• Arabella Fischer, Johannes Menger, Mohamed Mouhieddine, Mathias Seidel, Maximilian Edlinger-Stanger, Michele Bevilacqua, Jonas Brugger, Michael Hiesmayr, and Martin Dworschak.
• Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University Vienna, Vienna, Austria.
• J. Cardiothorac. Vasc. Anesth. 2023 Mar 1; 37 (3): 407414407-414.

ObjectivesThe identification of potential hemodynamic indicators to increase the predictive power of stroke-volume variation (SVV) for mean arterial pressure (MAP) and stroke volume (SV) fluid responsiveness.DesignA prospective intervention study.SettingAt a single-center university hospital.ParticipantsNineteen patients during major vascular surgery with 125 fluid interventions.InterventionsWhen SVV ≥13% occurred for >30 seconds, 250 mL of Ringer's lactate were given within 2 minutes.Measurements And Main ResultsHemodynamic variables, such as pulse-pressure variation (PPV) and dynamic arterial elastance (Edyn), were measured by pulse power-wave analysis. The outcomes were MAP and SV responsiveness, defined as an increase of at least 10% of MAP and SV within 5 minutes of the fluid intervention. Of the fluid interventions, 48% were MAP-responsive, and 66% were SV-responsive. The addition of PPV and Edyn cut-off values to the SVV cut-off decreased sensitivity from 1-to-0.66 to-0.82, and concomitantly increased specificity from 0-to- 0.65-to-0.93 for the prediction of MAP and SV responsiveness in the authors' study setting. The areas under the receiver operating characteristic curves of PPV and Edyn for the prediction of MAP responsiveness were 0.79 and 0.75, respectively. The areas under the receiver operating characteristic curves for PPV and Edyn to predict SV responsiveness were 0.85 and 0.77, respectively.ConclusionsThe PPV and Edyn showed good accuracy for the prediction of MAP and SV responsiveness in patients with elevated SVV during vascular surgery. Either PPV or Edyn may be used in conjunction with SVV to better predict MAP and SV fluid responsiveness in patients undergoing vascular surgery.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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