• Guo-Guang Ma, Guo-Wei Tu, Ji-Li Zheng, Du-Ming Zhu, Guang-Wei Hao, Jun-Yi Hou, Ying Su, Jing-Chao Luo, Kai Liu, and Zhe Luo.
• Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
• J. Cardiothorac. Vasc. Anesth. 2020 Jun 1; 34 (6): 1526-1533.

ObjectivesStroke volume variation (SVV) has been used to predict fluid responsiveness. The authors hypothesized the changes in SVV induced by passive leg raising (PLR) might be an indicator of fluid responsiveness in patients with protective ventilation after cardiac surgery.DesignA prospective single-center observational study.SettingA single cardiac surgery intensive care unit at a tertiary hospital.ParticipantsA total of 123 patients undergoing cardiac surgery with hemodynamic instability. Tidal volume was set between 6 and 8 mL/kg of ideal body weight.InterventionsPLR maneuver, fluid challenge.Measurements And Main ResultsSVV was continuously recorded using pulse contour analysis before and immediately after a PLR test and after fluid challenge (500 mL of colloid given over 30 min). Sixty-three (51.22%) patients responded to fluid challenge, in which PLR and fluid challenge significantly increased the SV and decreased the SVV. The decrease in SVV induced by PLR was correlated with the SV changes induced by fluid challenge. A 4% decrease in the SVV induced by PLR-discriminated responders to fluid challenge with an area under the curve of 0.90. The gray zone identified a range of SVV changes induced by PLR (between -3.94% and -2.91%) for which fluid responsiveness could not be predicted reliably. The gray zone included 15.45% of the patients. The SVV at baseline predicted fluid responsiveness with an area under the curve of 0.72.ConclusionsChanges in the SVV induced by PLR predicted fluid responsiveness in cardiac surgical patients with protective ventilation.Copyright © 2019 Elsevier Inc. All rights reserved.

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