Evaluation of stroke volume variation and pulse pressure variation as predictors of fluid responsiveness in patients undergoing protective one-lung ventilation

Fu, Qiang; Duan, Mingda; Zhao, Feng; Mi, Weidong

doi:10.5582/ddt.2015.01046

Cited by 26 publications

(20 citation statements)

References 29 publications

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“…Second, most restrictive strategies depend on the use of goal-directed therapy with invasive arterial monitoring (pulse pressure variation), cardiac output monitoring (stroke volume variation) or esophageal Doppler (aortic blood flow). The utility of PPV and SVV in patients with an open thorax on low-tidal volume ventilation is unclear [85,86]. Moreover, restrictive fluid regimens rely on the use of vasopressors to maintain perfusion pressure in the absence of hypovolemia.…”

Section: Perioperative Fluid Managementmentioning

confidence: 99%

“…Hypothermia (defined as a core temperature below 36 °C) can adversely affect drug metabolism and recovery from anaesthesia, increase coagulopathy and transfusion requirements, and cause patient discomfort. Hypothermia has also been identified as a risk factor for surgical site infections and cardiac complications [86,89]. The ERAS guidelines recommend the use of multi-modal techniques such as forced air warming and fluid warming to prevent hypothermia [10,89].…”

Section: Perioperative Fluid Managementmentioning

confidence: 99%

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The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection

et al. 2020

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Esophageal cancer surgery, comprising esophagectomy with radical lymphadenectomy, is a complex procedure associated with considerable morbidity and mortality. The enhanced recovery after surgery (ERAS) protocol which aims to improve perioperative care, minimize complications, and accelerate recovery is showing promise for achieving better perioperative outcomes. ERAS is a multimodal approach that has been reported to shorten the length of hospital stay, reduce surgical stress response, decrease morbidity, and expedite recovery. While ERAS components straddle preoperative, intraoperative, and postoperative periods, they need to be seen in continuum and not as isolated elements. In this review, we elaborate on the components of an ERAS protocol after esophagectomy including preoperative nutrition, prehabilitation, counselling, smoking and alcohol cessation, cardiopulmonary evaluation, surgical technique, anaesthetic management, intra-and postoperative fluid management and pain relief, mobilization and physiotherapy, enteral and oral feeding, removal of drains, and several other components. We also share our own institutional protocol for ERAS following esophageal resections.

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Section: Perioperative Fluid Managementmentioning

confidence: 99%

Section: Perioperative Fluid Managementmentioning

confidence: 99%

The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection

et al. 2020

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“…It has been shown that α 1 stimulation constricts the splanchnic capacitance vasculature, which is dilated under general anesthesia, and increases venous return and cardiac preload[ 15 ]. Although the ability of PPV as a predictor of fluid responsiveness during OLV is debatable[ 16 ], at least two studies have shown that PPV can predict fluid responsiveness during OLV[ 17 , 18 ]. In the present study, there were some differences in peak inspiratory pressure, ETCO 2 , and PaCO 2 between the two timepoints.…”

Section: Discussionmentioning

confidence: 99%

Phenylephrine does not improve oxygenation during one-lung ventilation: A randomized, double-blind, cross-over study

et al. 2018

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BackgroundPhenylephrine is an α1 adrenergic receptor agonist that causes pulmonary vasoconstriction, and so may effectively enhance hypoxic pulmonary vasoconstriction (HPV). However, there is little evidence that phenylephrine augments HPV in clinical situations. This study aimed to evaluate the clinical effects of phenylephrine infusion on oxygenation during one-lung ventilation (OLV) in patients undergoing thoracic surgery.MethodsThis was a prospective, randomized, double-blind, cross-over study. Included patients were those undergoing elective thoracic surgery in the lateral decubitus position with OLV. Patients were randomly allocated to two groups. The N-P group initially had OLV with normal saline infusion for 30 minutes; after a 10 minute interval, OLV was then maintained with phenylephrine infusion for 30 minutes. The P-N group had the drug-infusion in the reverse order. The primary outcome was arterial partial pressure of oxygen. Secondary outcomes were mean arterial pressure, heart rate, pulse pressure variation, perfusion index, and difference between bladder and skin temperature. Statistical analysis was performed using the student t-test, Fisher's exact test, and ANOVA for Cross-over design. P < 0.05 was considered statistically significant.ResultsTwenty-nine patients were analyzed. Although phenylephrine infusion significantly increased mean arterial pressure (P < 0.001), arterial partial pressure of oxygen did not differ between the two timepoints (P = 0.19). There was no carryover effect in arterial partial pressure of oxygen (P = 0.14). Phenylephrine infusion significantly decreased heart rate (P = 0.02) and pulse pressure variation (P < 0.001).ConclusionsPhenylephrine infusion did not improve oxygenation during OLV. The present results indicate that phenylephrine does not have clinically meaningful effects on HPV.Trial registrationUniversity Hospital Medical Information Network 000024317

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“…During lung surgeries under OLV, the non-ventilated lung does not generate cyclic changes in intrathoracic pressure and the operating side of the chest is opened. Hence, wide range of the pressure generated from mechanical ventilation is transmitted to the atmosphere 19 . Additionally, the patient develops 20% to 30% of intrapulmonary shunt in the non-dependent lung after hypoxic pulmonary vasoconstriction 20 .…”

Section: Discussionmentioning

confidence: 99%

“…Shunt does not take part in cyclic changes of stroke volume and the amount of pulmonary shunt left in the non-dependent lung would decrease the value of dynamic indices. For another reason, protective ventilation with small tidal volume under OLV produces reduced variations in pleural and trans-pulmonary pressure which decrease the cyclic changes in dynamic indices 6 , 19 . For these reasons, PPV threshold to predict fluid responsiveness is reported to be lower during OLV 3 .…”

Section: Discussionmentioning

confidence: 99%

The influence of positive end-expiratory pressure (PEEP) in predicting fluid responsiveness in patients undergoing one-lung ventilation

et al. 2021

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Background: Dynamic preload parameters such as pulse pressure variation (PPV) and stroke volume variation (SVV) have widely been used as accurate predictors for fluid responsiveness in patients under mechanical ventilation. To circumvent the limitation of decreased cyclic change of intrathoracic pressure, we performed an intermittent PEEP challenge test to evaluate whether PPV or SVV can predict fluid responsiveness during one-lung ventilation (OLV). Methods: Forty patients undergoing OLV were analyzed. Baseline hemodynamic variables including PPV and SVV and respiratory variables were recorded after chest opening in lateral position under OLV (T1). Five minutes after application of PEEP 10 cmH 2 O, the parameters were recorded (T2). Thereafter, PEEP was withdrawn to 0 cmH 2 O for 5 minutes (T3), and fluid loading was performed with balanced crystalloid solution 6 mL/kg of ideal body weight for 5 minutes. Five minutes after completion of fluid loading, all variables were recorded (T4). The patient was classified as fluid responder if SV increased ≥10% after fluid loading and as non-responder if SV increased <10%. Results: Prediction of fluid responsiveness was evaluated with area under the receiver operating characteristic (ROC) curve (AUC). Change in stroke volume variation (ΔSVV) showed AUC of 0.9 (P < 0.001), 95% CI = 0.82-0.99, sensitivity = 88%, specificity = 82% for discrimination of fluid responsiveness. Change in pulse pressure variation (ΔPPV) showed AUC of 0.88 (P < 0.001), 95% CI = 0.78-0.97, sensitivity = 83%, specificity = 72% in predictability of fluid responsiveness. Cardiac index and stroke volume were well maintained after PEEP challenge in non-responders while they increased in responders. Conclusions: ΔPPV and ΔSVV induced by PEEP challenge are reliable parameters to predict fluid responsiveness as well as very good predictors of fluid unresponsiveness during OLV.

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Evaluation of stroke volume variation and pulse pressure variation as predictors of fluid responsiveness in patients undergoing protective one-lung ventilation

Cited by 26 publications

References 29 publications

The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection

The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection

Phenylephrine does not improve oxygenation during one-lung ventilation: A randomized, double-blind, cross-over study

The influence of positive end-expiratory pressure (PEEP) in predicting fluid responsiveness in patients undergoing one-lung ventilation

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