Hemodynamic Changes via the Lung Recruitment Maneuver Can Predict Fluid Responsiveness in Stroke Volume and Arterial Pressure During One-Lung Ventilation

Abstract

BACKGROUND: We aimed to evaluate the ability of lung recruitment maneuver–induced hemodynamic changes to predict fluid responsiveness in patients undergoing lung-protective ventilation during one-lung ventilation (OLV). METHODS: Thirty patients undergoing thoracic surgery with OLV (tidal volume: 6 mL/kg of ideal body weight and positive end-expiratory pressure: 5 cm H2O) were enrolled. The study protocol began 30 minutes after starting OLV. Simultaneous recordings were performed for hemodynamic variables of heart rate, mean arterial pressure (MAP), stroke volume (SV), pulse pressure variation (PPV), and stroke volume variation (SVV) were recorded at 4 time points: before recruitment maneuver (continuous airway pressure: 30 cm H2O for 30 seconds), at the end of recruitment maneuver, and before and after volume loading (250 mL over 10 minutes). Patients were recognized as fluid responders if the increase in SV or MAP was >10%. Receiver operating characteristic curves for percent decrease in SV and MAP by recruitment maneuver (ΔSVRM and ΔMAPRM, respectively) were generated to evaluate the ability to discriminate fluid responders from nonresponders. The gray-zone approach was applied for ΔSVRM and ΔMAPRM. RESULTS: Of 30 patients, there were 17 SV-responders (57%) and 12 blood pressure (BP)-responders (40%). Area under the curve (AUC) for ΔSVRM to discriminate SV-responders from nonresponders was 0.84 (95% confidence interval [CI], 0.67-0.95; P < .001). The best threshold for ΔSVRM to discriminate the SV-responders was –23.7% (95% CI, –41.2 to –17.8; sensitivity, 76.5% [95% CI, 50.1-93.2]; specificity, 84.6% [95% CI, 54.6-98.1]). For BP-responders, AUC for ΔMAPRM was 0.80 (95% CI, 0.61-0.92, P < .001). The best threshold for ΔMAPRM was –17.3% (95% CI, –23.9 to –5.1; sensitivity, 75.0% [95% CI, 42.8-94.5]; specificity, 77.8% [95% CI, 52.4-93.6]). With the gray-zone approach, the inconclusive range of ΔSVRM for SV-responders was –40.1% to –13.8% including 13 (43%) patients, and that of ΔMAPRM was –23.9% to –5.1%, which included 16 (53%) patients. CONCLUSIONS: ΔSVRM and ΔMAPRM could predict hemodynamic responses after volume expansion during OLV.

Changes in stroke volume induced by lung recruitment maneuver can predict fluid responsiveness during intraoperative lung-protective ventilation in prone position

“…Third, the duration of hemodynamic stability of 1 min might be short. However, we decided the definition referred to the previous studies assessing fluid responsiveness [ 19 , 20 ]. Additionally, as shown in Table 2 , HR and MAP at T0, T1 and T3 were quite similar.…”

“…However, in this study, we administered 250 mL of HES solely to confirm fluid responsiveness, and do not recommend the continuous administration of HES during surgery. The administration of HES (250 mL) are frequently used in previous studies assessing fluid responsiveness, [ 19 , 44 ] and we consider that there may be few adverse effects induced by this infusion. Despite these limitations, the present study showed a new approach for assessing hemodynamic response after volume expansion in prone position.…”

“…1 . The study protocol was performed under stable hemodynamic conditions, which was defined as follows: mean arterial pressure (MAP) and heart rate (HR) changes within ±10% in 1 min before measurements [ 19 , 20 ]. Just before changing position from supine to prone (T0), hemodynamic variables including MAP, HR, SV, SVV, and PPV were recorded (in supine position).…”

Accuracy of stroke volume variation and pulse pressure variation in predicting fluid responsiveness undergoing one-lung ventilation during thoracic surgery: a systematic review and meta-analysis

“…Hydroxyethyl starch (HES) was adopted for the fluid responsiveness test in each study, at a dose of 7–10 mL/kg in six studies ( 5 , 13 - 17 ), a dose of 500 mL in two studies ( 6 , 19 ), and a dose of 250 mL in one study ( 16 ). The standards of fluid responsiveness were as follows: Δ[stroke volume index (SVI)] was used in five studies [≥10% in one study ( 18 ), ≥15% in two studies ( 13 , 17 ), >25% in two studies ( 6 , 15 )], ΔCI was used in three studies [≥10% in one study ( 11 ), >15% in two studies ( 14 , 19 )], and ΔSV ≥10% was used in one study ( 16 ). The characteristics of the individual studies are presented in Table 1 .…”

Prediction of fluid responsiveness. What’s new?

“…Recruitment manoeuvres, in the operating theatre or during acute respiratory distress syndrome, change cardiac loading conditions, and in particular, decrease cardiac preload. The decrease in stroke volume during a recruitment manoeuvre (application of continuous positive airway pressure of 30 cm H 2 O for 30 s [ 86 , 87 ], or of 25 cmH 2 O for 25 s [ 88 ]) predicted the response to a subsequent bolus of fluid in surgical patients during anaesthesia [ 86 , 88 ] and during one-lung ventilation [ 87 ]. Interestingly, changes in the plethysmographic perfusion index were tested under the same conditions but had less diagnostic value [ 89 ].…”