The Ability of Stroke Volume Variation Measured by a Noninvasive Cardiac Output Monitor to Predict Fluid Responsiveness in Mechanically Ventilated Children

Abstract

Continuous noninvasive cardiac output monitoring (NICOM) is a clinically useful tool in the pediatric setting. This study compared the ability of stroke volume variation (SVV) measured by NICOM with that of respiratory variations in the velocity of aortic blood flow (△Vpeak) and central venous pressure (CVP) to predict of fluid responsiveness in mechanically ventilated children after ventricular septal defect repair. The study investigated 26 mechanically ventilated children after the completion of surgery. At 30 min after their arrival in an intensive care unit, a colloid solution of 10 ml/kg was administrated for volume expansion. Hemodynamic variables, including CVP, stroke volume, and △Vpeak in addition to cardiac output and SVV in NICOM were measured before and 10 min after volume expansion. The patients with a stroke volume increase of more than 15 % after volume expansion were defined as responders. The 26 patients in the study consisted of 13 responders and 13 nonresponders. Before volume expansion, △Vpeak and SVV were higher in the responders (both p values <0.001). The areas under the receiver operating characteristic curves of △Vpeak, SVV, and CVP were respectively 0.956 (95 % CI 0.885-1.00), 0.888 (95 % CI 0.764-1.00), and 0.331 (95 % CI 0.123-0.540). This study showed that SVV by NICOM and △Vpeak by echocardiography, but not CVP, reliably predicted fluid responsiveness during mechanical ventilation after ventricular septal defect repair in children.

Applied Physiology at the Bedside to Drive Resuscitation Algorithms

“…One study on mechanically ventilated pediatric patients showed that respiratory changes in peak velocity outperformed SVV in identifying those who were volume responsive, with an AUC of 0.95. 72 These findings were confirmed in two other studies on a similar patient population. 73,74 …”

Does stroke volume variation predict fluid responsiveness in children: A systematic review and meta-analysis

“…Four studies used colloids as fluid bolus, one study used crystalloid, and one study did not report type of fluid given. Four studies were performed in the operating room during congenital heart surgery or craniosynostosis repair [14, 21–23], and two studies were performed in the PICU [13, 20]. SVV was tested by non-invasive measures such as NICOM (non-invasive cardiac output monitor) and USCOM (ultrasonic cardiac output monitor) in four studies, whereas two studies used invasive measures including PiCCO (pulse index continuous cardiac output) and Mostcare.…”

Respiratory variation in aortic blood flow peak velocity to predict fluid responsiveness in mechanically ventilated children: a systematic review and meta‐analysis

“…This could explain the differences in threshold values observed across studies. In most of these studies, the median or mean age of the population was less than 3 years, but the ranges did vary . Consequently, we cannot exclude age as a confounding factor, particularly with respect to the cutoff value of ΔVPeak in infants and newborns.…”