PREDICT FLUID RESPONSIVENESS AFTER OFF-PUMP CORONARY ARTERY BYPASS GRAFTING

Abstract

Thirty-two adult patients after off-pump coronary artery bypass grafting were enrolled into a prospective observational study. All patients received positive end expiratory pressure test (PEEP-test), mini-fluid challenge test (mFCT) and standard fluid challenge test (sFCT). Pulse pressure variation using two monitoring systems (PPVPiCCO, PPVNK), Stroke volume variation (SVV), heart-lung index (HLI) and plethysmogram variability index (PVI) were assessed before and after sFCT. The patients with an increase in cardiac index by ≥15% after fluid challenge were defined as fluid responders. According to receiver operating characteristic analysis, changes in mean arterial pressure induced by PEEP-test identified fluid responsiveness with AUC 0.73 (p= 0.03). The reduction in PPVPiCCO and SVV during mFCT predicted positive response to the fluid load with AUC 0.77 and 0.75, respectively (p< 0.05). Response to sFLT can be predicted by the assessment of PPVPiCCO (AUC 0.84), PPVNK (AUC 0.71), SVV (AUC 0.77) and HLI (AUC 0.77) (p< 0.05).

Keywords

• fluid responsiveness
• dynamic tests
• dynamic indices