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Validation of pulse pressure variation and corrected flow time as predictors of fluid responsiveness in patients in the prone position

Authors
 S.-Y. Yang  ;  J.-K. Shim  ;  Y. Song  ;  S.-J. Seo  ;  Y.-L. Kwak 
Citation
 BRITISH JOURNAL OF ANAESTHESIA, Vol.110(5) : 713-720, 2013 
Journal Title
BRITISH JOURNAL OF ANAESTHESIA
ISSN
 0007-0912 
Issue Date
2013
MeSH
Adult ; Aged ; Blood Pressure/physiology ; Female ; Fluid Therapy/methods* ; Hemodynamics/physiology ; Humans ; Intraoperative Care/methods ; Lumbar Vertebrae/surgery* ; Male ; Middle Aged ; Monitoring, Intraoperative/methods* ; Prone Position/physiology ; Prospective Studies ; Sensitivity and Specificity ; Spinal Fusion ; Stroke Volume/physiology ; Supine Position/physiology ; Young Adult
Keywords
fluids, i.v. ; heart, cardiac output ; monitoring, arterial pressure ; position, prone
Abstract
BACKGROUND:
The aim of this prospective trial was to investigate the ability of pulse pressure variation (PPV) and corrected flow time (FTc) to predict fluid responsiveness in the prone position.
METHODS:
Forty-four patients undergoing lumbar spine surgery in the prone position on a Wilson frame were prospectively studied. PPV and FTc were measured before and after a colloid bolus (6 ml kg(-1)) both in the supine and in the prone positions. Fluid responsiveness was defined as an increase in the stroke volume index of ≥ 10% as measured by oesophageal Doppler.
RESULTS:
In the supine position, 26 patients were responders and the areas under the curve (AUC) of the receiver-operator characteristic (ROC) curves of PPV and FTc were 0.935 [95% confidence interval (CI): 0.870-0.999, P<0.001] and 0.822 (95% CI: 0.682-0.961, P<0.001), respectively. The optimal cut-off PPV and FTc values were 15% (sensitivity 73%, specificity 94%) and 358 ms (sensitivity 88%, specificity 78%), respectively. In the prone position, 34 patients were responders and the AUCs of PPV and FTc were 0.969 (95% CI: 0.912-1.000, P<0.001) and 0.846 (95% CI: 0.706-0.985, P=0.001), respectively. The optimal cut-off PPV and FTc values were 14% (sensitivity 97%, specificity 90%) and 331 ms (sensitivity 77%, specificity 90%), respectively.
CONCLUSIONS:
While the predictability of PPV was significantly higher than that of FTc in the prone position, both variables showed high predictability and remained as useful indices for guiding fluid therapy in prone patients with minimal alterations in their optimal cut-off values to predict fluid responsiveness. Clinical trial registration URL: http://www.clinicaltrials.gov/ct2/show/NCT01646359?term=NCT01646359&rank=1 and unique identification number NCT01646359.
Files in This Item:
T201301526.pdf Download
DOI
10.1093/bja/aes475
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Song, Young(송영) ORCID logo https://orcid.org/0000-0003-4597-387X
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/86841
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