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The comparison of stroke volume variation with central venous pressure in predicting fluid responsiveness in septic patients with acute circulatory failure.

Angappan S, Parida S, Vasudevan A, Badhe AS - Indian J Crit Care Med (2015)

Bottom Line: Volume expansion decreased SVV from 18.86 ± 4.35 to 7.57 ± 1.80 and volume expansion-induced changes in SVV moderately correlated with volume expansion-induced changes in CI.When predicting fluid responsiveness in mechanically ventilated patients in septic shock, SVV is more effective than CVP.Trends in SVV, as reflected by decreases with volume replacement, seem to correlate much better with increases in CI.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, JIPMER, Puducherry, India.

ABSTRACT

Purpose: The present study was designed to investigate the efficacy of stroke volume variation (SVV) in predicting fluid responsiveness and compare it to traditional measures of volume status assessment like central venous pressure (CVP).

Methods: Forty-five mechanically ventilated patients in sepsis with acute circulatory failure. Patients were not included when they had atrial fibrillation, other severe arrhythmias, permanent pacemaker, or needed mechanical cardiac support. Furthermore, excluded were patients with hypoxemia and a CVP >12. Patients received volume expansion in the form of 500 ml of 6% hydroxyethyl starch.

Results: The volume expansion-induced increase in  cardiac index (CI) was >15% in 29 patients (labeled responders) and <15% in 16 patients (labeled nonresponders). Before volume expansion, SVV was higher in responders than in nonresponders. Receiver operating characteristic curves analysis showed that SVV was a more accurate indicator of fluid responsiveness than CVP. Before volume expansion, an SVV value of 13% allowed discrimination between responders and nonresponders with a sensitivity of 78% and a specificity of 89%. Volume expansion-induced changes in CI weakly and positively correlated with SVV before volume expansion. Volume expansion decreased SVV from 18.86 ± 4.35 to 7.57 ± 1.80 and volume expansion-induced changes in SVV moderately correlated with volume expansion-induced changes in CI.

Conclusions: When predicting fluid responsiveness in mechanically ventilated patients in septic shock, SVV is more effective than CVP. Nevertheless, the overall correlation of baseline SVV with increases in CI remains poor. Trends in SVV, as reflected by decreases with volume replacement, seem to correlate much better with increases in CI.

No MeSH data available.


Related in: MedlinePlus

Receiver operating characteristic curve for stroke volume variation with the area under the receiver operating characteristic curve of 0.716 with 95% confidence interval (0.56–0.84). ROC: Receiver operating characteristic; SVV: Stroke volume variation
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Figure 2: Receiver operating characteristic curve for stroke volume variation with the area under the receiver operating characteristic curve of 0.716 with 95% confidence interval (0.56–0.84). ROC: Receiver operating characteristic; SVV: Stroke volume variation

Mentions: As shown in Table 3, all the hemodynamic variables showed a significant change after volume expansion from their baseline values except the SVRI. Before volume expansion, SVV ranged from 1% to 24% with the 95% confidence intervals between 14% and 23%. Before volume expansion, SVV was not correlated with the CVP. Volume expansion increased CI from 3.11 ± 0.30 to 3.66 ± 0.41 L/min/m2 (P < 0.001). Table 4 represents the hemodynamic variables before volume expansion among responders and nonresponders. Before volume expansion, SVV (20.4 + 2.77 vs. 15.9 ± 4.2, P = 0.01) was higher in responder than in nonresponder patients, whereas CVP (9 ± 1.64 vs. 8.7 ± 1.9 mm Hg) was not significantly different between the two groups. The AUROC curves were as follows: 0.716 with 95% CI (0.56–0.84) for SVV and 0.562 with 95% CI (0.41–0.71) for CVP [Figures 2 and 3, respectively]. The area for SVV was significantly greater than the area for CVP (P < 0.01). The threshold SVV value of 13% allowed discrimination between responder and nonresponder patients with a sensitivity of 78% and a specificity of 89%.


The comparison of stroke volume variation with central venous pressure in predicting fluid responsiveness in septic patients with acute circulatory failure.

Angappan S, Parida S, Vasudevan A, Badhe AS - Indian J Crit Care Med (2015)

Receiver operating characteristic curve for stroke volume variation with the area under the receiver operating characteristic curve of 0.716 with 95% confidence interval (0.56–0.84). ROC: Receiver operating characteristic; SVV: Stroke volume variation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4502492&req=5

Figure 2: Receiver operating characteristic curve for stroke volume variation with the area under the receiver operating characteristic curve of 0.716 with 95% confidence interval (0.56–0.84). ROC: Receiver operating characteristic; SVV: Stroke volume variation
Mentions: As shown in Table 3, all the hemodynamic variables showed a significant change after volume expansion from their baseline values except the SVRI. Before volume expansion, SVV ranged from 1% to 24% with the 95% confidence intervals between 14% and 23%. Before volume expansion, SVV was not correlated with the CVP. Volume expansion increased CI from 3.11 ± 0.30 to 3.66 ± 0.41 L/min/m2 (P < 0.001). Table 4 represents the hemodynamic variables before volume expansion among responders and nonresponders. Before volume expansion, SVV (20.4 + 2.77 vs. 15.9 ± 4.2, P = 0.01) was higher in responder than in nonresponder patients, whereas CVP (9 ± 1.64 vs. 8.7 ± 1.9 mm Hg) was not significantly different between the two groups. The AUROC curves were as follows: 0.716 with 95% CI (0.56–0.84) for SVV and 0.562 with 95% CI (0.41–0.71) for CVP [Figures 2 and 3, respectively]. The area for SVV was significantly greater than the area for CVP (P < 0.01). The threshold SVV value of 13% allowed discrimination between responder and nonresponder patients with a sensitivity of 78% and a specificity of 89%.

Bottom Line: Volume expansion decreased SVV from 18.86 ± 4.35 to 7.57 ± 1.80 and volume expansion-induced changes in SVV moderately correlated with volume expansion-induced changes in CI.When predicting fluid responsiveness in mechanically ventilated patients in septic shock, SVV is more effective than CVP.Trends in SVV, as reflected by decreases with volume replacement, seem to correlate much better with increases in CI.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, JIPMER, Puducherry, India.

ABSTRACT

Purpose: The present study was designed to investigate the efficacy of stroke volume variation (SVV) in predicting fluid responsiveness and compare it to traditional measures of volume status assessment like central venous pressure (CVP).

Methods: Forty-five mechanically ventilated patients in sepsis with acute circulatory failure. Patients were not included when they had atrial fibrillation, other severe arrhythmias, permanent pacemaker, or needed mechanical cardiac support. Furthermore, excluded were patients with hypoxemia and a CVP >12. Patients received volume expansion in the form of 500 ml of 6% hydroxyethyl starch.

Results: The volume expansion-induced increase in  cardiac index (CI) was >15% in 29 patients (labeled responders) and <15% in 16 patients (labeled nonresponders). Before volume expansion, SVV was higher in responders than in nonresponders. Receiver operating characteristic curves analysis showed that SVV was a more accurate indicator of fluid responsiveness than CVP. Before volume expansion, an SVV value of 13% allowed discrimination between responders and nonresponders with a sensitivity of 78% and a specificity of 89%. Volume expansion-induced changes in CI weakly and positively correlated with SVV before volume expansion. Volume expansion decreased SVV from 18.86 ± 4.35 to 7.57 ± 1.80 and volume expansion-induced changes in SVV moderately correlated with volume expansion-induced changes in CI.

Conclusions: When predicting fluid responsiveness in mechanically ventilated patients in septic shock, SVV is more effective than CVP. Nevertheless, the overall correlation of baseline SVV with increases in CI remains poor. Trends in SVV, as reflected by decreases with volume replacement, seem to correlate much better with increases in CI.

No MeSH data available.


Related in: MedlinePlus