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Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac and PiCCOplus system.

Hofer CK, Senn A, Weibel L, Zollinger A - Crit Care (2008)

Bottom Line: P < 0.05 was considered statistically significant.There was no significant difference between the areas under the curve for SVVFloTrac and SVVPiCCO; the optimal threshold values given by the receiver operating characteristic curves were 9.6% for SVVFloTrac (sensitivity 91% and specificity 83%) and 12.1% for SVVPiCCO (sensitivity 87% and specificity 76%).In comparison with SVVPiCCO, SVVFloTrac has a lower threshold value.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital, Birmensdorferstrasse, CH-8063 Zurich, Switzerland. christoph.hofer@triemli.stzh.ch

ABSTRACT

Introduction: Stroke volume variation (SVV) has repeatedly been shown to be a reliable predictor of fluid responsiveness. Various devices allow automated clinical assessment of SVV. The aim of the present study was to compare prediction of fluid responsiveness using SVV, as determined by the FloTrac/Vigileo system and the PiCCOplus system.

Methods: In patients who had undergone elective cardiac surgery, SVVFloTrac was determined via radial FloTrac sensor, and SVVPiCCO and pulse pressure variation were assessed via a femoral PiCCO catheter. Stroke volume was assessed by transpulmonary thermodilution. All variables were recorded before and after a volume shift induced by a change in body positioning (from 30 degrees head-up position to 30 degrees head-down position). Pearson correlation, t-test, and Bland-Altman analysis were performed. Area under the curve was determined by plotting receiver operating characteristic curves for changes in stroke volume in excess of 25%. P < 0.05 was considered statistically significant.

Results: Body positioning resulted in a significant increase in stroke volume; SVVFloTrac and SVVPiCCO decreased significantly. Correlations of SVVFloTrac and SVVPiCCO with change in stroke volume were similar. There was no significant difference between the areas under the curve for SVVFloTrac and SVVPiCCO; the optimal threshold values given by the receiver operating characteristic curves were 9.6% for SVVFloTrac (sensitivity 91% and specificity 83%) and 12.1% for SVVPiCCO (sensitivity 87% and specificity 76%). There was a clinically acceptable agreement and strong correlation between SVVFloTrac and SVVPiCCO.

Conclusion: SVVs assessed using the FloTrac/Vigileo and the PiCCOplus systems exhibited similar performances in terms of predicting fluid responsiveness. In comparison with SVVPiCCO, SVVFloTrac has a lower threshold value.

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Prediction of fluid responsiveness: Pearson correlations. Shown are Pearson correlations between stroke volume variation (SVV) assessed using the FloTrac™/Vigileo™ and the PiCCOplus™ systems in head-up position and stroke volume (SV) changes induced by 30° head-down positioning. ΔSV, stroke volume change (%).
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Figure 3: Prediction of fluid responsiveness: Pearson correlations. Shown are Pearson correlations between stroke volume variation (SVV) assessed using the FloTrac™/Vigileo™ and the PiCCOplus™ systems in head-up position and stroke volume (SV) changes induced by 30° head-down positioning. ΔSV, stroke volume change (%).

Mentions: For patients with an increase in SV of greater than 25%, baseline SVVFloTrac and SVVPiCCO were 16 ± 4% and 19 ± 5%, respectively. In patients with an increase in SV of under 10%, baseline SVVFloTrac and SVVPiCCO were 9 ± 2% and 11 ± 3%, respectively. Results of ROC curve and linear regression analyses for the prediction of SV changes induced by altered body positioning are summarized in Figure 2 and Table 2. There was no significant difference between AUCs with respect to identifying a SV increase of more than 25% for SVVFloTrac and SVVPiCCO (Table 3). Optimal threshold values given by the ROC curves were 9.6% for SVVFloTrac (sensitivity 91% and specificity 83%) and 12.1% for SVVPiCCO (sensitivity 87% and specificity 76%). Based on these threshold values, positive and negative predictive values were 80% and 92% for SVVFloTrac, respectively; corresponding values for SVVPiCCO were 77% and 90%. There was no significant difference between identification of patients with a SV increase of more than 25% using SVVFloTrac and SVVPiCCO (P = 0.523). Correlations between SVVFloTrac and SVVPiCCO and changes of SV (ΔSV) were similar (Tables 2 and 4, and Figure 3).


Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac and PiCCOplus system.

Hofer CK, Senn A, Weibel L, Zollinger A - Crit Care (2008)

Prediction of fluid responsiveness: Pearson correlations. Shown are Pearson correlations between stroke volume variation (SVV) assessed using the FloTrac™/Vigileo™ and the PiCCOplus™ systems in head-up position and stroke volume (SV) changes induced by 30° head-down positioning. ΔSV, stroke volume change (%).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2481481&req=5

Figure 3: Prediction of fluid responsiveness: Pearson correlations. Shown are Pearson correlations between stroke volume variation (SVV) assessed using the FloTrac™/Vigileo™ and the PiCCOplus™ systems in head-up position and stroke volume (SV) changes induced by 30° head-down positioning. ΔSV, stroke volume change (%).
Mentions: For patients with an increase in SV of greater than 25%, baseline SVVFloTrac and SVVPiCCO were 16 ± 4% and 19 ± 5%, respectively. In patients with an increase in SV of under 10%, baseline SVVFloTrac and SVVPiCCO were 9 ± 2% and 11 ± 3%, respectively. Results of ROC curve and linear regression analyses for the prediction of SV changes induced by altered body positioning are summarized in Figure 2 and Table 2. There was no significant difference between AUCs with respect to identifying a SV increase of more than 25% for SVVFloTrac and SVVPiCCO (Table 3). Optimal threshold values given by the ROC curves were 9.6% for SVVFloTrac (sensitivity 91% and specificity 83%) and 12.1% for SVVPiCCO (sensitivity 87% and specificity 76%). Based on these threshold values, positive and negative predictive values were 80% and 92% for SVVFloTrac, respectively; corresponding values for SVVPiCCO were 77% and 90%. There was no significant difference between identification of patients with a SV increase of more than 25% using SVVFloTrac and SVVPiCCO (P = 0.523). Correlations between SVVFloTrac and SVVPiCCO and changes of SV (ΔSV) were similar (Tables 2 and 4, and Figure 3).

Bottom Line: P < 0.05 was considered statistically significant.There was no significant difference between the areas under the curve for SVVFloTrac and SVVPiCCO; the optimal threshold values given by the receiver operating characteristic curves were 9.6% for SVVFloTrac (sensitivity 91% and specificity 83%) and 12.1% for SVVPiCCO (sensitivity 87% and specificity 76%).In comparison with SVVPiCCO, SVVFloTrac has a lower threshold value.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital, Birmensdorferstrasse, CH-8063 Zurich, Switzerland. christoph.hofer@triemli.stzh.ch

ABSTRACT

Introduction: Stroke volume variation (SVV) has repeatedly been shown to be a reliable predictor of fluid responsiveness. Various devices allow automated clinical assessment of SVV. The aim of the present study was to compare prediction of fluid responsiveness using SVV, as determined by the FloTrac/Vigileo system and the PiCCOplus system.

Methods: In patients who had undergone elective cardiac surgery, SVVFloTrac was determined via radial FloTrac sensor, and SVVPiCCO and pulse pressure variation were assessed via a femoral PiCCO catheter. Stroke volume was assessed by transpulmonary thermodilution. All variables were recorded before and after a volume shift induced by a change in body positioning (from 30 degrees head-up position to 30 degrees head-down position). Pearson correlation, t-test, and Bland-Altman analysis were performed. Area under the curve was determined by plotting receiver operating characteristic curves for changes in stroke volume in excess of 25%. P < 0.05 was considered statistically significant.

Results: Body positioning resulted in a significant increase in stroke volume; SVVFloTrac and SVVPiCCO decreased significantly. Correlations of SVVFloTrac and SVVPiCCO with change in stroke volume were similar. There was no significant difference between the areas under the curve for SVVFloTrac and SVVPiCCO; the optimal threshold values given by the receiver operating characteristic curves were 9.6% for SVVFloTrac (sensitivity 91% and specificity 83%) and 12.1% for SVVPiCCO (sensitivity 87% and specificity 76%). There was a clinically acceptable agreement and strong correlation between SVVFloTrac and SVVPiCCO.

Conclusion: SVVs assessed using the FloTrac/Vigileo and the PiCCOplus systems exhibited similar performances in terms of predicting fluid responsiveness. In comparison with SVVPiCCO, SVVFloTrac has a lower threshold value.

Show MeSH
Related in: MedlinePlus