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Comparative Study
. 2013 Sep;25(6):466-74.
doi: 10.1016/j.jclinane.2013.04.010. Epub 2013 Aug 17.

Comparison of stroke volume and fluid responsiveness measurements in commonly used technologies for goal-directed therapy

Simon J Davies  1 , Simran Minhas, R Jonathan T Wilson, David Yates, Simon J Howell
Affiliations
Comparative Study

Comparison of stroke volume and fluid responsiveness measurements in commonly used technologies for goal-directed therapy

Simon J Davies et al. J Clin Anesth. 2013 Sep.

Abstract

Study objective: To compare stroke volume (SV) and preload responsiveness measurements from different technologies with the esophageal Doppler monitor (EDM).

Design: Prospective measurement study.

Setting: Operating room.

Patients: 20 ASA physical status 3 patients undergoing vascular, major urological, and bariatric surgery.

Interventions: Subjects received fluids using a standard Doppler protocol of 250 mL of colloid administered until SV no longer increased by >10%, and again when the measured SV decreased by 10%.

Measurements: Simultaneous readings of SV, stroke volume variation (SVV) and pulse pressure variation (PPV) from the LiDCOrapid, and SVV from the FloTrac/Vigileo were compared with EDM measurements. The pleth variability index (PVI) also was recorded.

Main results: No correlation was seen in percentage SV change as measured by either the LiDCOrapid (r=0.05, P=0.616) or FloTrac (r=0.09, P= 0.363) systems compared with the EDM. Correlation was present between the LiDCOrapid and FloTrac (r=0.515, P<0.0001). Percentage error compared with the EDM was 81% for the FloTrac and 90% for the LiDCOrapid. SVV as measured by LiDCOrapid differed for fluid responders and nonresponders (10% vs 7%; P=0.021). Receiver operator curve analysis to predict a 10% increase in SV from the measured variables showed an area under the curve of 0.57 (95% CI 0.43-0.72) for SVV(FloTrac), 0.64 (95% CI 0.52-0.78) for SVV(LiDCO), 0.61 (95% CI 0.46 -0.76) for PPV, and 0.59 (95% CI 0.46 -0.71) for PVI.

Conclusions: Stroke volume as measured by the FloTrac and LiDCOrapid systems does not correlate with the esphageal Doppler, has poor concordance, and a clinically unacceptable percentage error. The predictive value of the fluid responsiveness parameters is low, with only SVV measured by the LiDCOrapid having clinical utility.

Keywords: Cardiac output; Fluid optimization; Monitoring; Preload responsiveness; Pulse contour analysis.

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