Different predictivity of fluid responsiveness by pulse pressure variation in children after surgical repair of ventricular septal defect or tetralogy of Fallot

Ding, Heyu; Pan, Shoudong; Wang, Xiaonan; Qingyan, Jia; Luo, Yi; Li, Jia; Ouyang, Chuying

doi:10.1111/pan.13218

Cited by 12 publications

(14 citation statements)

References 27 publications

(57 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some studies using the pressure recording analytical method (Vygon; Vytech, Italy) or the PiCCO monitoring system (PiCCO Plusw, version 6.0; Pulsion Medical Systems, Germany) have shown that PPV can predict fluid responsiveness in pediatric cardiac surgery [12–14] (Table 1). However, in a study in children after the surgical repair of a ventricular septal defect or tetralogy of Fallot [12], PPV was measured in an open chest and the amount of fluid administered was 20 ml/kg/h for 15 min, making it difficult to compare the results with those from patients in whom measurements were taken with the chest closed or those who received 10 ml/kg fluid for volume expansion. In addition, the reference value for assessing an increase in cardiac index was measured using the same device that measured PPV [12].…”

Section: Potential Predictors Of Fluid Responsivenesmentioning

confidence: 99%

“…However, in a study in children after the surgical repair of a ventricular septal defect or tetralogy of Fallot [12], PPV was measured in an open chest and the amount of fluid administered was 20 ml/kg/h for 15 min, making it difficult to compare the results with those from patients in whom measurements were taken with the chest closed or those who received 10 ml/kg fluid for volume expansion. In addition, the reference value for assessing an increase in cardiac index was measured using the same device that measured PPV [12]. Another study had the limitations of having a retrospective design and a small number of patients [13].…”

Section: Potential Predictors Of Fluid Responsivenesmentioning

confidence: 99%

See 1 more Smart Citation

Fluid responsiveness in the pediatric population

Lee

Kim

Jang

et al. 2019

Korean J Anesthesiol

View full text Add to dashboard Cite

It is challenging to predict fluid responsiveness, that is, whether the cardiac index or stroke volume index would be increased by fluid administration, in the pediatric population. Previous studies on fluid responsiveness have assessed several variables derived from pressure wave measurements, plethysmography (pulse oximeter plethysmograph amplitude variation), ultrasonography, bioreactance data, and various combined methods. However, only the respiratory variation of aortic blood flow peak velocity has consistently shown a predictive ability in pediatric patients. For the prediction of fluid responsiveness in children, flow- or volume-dependent, noninvasive variables are more promising than pressure-dependent, invasive variables. This article reviews various potential variables for the prediction of fluid responsiveness in the pediatric population. Differences in anatomic and physiologic characteristics between the pediatric and adult populations are covered. In addition, some important considerations are discussed for future studies on fluid responsiveness in the pediatric population.

show abstract

Section: Potential Predictors Of Fluid Responsivenesmentioning

confidence: 99%

Section: Potential Predictors Of Fluid Responsivenesmentioning

confidence: 99%

Fluid responsiveness in the pediatric population

Lee

Kim

Jang

et al. 2019

Korean J Anesthesiol

View full text Add to dashboard Cite

show abstract

“…Some studies have shown that its accuracy is higher than CVP. (18,19) To the best of our knowledge, this is the rst study that demonstrated the good predictability of SVV for assessing uid responsiveness after volume challenge in pediatric Fontan patients, proving that SVV is a simple, fast, direct and noninvasive method with good reproducibility. SVV can be measured with high-quality values in any individual patients.…”

Section: Discussionmentioning

confidence: 76%

Prediction of Volume Responsiveness by Stroke Volume Variation vs. Central Venous Pressure in Children Undergoing Fontan Operation

Song

Hou

Bai

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Fontan operation is a palliative medical procedure performed on children with single-ventricle defects. As postoperative success of the procedure largely depends on the preload volume, it is necessary to ensure the effective volume of systemic circulation by maintaining an appropriate pressure gradient between the systemic vein and the left atrium. However, there is a lack of effective indexes to evaluate volume responsiveness in Fontan patients. Stroke volume variation (SVV) is a dynamic hemodynamic parameter based on cardiopulmonary interaction in mechanical ventilation. This study is to validate the sensitivity and specificity of SVV vs. central venous pressure (CVP) in assessing volume responsiveness of Fontan patients.Method: 64 children were included in this prospective study with single-ventricle who underwent modified Fontan operation between May 2018 and January 2020. Patients were given 10ml·kg− 1 albumin for volume challenge within 10 min after CPB. Before and after volume challenge, the invasive arterial pressure module was connected to Mostcare™ equipment to collect SBP, MBP, DBP, SVV, CI and SVRI dynamically in a time window of 30 s at a frequency of 1000 Hz. According to the range of CI change, patients with ΔCI ≥ 15% were classified into response (R) group and patients with ΔCI < 15% into non-response (NR) group. Using SVV and CVP as indicators, the ROC of the patients was established, and the AUC, diagnostic threshold, sensitivity and specificity were calculated.Results: The 64 pediatric patients included with a mean age of 4.85 ± 1.20 years, a mean height of 98.00 ± 16.74 cm and a mean weight of 15.65 ± 5.37 kg. The SVV value was 17.15 ± 3.97% and 13.45 ± 2.45% before and after fluid challenge treatment vs. 18.60 ± 1.83 mmHg and 20.20 ± 2.39 mmHg for CVP in responders. The AUC of SVV was 0.74 (95% confidence interval [CI] 0.54–0.94, P < 0.05) and the cutoff value was 16%, offering a sensitivity of 50% and a specificity of 91.7% vs.0.70 (95% CI 0.50–0.92, P > 0.05), 19.5 mmHg, 58% and 76% for CVP.Conclusion: SVV exhibited a good predictive value for volume responsiveness in pediatric Fontan patients. Appropriate volume therapy according to SVV could improve the cardiac function of such patients.Trial registration: This research was registered in Chinese Clinical Trail Registry on Jan 26, 2018. Registration number is ChiCTR1800014654.Registry URL is http://www.chictr.org.cn/showproj.aspx?proj=25019. This observational prospective study was approved by the Local Ethics Committee of Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University (SCMCIRB-K2017035)

show abstract

“…SVV has been used in predicting fluid response in children receiving cardiac surgery. Some studies have shown that its accuracy is higher than CVP [ 18 , 19 ]. To the best of our knowledge, this is the first study that demonstrated the good predictability of SVV for assessing fluid responsiveness after fluid challenge in pediatric Fontan patients, proving that it is a simple, fast, direct, and noninvasive method with good reproducibility.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Fluid Responsiveness by Stroke Volume Variation in Children Undergoing Fontan Operation

Song

Hou

Bai

et al. 2020

BioMed Research International

View full text Add to dashboard Cite

Background. Fontan operation is a palliative medical procedure performed on children with single-ventricle defects. As postoperative success of the procedure largely depends on the preload volume, it is necessary to maintain an appropriate pressure gradient between the systemic vein and the left atrium to ensure the effective volume of systemic circulation. However, there is a lack of effective indexes to evaluate fluid responsiveness in Fontan patients. Stroke volume variation (SVV) is a dynamic hemodynamic parameter based on cardiopulmonary interaction in mechanical ventilation. This study is aimed at validating the sensitivity and specificity of SVV and central venous pressure (CVP) in assessing the fluid responsiveness of Fontan patients. Method. Sixty-four children with single ventricle who underwent modified Fontan operation between May 2018 and January 2020 were included in this study. Patients were administered 10 ml·kg-1 albumin for fluid challenge within 10 min after cardiopulmonary bypass. Before and after fluid challenge, the invasive arterial pressure module was connected to MostCare™ equipment to collect the cardiac index (CI) and SVV dynamically in a time window of 30 s at a frequency of 1000 Hz. According to the range of CI change, patients with Δ CI ≥ 15 % were classified into the responder (R) group and those with Δ CI < 15 % into the nonresponder (NR) group. Using SVV and CVP as indicators, the receiver operating characteristic (ROC) curve of the patients was established, and the area under curve (AUC), diagnostic threshold, sensitivity, and specificity were calculated. Results. The SVV values were 16.28% (25th and 75th percentiles 14.17%-19.24%) and 13.68% (25th and 75th percentiles 12.90%-15.89%) before and after fluid challenge treatment in responders, respectively, and the values were 18.60 ± 1.83 mmHg before and 20.20 ± 2.39 mmHg for CVP after treatment. The AUC of SVV was 0.74 (95% confidence interval (CI) 0.54-0.94, P < 0.05 ), and the cutoff value was 16%, offering a sensitivity of 50% and a specificity of 91.7%. Meanwhile, the AUC of CVP was 0.70 (95% CI 0.50-0.92, P > 0.05 ), and the cutoff value was 19.5 mmHg, offering a sensitivity of 58% and a specificity of 76%. Conclusion. SVV exhibited a good predictive value for fluid responsiveness in pediatric Fontan patients. Appropriate fluid therapy according to SVV could improve the cardiac function of such patients. Trial registration. This study was registered in Chinese Clinical Trail Registry on Jan 26, 2018. Registration number is ChiCTR1800014654. Registry URL is http://www.chictr.org.cn/showproj.aspx?proj=25019. This observational prospective study was approved by the Local Ethics Committee of Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University (SCMCIRB-K2017035).

show abstract

Different predictivity of fluid responsiveness by pulse pressure variation in children after surgical repair of ventricular septal defect or tetralogy of Fallot

Abstract: Pulse pressure variation is predictive of fluid responsiveness in ventricular septal defect and tetralogy of Fallot patients following cardiac surgery.

Cited by 12 publications

References 27 publications

Fluid responsiveness in the pediatric population

Fluid responsiveness in the pediatric population

Prediction of Volume Responsiveness by Stroke Volume Variation vs. Central Venous Pressure in Children Undergoing Fontan Operation

Prediction of Fluid Responsiveness by Stroke Volume Variation in Children Undergoing Fontan Operation

Contact Info

Product

Resources

About