Stroke volume variation and indexed stroke volume measured using bioreactance predict fluid responsiveness in postoperative children1

摘要

Background. Postoperative fluid management can be challenging in children after haemorrhagic surgery. The goal of this study was to assess the ability of dynamic cardiovascular variables measured using bioreactance (NICOM?, Cheetah Medical, Tel Aviv, Israel) to predict fluid responsiveness in postoperative children. Methods. Children sedated and mechanically ventilated, who require volume expansion (VE) during the immediate postoperative period, were included. Indexed stroke volume (SVi), cardiac index, and stroke volume variation (SVV) were measured using the NICOM? device. Responders (Rs) to VE were patients showing an increase in SV measured using transthoracic echocardiography of at least 15% after VE. Data are median [95% confidence interval (CI)]. Results. Thirty-one patients were included, but one patient was excluded because of the lack of calibration of the NICOM? device. Before VE, SVi [33 (95% CI 31-36) vs 24 (95% CI 21-28) ml m"2; P=0.006] and SVV [8 (95% CI 4-11) vs 13 (95% CI 11-15)%; P=0.004] were significantly different between non-responders and Rs. The areas under the receiver operating characteristic curves of SVi and SVV for predicting fluid responsiveness were 0.88 (95% CI 0.71-0.97) and 0.81 (95% CI 0.66-0.96), for a cut-off value of 29 ml m"2 (grey zone 27-29 ml rrT2) and 10% (grey zone 9-15%), respectively. Conclusions. The results of this study show that SVi and SVV non-invasively measured by bioreactance are predictive of fluid responsiveness in sedated and mechanically ventilated children after surgery.