• Aya Kimura, Koichi Suehiro, Takashi Juri, Yohei Fujimoto, Hisako Yoshida, Katsuaki Tanaka, Takashi Mori, and Kiyonobu Nishikawa.
• From the Departments of Anesthesiology.
• Anesth. Analg. 2021 Jul 1; 133 (1): 44-52.

BackgroundWe 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).MethodsThirty 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.ResultsOf 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.ConclusionsΔSVRM and ΔMAPRM could predict hemodynamic responses after volume expansion during OLV.Copyright © 2021 International Anesthesia Research Society.

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