Background: The aim of this study was to evaluate whether a 20-second end-expiratory occlusion (EEO) test can predict fluid responsiveness in cardiac surgery patients in the operating theatre.
Methods: This prospective study enrolled 75 mechanically ventilated patients undergoing elective coronary artery bypass grafting surgery. Hemodynamic data coupled with transesophageal echocardiography monitoring of the velocity time integral (VTI) and the peak velocity (Vmax) at the left ventricular outflow tract were collected at each step (baseline 1, EEO, baseline 2 and fluid challenge). Patients were divided into fluid responders (increase in VTI >= 15%) and non-responders (increase in VTI <15%) after a fluid challenge (6 mL 0.9% saline per kg, given in 10 minutes).
Results: Fluid challenge significantly increased the VTI by more than 15% in 36 (48%) patients (responders). An increase in VTI greater than 5% during the EEO test predicted fluid responsiveness with a sensitivity of 81% and a specificity of 93%. The area under the receiver-operating characteristic curve (AUROC) of Delta VTI-EEO was 0.90 [95% confidence interval (CI): 0.83-0.97]. Delta Vmax-EEO was poorly predictive of fluid responsiveness, with an AUC of 0.75 (95% CI: 0.63-0.86).
Conclusions: Changes in VTI induced by a 20-second EEO can reliably predict fluid responsiveness in cardiac surgical patients in the operating theatre, whereas the changes in Vmax cannot.
[1]Fudan Univ, Dept Anesthesiol, Zhongshan Hosp, 180 Fenglin Rd, Shanghai 200032, Peoples R China;
[2]Fudan Univ, Dept Crit Care Med, Zhongshan Hosp, 180 Fenglin Rd, Shanghai 200032, Peoples R China;
[3]Fudan Univ, Zhongshan Hosp, Dept Crit Care Med, Xiamen Branch, Xiamen 361015, Fujian, Peoples R China
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