Dynamic Indices for the Prediction of Fluid Responsiveness in Laparoscopic Urologic Surgery under General Anaesthesia: An Interventional Study

Abstract

Objective: This study aims to evaluate the ability of stroke volume variation (SVV), pulse pressure variation (PPV), and change in PVV and SVV after tidal volume challenge testing (ΔPPV and ΔSVV) aiming to predict fluid responsiveness in patients undergoing laparoscopic urologic surgery. Material and Methods: A prospective interventional study was performed with 23 patients undergoing urologic surgery while they were placed in Trendelenburg positions. A Vigileo/FloTrac system was used for the analysis. Hemodynamic data such as: arterial pressure (MAP), heart rate (HR), peak airway pressure (PIP), stroke volume (SV), cardiac output (CO), SVV, and PPV were recorded at the tidal volume settings of 8 mL/kg and 12 mL/kg before, and after a fluid challenge (FC). Fluid responsiveness was defined as an increase in SV(ΔSV) ≥15.0%. Results: After tidal volume challenge tests, there were significant increases in PIP in both groups. PPV increased only in the responders, as opposed to SVV, which increased significantly only in non-responders after tidal volume challenge test. After fluid challenge, PVV and SVV decreased gradually and significantly in both groups. The area under the ROC curves of patients undergoing laparoscopic urologic surgery was 0.872 (95% CI: 0.57-0.96) for ΔPPV, this change was the highest compared to other parameters. The threshold of the ΔPPV of patients undergoing laparoscopic urologic surgery was 4% with a sensitivity at 0.75 and specificity at 0.93. Conclusion: Change in PPV after the tidal volume challenge test from 8 mL/kg to 12 mL/kg can be used as an effective indicator to monitor fluid responsiveness in regards to patients undergoing urologic surgery.

Keywords

• dynamic indices
• predict fluid responsiveness
• urologic surgery