Journal of clinical monitoring and computing
-
J Clin Monit Comput · Aug 2014
Variations in the pre-ejection period induced by ventricular extra systoles may be feasible to predict fluid responsiveness.
Monitoring that can predict fluid responsiveness is an unsettled matter for spontaneously breathing patients. Based on the convincing results with dynamic monitoring based on preload variations induced by mechanical ventilation, we hypothesised that the extra systolic post-ectopic beat could constitute a similar intermittent preload shift inducing a brief variation in blood pressure and that the magnitude of this variation could predict the hemodynamic response to volume expansion in sedated pigs. Ten pigs were sedated and hemodynamically monitored and four intravascular volume shifts were made: blood depletion (25% of estimated blood volume; 660 ml), retransfusion (of 500 ml depleted blood), and two sequential volume expansions (500 ml colloid each). ⋯ Ventricular extra systoles were generally useful for fluid responsiveness prediction (ROC areas >0.65). ∆PEP variables best predicted fluid responsiveness: ∆PEP derived from arterial pressure curve and ECG had ROC area of 0.84 and sensitivity of 0.77 and specificity of 0.71; ∆PEP derived from plethysmographic curve and ECG had ROC area of 0.79 and sensitivity of 0.71 and specificity of 0.70. However, ∆PP was not a useful variable in this study (ROC area <0.65). Hemodynamic analysis of post ectopic beats may be a feasible method for fluid responsiveness prediction.