Assessment of Fluid Responsiveness in Patients After Cardiac Surgery

Hemodynamics, Patient Monitoring

functional hemodynamic parameter, passive leg raising, stroke volume variation, pulse pressure variation

To overcome the limited accuracy of functional hemodynamic parameters such as stroke volume and pulse pressure variation (SVV and PPV) during spontaneous breathing, a Passive Leg Raising (PLR) manoeuvre has been suggested as a reliable predictor of fluid responsiveness. Aim of this study was to evaluate fluid responsiveness using SVV, PPV and PLR during the transition from controlled to spontaneous breathing in cardiac surgery patients

In patients after elective off-pump CABG are enrolled hemodynamic measurements are performed in the postoperative period upon arrival in the ICU using a PiCCO2 system (Pulsion Medical Systems, Munich, Germany). Controlled fluid challenges (500 ml) are done at 3 time-points: A) during controlled mechanical ventilation B) during pressure support ventilation with spontaneous breathing and C) after extubation. Stroke volume (SV), SVV and PPV as well as standard hemodynamic parameters (MAP = mean arterial pressure, HR = heart rate) are assessed. A PLR is performed before fluid administration at all 3 time points. A positive response is defined as an increase in SV\>15 %. Prediction of fluid responsiveness will be tested by AUC (area under the receiver operating characteristic - ROC - curve).

Switzerland