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Online ISSN 1827-1596
Cecconi M. 1, Monti G. 2, Hamilton M. A. 1, Puntis M. 1, Dawson D. 1, Tuccillo M. L. 1, 3, Della Rocca G. 3, Grounds R. M. 1, Rhodes A. 1
1 Department of General Intensive Care, St George’s Healthcare NHS Trust, London, UK;
2 General Intensive Care, Niguarda Hospital, Milan, Italy;
3 Department of Anesthesia and Intensive Care Medicine, Medical School University of Udine, Udine, Italy
BACKGROUND: In this study we quantify the ability of dynamic cardiovascular parameters measured by the PulseCOTM algorithm of the LiDCO™plus monitor to predict the response to a fluid challenge in post-operative patients.
METHODS: Surgical patients, admitted to the Intensive Care Unit from the operating theatre were monitored with the LiDCO™plus system. A number of static and dynamic cardiovascular measurements were recorded before and after a fluid challenge. Receiver Operator Characteristic (ROC) curve analysis was used to identify the baseline values, with optimum sensitivity and specificity, to predict responsiveness to a fluid challenge.
RESULTS: Thirty-one patients were enrolled, and received protocol-based fluid challenges. Twelve (38%) responded by demonstrating an increase in stroke volume of >15%. Heart rate (HR) and central venous pressure (CVP) were not statistically different between responders and non-responders. Mean arterial pressure (mAP), systolic pressure variation (SPV), pulse pressure variation (PPV) and stroke volume variation (SVV) were statistically different between responders and non-responders. Parameters with a ROC area under the curve (AUC) significantly >0.5 included SPV 0.70 (0.52-0.88) P=0.046, PPV 0.87 (0.76-0.99) P<0.0002 and SVV 0.84 (0.71-0.96) P=0.0005. The best cut-off values (sensitivity and specificity) to predict fluid were SPV >9 mmHg (73%, 76%), PPV >13% (83%, 74%) and SVV >12.5% (75%, 83%). ROC analysis did not show the AUC to be significantly >0.5 for HR, mAP and CVP
CONCLUSION: Dynamic indices measured by PulseCO™ (LiDCO) have a high sensitivity and specificity in predicting fluid responsiveness in sedated and mechanically ventilated patients. A cut-off value for PPV of 13% is the most sensitive and specific indicator of fluid responsiveness.