• Jin Xie, Jingjie Wan, Li Xu, Yukun Zhang, and Jun Chen.
• Intensive Care Unit of the Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
• J. Cardiothorac. Vasc. Anesth. 2023 Jun 1; 37 (6): 911918911-918.

ObjectiveTo assess whether velocity-time integral (VTI) variation and peak velocity (Vpeak) variation of the left ventricular outflow tract (LVOT) accurately could predict fluid responsiveness in postoperative critically ill patients mechanically ventilated at low tidal volumes.DesignA prospective, single-center, observational study.SettingA surgical intensive care unit at a tertiary hospital.ParticipantsSixty postoperative critically ill patients with deep sedation and mechanical ventilation (tidal volume <8 mL/kg) were included in this study.InterventionsPassive leg raising (PLR).Measurement And Main ResultsPulse pressure variation (PPV), VTI variation, and Vpeak variation were measured at baseline and after PLR by transthoracic echocardiography. The fluid responsiveness was defined as an increase (>10%) in stroke volume after PLR. Thirty-two (53.3%) patients were fluid responders. The areas under the receiver operating characteristic (AUROC) curves for PPV were 0.797, and the gray zone was large and included 58.3% of patients. Both VTI variation and Vpeak variation predicted fluid responsiveness with the AUROC of 0.919 and 0.905; meanwhile, the best cutoff values were 12.51% (sensitivity of 71.9%; specificity of 75.0%) and 11.76% (sensitivity of 81.3%; specificity of 89.3%). The gray zones of VTI variation and Vpeak variation were from 7.41% to 11.88% (contained 23.3% patients) and from 9.96% to 13.10% (contained 28.3% patients).ConclusionsIn postoperative critically ill patients mechanically ventilated with tidal volume <8 mL/kg, the VTI variation and Vpeak variation of LVOT accurately could predict fluid responsiveness, and VTI variation showed more accuracy than Vpeak variation in predicting fluid responsiveness.Copyright © 2023 Elsevier Inc. All rights reserved.

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