INTRODUCTION: Dynamic indices of fluid responsiveness (FR) such as pulse pressure variation (PPV) and stroke volume variation (SVV) differ among hemodynamic monitors, which use proprietary algorithms, and vary even over a short period of time. We aimed to compare the baseline values, fluctuation and predictive value for FR of PPV and SVV measured by three minimally invasive monitors. PATIENTS AND METHODS: Twenty patients undergoing high-risk abdominal surgery were included and 45 fluid challenges were analysed. The patients were simultaneously monitored using Carescape B650, LiDCO Rapid and FloTrac/Vigileo system. Cardiac output (CO), PPV and SVV were recorded before and after the fluid challenge of 500 ml of balanced crystalloid solution. An increase in CO ≥ 15 % defined fluid responders. Concurrently recorded arterial waveform was used for offline calculation of PPV. RESULTS: Mean baseline values of the indices ranged between 8.6 % and 13.4 %. LiDCO showed higher fluctuation of indices compared to the other monitors. Area under the receiver operating characteristic curve (AUROC) ranged from 0.71 to 0.76 with optimal cut-off value between 7.5 % and 13.9 %. AUROC increased for all indices when FR was defined as an increase in stroke volume. Furthermore, a decrease in PPV or SVV after fluid challenge (ΔPPV, ΔSVV) proved a better marker of FR (AUROC 0.82-0.93) than baseline values with a uniform threshold of approximately -3%. CONCLUSIONS: Although a significant range of baselines variations and optimal cut-off values was observed, the predictive value of PPV and SVV from all the monitors was only moderate and comparable. Nevertheless, ΔPPV and ΔSVV appear to be a reliable and device-independent markers of FR.

Department of Anaesthesiology and Intensive Care St Anne's University Hospital Brno Brno Czech Republic

Faculty of Medicine Masaryk University Brno Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic

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Pinsky M.R. Functional hemodynamic monitoring. Crit. Care Clin. 2015;31:89–111. doi: 10.1016/j.ccc.2014.08.005. PubMed DOI PMC

Michard F., Teboul J.L. Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation. Crit. Care. 2000;4:282–289. doi: 10.1186/cc710. PubMed DOI PMC

Messina A., Pelaia C., Bruni A., Garofalo E., Bonicolini E., Longhini F., et al. Fluid challenge during anesthesia: a systematic review and meta-analysis. Anesth. Analg. 2018;127:1353–1364. doi: 10.1213/ANE.0000000000003834. PubMed DOI

Bednarczyk J.M., Fridfinnson J.A., Kumar A., Blanchard L., Rabbani R., Bell D., et al. Incorporating dynamic assessment of fluid responsiveness into goal-directed therapy: a systematic review and meta-analysis. Crit. Care Med. 2017;45:1538–1545. doi: 10.1097/CCM.0000000000002554. PubMed DOI PMC

Lopes M.R., Oliveira M.A., Pereira V.O.S., Lemos I.P.B., Auler J.O.C., Michard F. Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial. Crit. Care. 2007;11:R100. doi: 10.1186/cc6117. PubMed DOI PMC

Wyffels P.A.H., De Hert S., Wouters P.F. Measurement error of pulse pressure variation. J. Clin. Monit. Comput. 2023 doi: 10.1007/s10877-023-01099-x. PubMed DOI

Perel A. Automated assessment of fluid responsiveness in mechanically ventilated patients. Anesth. Analg. 2008;106:1031–1033. doi: 10.1213/ane.0b013e318167abe5. PubMed DOI

Derichard A., Robin E., Tavernier B., Costecalde M., Fleyfel M., Onimus J., et al. Automated pulse pressure and stroke volume variations from radial artery: evaluation during major abdominal surgery. Br. J. Anaesth. 2009;103:678–684. doi: 10.1093/bja/aep267. PubMed DOI

Khwannimit B., Bhurayanontachai R. Prediction of fluid responsiveness in septic shock patients: comparing stroke volume variation by FloTrac/Vigileo and automated pulse pressure variation. Eur. J. Anaesthesiol. 2012;29:64–69. doi: 10.1097/EJA.0b013e32834b7d82. PubMed DOI

Hofer C.K., Senn A., Weibel L., Zollinger A. Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac and PiCCOplus system. Crit. Care. 2008;12:R82. doi: 10.1186/cc6933. PubMed DOI PMC

de Wilde R.B.P., Geerts B.F., van den Berg P.C.M., Jansen J.R.C. A comparison of stroke volume variation measured by the LiDCOplus and FloTrac-Vigileo system. Anaesthesia. 2009;64:1004–1009. doi: 10.1111/j.1365-2044.2009.06009.x. PubMed DOI

Ganter M.T., Geisen M., Hartnack S., Dzemali O., Hofer C.K. Prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters. BMC Anesthesiol. 2018;18:55. doi: 10.1186/s12871-018-0520-x. PubMed DOI PMC

Reuter D.A., Kirchner A., Felbinger T.W., Weis F.C., Kilger E., Lamm P., et al. Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function. Crit. Care Med. 2003;31:1399–1404. doi: 10.1097/01.CCM.0000059442.37548.E1. PubMed DOI

Mahjoub Y., Pila C., Friggeri A., Zogheib E., Lobjoie E., Tinturier F., et al. Assessing fluid responsiveness in critically ill patients: false-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle. Crit. Care Med. 2009;37:2570–2575. doi: 10.1097/CCM.0b013e3181a380a3. PubMed DOI

Le Manach Y., Hofer C.K., Lehot J.-J., Vallet B., Goarin J.-P., Tavernier B., et al. Can changes in arterial pressure be used to detect changes in cardiac output during volume expansion in the perioperative period? Anesthesiology. 2012;117:1165–1174. doi: 10.1097/ALN.0b013e318275561d. PubMed DOI

Michard F., Boussat S., Chemla D., Anguel N., Mercat A., Lecarpentier Y., et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am. J. Respir. Crit. Care Med. 2000;162:134–138. doi: 10.1164/ajrccm.162.1.9903035. PubMed DOI

Sun X., Xu W. Fast implementation of DeLong's algorithm for comparing the areas under correlated receiver operating characteristic curves. IEEE Signal Process. Lett. 2014;21:1389–1393. doi: 10.1109/LSP.2014.2337313. DOI

Yang X., Du B. Does pulse pressure variation predict fluid responsiveness in critically ill patients? A systematic review and meta-analysis. Crit. Care. 2014;18:650. doi: 10.1186/s13054-014-0650-6. PubMed DOI PMC

Zlicar M., Novak-Jankovic V., Blagus R., Cecconi M. Predictive values of pulse pressure variation and stroke volume variation for fluid responsiveness in patients with pneumoperitoneum. J. Clin. Monit. Comput. 2018;32:825–832. doi: 10.1007/s10877-017-0081-4. PubMed DOI

Chin J.H., Lee E.H., Hwang G.S., Choi W.J. Prediction of fluid responsiveness using dynamic preload indices in patients undergoing robot-assisted surgery with pneumoperitoneum in the Trendelenburg position. Anaesth. Intensive Care. 2013;41:515–522. doi: 10.1177/0310057X1304100413. PubMed DOI

Guinot P.-G., de Broca B., Bernard E., Abou Arab O., Lorne E., Dupont H. Respiratory stroke volume variation assessed by oesophageal Doppler monitoring predicts fluid responsiveness during laparoscopy. Br. J. Anaesth. 2014;112:660–664. doi: 10.1093/bja/aet430. PubMed DOI

Moon E.-J., Lee S., Yi J.-W., Kim J.H., Lee B.-J., Seo H. Stroke volume variation and stroke volume index can predict fluid responsiveness after mini-volume challenge test in patients undergoing laparoscopic cholecystectomy. Medicina (Kaunas) 2019;56:E3. doi: 10.3390/medicina56010003. PubMed DOI PMC