Assessment of the effect of rapid crystalloid infusion on stroke volume variation and pleth variability index after a preoperative fast

• Published in: Journal of clinical monitoring and computing Vol. 24; no. 5; pp. 385 - 389
• Main Authors: Wajima, Zen’ichiro, Shiga, Toshiya, Imanaga, Kazuyuki, Inoue, Tetsuo
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.10.2010; Springer
• Subjects: Adult; Algorithms; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Blood Pressure - drug effects; Cardiac Output - drug effects; Critical Care Medicine; Dehydration - drug therapy; Dehydration - physiopathology; Fasting - physiology; Female; Health Sciences; Heart Rate - drug effects; Humans; Infusions, Intravenous; Intensive; Intensive care medicine; Isotonic Solutions - administration & dosage; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Monitoring, Physiologic - statistics & numerical data; Neurology; Preoperative Care; Respiration, Artificial; Statistics for Life Sciences; Stroke Volume - drug effects; Stroke Volume - physiology; Vascular diseases and vascular malformations of the nervous system; Young Adult; rapid crystalloid infusion; dehydration; stroke volume variation; pleth variability index; Intensive care; Variability; Preoperative; Dehydration; Systolic volume; Resuscitation
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-010-9259-8

Objective Stroke volume variation (SVV) during controlled mechanical ventilation is a useful predictor in response to volume expansion, and pleth variability index (PVI), a novel algorithm allowing for automated and continuous calculation of the respiratory variations in the pulse oximeter waveform amplitude, can also predict fluid responsiveness non-invasively in mechanically ventilated patients. The aim of this study was (1) to determine whether acute fluid infusion affects SVV and PVI, and (2) to compare the two values in the case of acute fluid infusion after a preoperative fast following general anesthesia induction. Methods After tracheal intubation, the patients’ lungs were mechanically ventilated. Subjects were anesthetized using sevoflurane and were given a rapid, constant-rate infusion of crystalloid (500 ml in 15 min). Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), cardiac output (CO), cardiac index (CI), SVV, and PVI were measured at baseline and after 250 and 500 ml had been infused, and these values were compared. Results SAP, DAP, CO, and CI were unchanged after the infusion. HR and SVV decreased significantly after the infusion. SVI increased significantly after the infusion. There was a significant difference in PVI only between the post 250 ml and post 500 ml infusions. Conclusions A rapid infusion of 250–500 ml of a crystalloid in nearly healthy subjects who had fasted overnight returned their SVV to within the normal range. In such cases, SVV is a more sensitive predictor of fluid responsiveness than is PVI, and the infusion gradually increased SVI.