• Anaesth Crit Care Pain Med · Dec 2015

    Observational Study

    Mini-fluid challenge can predict arterial pressure response to volume expansion in spontaneously breathing patients under spinal anaesthesia.

    • Pierre-Grégoire Guinot, Eugénie Bernard, Kévin Deleporte, Sandra Petiot, Hervé Dupont, and Emmanuel Lorne.
    • Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor-Pauchet, 80054 Amiens, France; Inserm U1088, Jules-Verne University of Picardy, Chemin du Thil, 80039 Amiens cedex 1, France. Electronic address: guinotpierregregoire@gmail.com.
    • Anaesth Crit Care Pain Med. 2015 Dec 1; 34 (6): 333-7.

    IntroductionThe objective of this study was to test whether stroke volume (SV) variations in response to a fixed mini-fluid challenge (ΔSV100) measured by impedance cardiography (ICG) could predict an increase in arterial pressure with volume expansion in spontaneously breathing patients under spinal anaesthesia.MethodsThirty-four patients, monitored by ICG who required intravenous fluid to expand their circulating volume during surgery under spinal anaesthesia, were studied. Haemodynamic variables and bioimpedance indices (blood pressure, SV, cardiac output [CO]) were measured before and after fluid challenge with 100mL of crystalloid, and before/after volume expansion. Responders were defined by ≥15% increase in systolic arterial pressure (SAP) after infusion of 500 mL of crystalloid solution.ResultsSAP increased by ≥15% in 20 (59%) of the 34 patients. SAP, SV, and CO increased and HR decreased only in responders. SV variations in response to mini-fluid challenge and volume expansion differed between patients who showed arterial responsiveness and those in whom SAP did not increase with volume expansion (11.6% [9.1-19.3] versus 2.5% [1.3-7], P<0.001, and 22.4% [11.7-36.6] versus 0.9 [0-5.5], P<0.001, respectively). ΔSV100 predicted an increase of arterial pressure with an area under the receiver operating characteristic (AUC) curve of 0.89 (CI95%: 0.73-0.97, P<0.001). The cut-off was 5%. Baseline SAP and HR were not predictive of arterial responsiveness (P>0.05).ConclusionA ΔSV100 over 5% accurately predicted arterial pressure response to volume expansion during surgery.Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

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