Change in left ventricular velocity time integral during Trendelenburg maneuver predicts fluid responsiveness in cardiac surgical patients in the operating room

Ma, Genshan; Xu, Li; Luo, Jing-Chao; Hou, Jun; Hao, Guang-Wei; Su, Ying; Liu, Kai; Yu, Shen-Ji; Tu, Guo-Wei; Luo, Zhe

doi:10.21037/qims-20-700

Cited by 5 publications

(5 citation statements)

References 35 publications

(40 reference statements)

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“…Note that some other tests like EEO and Vt challenge might also be suitable in the case of prone positioning. Similar results with the Trendelenburg manoeuvre have been described in patients under veno-arterial extracorporeal membrane oxygenation [ 92 ] and during the surgical intervention [ 93 ].…”

Section: Other Testssupporting

confidence: 82%

Prediction of fluid responsiveness. What’s new?

Monnet

Shi

Teboul

2022

Ann. Intensive Care

104

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Although the administration of fluid is the first treatment considered in almost all cases of circulatory failure, this therapeutic option poses two essential problems: the increase in cardiac output induced by a bolus of fluid is inconstant, and the deleterious effects of fluid overload are now clearly demonstrated. This is why many tests and indices have been developed to detect preload dependence and predict fluid responsiveness. In this review, we take stock of the data published in the field over the past three years. Regarding the passive leg raising test, we detail the different stroke volume surrogates that have recently been described to measure its effects using minimally invasive and easily accessible methods. We review the limits of the test, especially in patients with intra-abdominal hypertension. Regarding the end-expiratory occlusion test, we also present recent investigations that have sought to measure its effects without an invasive measurement of cardiac output. Although the limits of interpretation of the respiratory variation of pulse pressure and of the diameter of the vena cava during mechanical ventilation are now well known, several recent studies have shown how changes in pulse pressure variation itself during other tests reflect simultaneous changes in cardiac output, allowing these tests to be carried out without its direct measurement. This is particularly the case during the tidal volume challenge, a relatively recent test whose reliability is increasingly well established. The mini-fluid challenge has the advantage of being easy to perform, but it requires direct measurement of cardiac output, like the classic fluid challenge. Initially described with echocardiography, recent studies have investigated other means of judging its effects. We highlight the problem of their precision, which is necessary to evidence small changes in cardiac output. Finally, we point out other tests that have appeared more recently, such as the Trendelenburg manoeuvre, a potentially interesting alternative for patients in the prone position.

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Section: Other Testssupporting

confidence: 82%

Prediction of fluid responsiveness. What’s new?

Monnet

Shi

Teboul

2022

Ann. Intensive Care

104

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show abstract

“…We did not measure the SV ∆ during head-down positioning, thus we cannot know for certain the functional cardiac state of the healthy subjects we studied. Nevertheless, Trendelenburg is a well-accepted means of increasing preload and testing functional hemodynamics [36,37,56]. In addition, we found a strong relationship between SV ∆ and ccFT ∆ in this population; a +2% ccFT ∆ threshold is an excellent surrogate for +10% SV ∆ [23,24,26].…”

Section: Discussionmentioning

confidence: 50%

“…Trendelenburg positioning is reported to accurately predict patients who respond to intravenous fluid administration; however, the maneuver itself is variably practiced. For example, Ma and colleagues moved patients from 15 degrees head above the horizontal to 15 degrees below; this resulted in an excellent diagnostic accuracy with 100% sensitivity [36]. On the other hand, Terai and colleagues performed the maneuver by comparing the horizontal (i.e., supine) to head-down in healthy subjects [37].…”

Section: Discussionmentioning

confidence: 99%

Inferior Vena Caval Measures Do Not Correlate with Carotid Artery Corrected Flow Time Change Measured Using a Wireless Doppler Patch in Healthy Volunteers

Kenny,

Prager,

Rola

et al. 2023

Diagnostics

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(1) Background: The inspiratory collapse of the inferior vena cava (IVC), a non-invasive surrogate for right atrial pressure, is often used to predict whether a patient will augment stroke volume (SV) in response to a preload challenge. There is a correlation between changing stroke volume (SV∆) and corrected flow time of the common carotid artery (ccFT∆). (2) Objective: We studied the relationship between IVC collapsibility and ccFT∆ in healthy volunteers during preload challenges. (3) Methods: A prospective, observational, pilot study in euvolemic, healthy volunteers with no cardiovascular history was undertaken in a local physiology lab. Using a tilt-table, we studied two degrees of preload augmentation from (a) supine to 30-degrees head-down and (b) fully-upright to 30-degrees head down. In the supine position, % of IVC collapse with respiration, sphericity index and portal vein pulsatility was calculated. The common carotid artery Doppler pulse was continuously captured using a wireless, wearable ultrasound system. (4) Results: Fourteen subjects were included. IVC % collapse with respiration ranged between 10% and 84% across all subjects. Preload responsiveness was defined as an increase in ccFT∆ of at least 7 milliseconds. A total of 79% (supine baseline) and 100% (head-up baseline) of subjects were preload-responsive. No supine venous measures (including IVC % collapse) were significantly related to ccFT∆. (5) Conclusions: From head-up baseline, 100% of healthy subjects were ‘preload-responsive’ as per the ccFT∆. Based on the 42% and 25% IVC collapse thresholds in the supine position, only 50% and 71% would have been labeled ‘preload-responsive’.

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“…[45] Although several studies have reported that the LVOT-VTI can predict fluid responsiveness, it has some limitations, including severe aortic regurgitation or obstruction, arrhythmias, and severe measurement errors. [46,47] However, Vignon et al [48] compared several ultrasound indicators to monitor fluid responsiveness in mechanically ventilated patients and found that LVOT-VTI had the highest sensitivity to measure the diameter of the superior vena cava, while respiratory variability had the highest specificity, which was better than IVC-related measures and LVOT-VTI. For improved accuracy, appropriate measures should be taken according to their characteristics, and more than one measure should be used to assess fluid responsiveness.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided fluid resuscitation versus usual care guided fluid resuscitation in patients with septic shock: a systematic review and meta-analysis

Chen

Xiao

Liu

et al. 2023

Emerg Crit Care Med

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Background: Ultrasound is widely used in critical care for fluid resuscitation in critically ill patients. We conducted a systematic review to assess the relationship between ultrasound-guided fluid resuscitation strategies and usual care in septic shock.Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, and registers for randomized controlled trials to evaluate the prognosis of ultrasound-guided fluid resuscitation in patients with septic shock.Results: Twelve randomized controlled studies with 947 participants were included. Ultrasound-guided fluid resuscitation in patients with septic shock was associated with reduced mortality (risk ratio: 0.78; 95% confidence interval [CI]: 0.65 to 0.94; P = 0.007) and 24-hour fluid volume (mean differences [MD]: −1.02; 95% CI: −1.28 to −0.75; P < 0.001), low heterogeneity (I 2 = 29%, I 2 = 0%), and increased dose of norepinephrine (MD: 0.07; 95% CI: 0.02-0.11; P = 0.002) and dobutamine dose (MD: 2.2; 95% CI: 0.35-4.04; P = 0.02), with low heterogeneity (I 2 = 45%, I 2 = 0%). There was no reduction in the risk of dobutamine use (risk ratio: 1.67; 95% CI: 0.52 to 5.36; P = 0.39; I 2 = 0%). Inferior vena cava-related measures reduced the length of hospital stay (MD: −2.91; 95% CI: −5.2 to −0.62; P = 0.01; low heterogeneity, I 2 = 8%) and length of intensive care unit stay (MD: −2.77; 95% CI: −4.51 to −1.02; P = 0.002; low heterogeneity, I 2 = 0%). The use of the passive leg-raising test combined with echocardiography to assess fluid reactivity was superior. Ultrasound-guided fluid resuscitation did not significantly change the length of the free intensive care unit stay (MD: 1.5; 95% CI: −3.81 to 6.81; P = 0.58; I 2 = 0%).Conclusion: Ultrasound-guided fluid resuscitation in patients with septic shock is beneficial, especially when using inferior vena cavarelated measures and the passive leg-raising test combined with echocardiography.

show abstract

Change in left ventricular velocity time integral during Trendelenburg maneuver predicts fluid responsiveness in cardiac surgical patients in the operating room

Cited by 5 publications

References 35 publications

Prediction of fluid responsiveness. What’s new?

Prediction of fluid responsiveness. What’s new?

Inferior Vena Caval Measures Do Not Correlate with Carotid Artery Corrected Flow Time Change Measured Using a Wireless Doppler Patch in Healthy Volunteers

Ultrasound-guided fluid resuscitation versus usual care guided fluid resuscitation in patients with septic shock: a systematic review and meta-analysis

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