstrate a good predicting value (ROC area 0.870, 0.877 and 0.943 with P = 0.010, 0.009 and 0.002, respectively). A statistically significant correlation was found between preoperative values of DPP, SVV and RSVT and percentage changes in SVI after volume load (better than the values of HR, AP, CVP).

Conclusion

Functional parameters are superior to static indicators of cardiac preload in predicting the response to fluid administration. DPP and SVV, with their suggested threshold value, can predict fluid responsiveness in patients undergoing major abdominal surgery. The RSVT may be a more accurate predictor of fluid responsiveness although its performance demands a complex respiratory manoeuvre and is dependent on offline measurement and calculations, which limits its clinical use.