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Stroke volume variation does not predict fluid responsiveness in patients with septic shock on pressure support ventilation
Author(s) -
Perner A.,
Faber T.
Publication year - 2006
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2006.01120.x
Subject(s) - medicine , cardiac index , stroke volume , cardiac output , septic shock , pulse pressure , ventilation (architecture) , cardiology , shock (circulatory) , central venous pressure , mean arterial pressure , anesthesia , mechanical ventilation , hemodynamics , preload , blood pressure , heart rate , sepsis , mechanical engineering , engineering
Background: Stroke volume variation (SVV) – as measured by the pulse contour cardiac output (PiCCO ® ) system – predicts the cardiac output response to a fluid challenge in patients on controlled ventilation. Whether this applies to patients on pressure support ventilation is unknown. Methods: Thirty consecutive patients with septic shock were included. All were on pressure support ventilation, monitored using the PiCCO ® system and receiving 500 ml of colloid on clinical indications. Arterial pulse contour SVV and the transpulmonary thermodilution cardiac index were measured before and after fluid challenge. Results: Forty‐seven per cent of the patients were defined as fluid responders by an observed increase of > 10% in the cardiac index after fluid. Prior to fluid challenge, the cardiac index was lower in responders compared with non‐responders (mean ± SD, 3.0 ± 0.6 vs. 4.0 ± 1.2 l/min/m 2 , P < 0.01). In contrast, pre‐infusion values of SVV were similar between subsequent responders and non‐responders (13 ± 5 vs. 16 ± 6%, P = 0.26). The mean areas under the ROC curves were 0.77 (95% confidence interval, 0.60–0.94) and 0.52 (0.30–0.73) for pre‐fluid cardiac index and SVV, respectively, indicating a predictive power of only the cardiac index. Conclusions: SVV did not predict the response in cardiac output to fluid challenge in patients with septic shock on pressure support ventilation.