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Observational Study
. 2023 Aug 26;53(5):1224-1233.
doi: 10.55730/1300-0144.5688. eCollection 2023.

Novel parameters for predicting fluid responsiveness during the mini fluid challenge and ability of the cardiac power index: an observational cohort study

Taner Abdullah  1 , Hürü Ceren Gökduman  1 , İşbara Alp Enişte  1 , Ayşe Gülşah Atasever  2 , Achmet Ali  3 , Funda Gümüş Özcan  1
Affiliations
Observational Study

Novel parameters for predicting fluid responsiveness during the mini fluid challenge and ability of the cardiac power index: an observational cohort study

Taner Abdullah et al. Turk J Med Sci. .

Abstract

Background/aim: The percentage change in the stroke volume index (SVI) due to the mini fluid challenge (MFC) (MFC-ΔSVI%) is used commonly in daily practice. However, up to 20% of patients remain in the gray zone of this variable. Thus, it was aimed to compare the MFC-ΔSVI% and the percentage change in the cardiac power index (CPI) due to the MFC (MFC-ΔCPI%) with the baseline values of the pulse pressure variation (PPV) and stroke volume variation (SVV) in terms of their abilities to predict fluid responsiveness.

Materials and methods: The SVI, CPI, SVV, and PPV were recorded before 100 mL of isotonic saline was infused (MFC), after MFC was completed, and after an additional 400 mL of isotonic saline was infused to complete 500 mL of fluid loading (FL). Patients whose SVI increased more than 15% after the FL were defined as fluid responders.

Results: Sixty-seven patients completed the study and 35 (52%) of them were responders.The areas under the receiver operating characteristics curves for the MFC-ΔSVI% and MFC-ΔCPI% (0.94; 95% CI: 0.86-0.99 and 0.89; 95% CI: 0.79-0.95, respectively) were significantly higher than those for the SVV and PPV (0.63; 95% CI: 0.50-0.75 and 0.55; 95% CI: 0.42-0.67, respectively) (p < 0.001 for all of the comparisons). The gray zone analysis revealed that the MFC-ΔSVI% values of 12 patients were in the gray zone. Of the 12, the MFC-ΔCPI% values of 7 patients were outside of the gray zone.

Conclusion: Fluid responsiveness can be predicted more accurately using the MFC-ΔSVI% and MFC-ΔCPI% than using the SVV and PPV. Additionally, concomitant use of the MFC-ΔSVI% and MFC-ΔCPI% is recommended, as this approach diminishes the number of patients in the gray zone.

Keywords: Intraoperative monitoring; fluid therapy; positive-pressure respiration; stroke volume.

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Conflict of interest statement

Conflict of interest: The authors declare that there are no conflicts of interest/competing interests.

Figures

Figure 1
Figure 1
Study flow chart. BMI: body mass index, Crs: static respiratory system compliance, LVEF: left ventricle ejection fraction, ASA score: American Society of Anesthesiologists score.
Figure 2
Figure 2
ROC curves generated for the MFC-ΔSVI%, MFC-ΔCPI%, SVV, and PPV showing the ability to predict fluid responsiveness.
Figure 3
Figure 3
Gray zones of the MFC-ΔSVI% and MFC-ΔCPI%. a. Gray zone of the MFC-ΔSVI%. The lower cut-off point is 4.8% (with 94.3% sensitivity). The upper cut-off point is −6.67% (with 93.8% specificity). The gray zone includes 12 (17.9%) patients. b. Gray zone of the MFC-ΔCPI%. The upper cut-off point is 9.4% (with 90.6% specificity). The lower cut-off point is 2.9% (with 94.3% sensitivity). The gray zone includes 18 (26.9%) patients.
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