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. 2021 Jan 26;11(1):16.
doi: 10.1186/s13613-021-00811-x.

Trendelenburg maneuver predicts fluid responsiveness in patients on veno-arterial extracorporeal membrane oxygenation

Affiliations

Trendelenburg maneuver predicts fluid responsiveness in patients on veno-arterial extracorporeal membrane oxygenation

Jing-Chao Luo et al. Ann Intensive Care. .

Abstract

Background: Evaluation of fluid responsiveness during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support is crucial. The aim of this study was to investigate whether changes in left ventricular outflow tract velocity-time integral (ΔVTI), induced by a Trendelenburg maneuver, could predict fluid responsiveness during VA-ECMO.

Methods: This prospective study was conducted in patients with VA-ECMO support. The protocol included four sequential steps: (1) baseline-1, a supine position with a 15° upward bed angulation; (2) Trendelenburg maneuver, 15° downward bed angulation; (3) baseline-2, the same position as baseline-1, and (4) fluid challenge, administration of 500 mL gelatin over 15 min without postural change. Hemodynamic parameters were recorded at each step. Fluid responsiveness was defined as ΔVTI of 15% or more, after volume expansion.

Results: From June 2018 to December 2019, 22 patients with VA-ECMO were included, and a total of 39 measurements were performed. Of these, 22 measurements (56%) met fluid responsiveness. The R2 of the linear regression was 0.76, between ΔVTIs induced by Trendelenburg maneuver and the fluid challenge. The area under the receiver operating characteristic curve of ΔVTI induced by Trendelenburg maneuver to predict fluid responsiveness was 0.93 [95% confidence interval (CI) 0.81-0.98], with a sensitivity of 82% (95% CI 60-95%), and specificity of 88% (95% CI 64-99%), at a best threshold of 10% (95% CI 6-12%).

Conclusions: Changes in VTI induced by the Trendelenburg maneuver could effectively predict fluid responsiveness in VA-ECMO patients. Trial registration ClinicalTrials.gov, NCT03553459 (the TEMPLE study). Registered on May 30, 2018.

Keywords: Fluid responsiveness; Trendelenburg maneuver; Veno-arterial extracorporeal membrane oxygenation.

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Conflict of interest statement

All authors have no competing interests.

Figures

Fig. 1
Fig. 1
The study protocols. a An outline of each step; b a clinical scenery of VA-ECMO patient; c the 15° upward bed angulation for measurements at baselines and fluid challenge. d The 15° downward bed angulation for measurements in the Trendelenburg position
Fig. 2
Fig. 2
Linear regression between changes in velocity–time integral (ΔVTI, a), systolic blood pressure (ΔSBP, b), diastolic blood pressure (ΔDBP, c) and pulse pressure (ΔPP, d) induced by the Trendelenburg position and the fluid challenge. Solid and dashed lines indicate regression lines and their 95% confidential intervals
Fig. 3
Fig. 3
Individual values of velocity–time integral (VTI) of each step in non-responders (a) and responders (b) as well as receiver operating characteristics curve (c) and grey zone analysis (d) of changes in VTI induced by the Trendelenburg position to predict fluid responsiveness

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