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Comparison of positive end-expiratory pressure?induced increase in central venous pressure and passive leg raising to predict fluid responsiveness in patients with atrial fibrillation

 N. Kim  ;  J.-K. Shim  ;  H. G. Choi  ;  M. K. Kim  ;  J. Y. Kim  ;  Y.-L. Kwak 
 BRITISH JOURNAL OF ANAESTHESIA, Vol.116(3) : 350-356, 2016 
Journal Title
Issue Date
Aged ; Atrial Fibrillation/physiopathology* ; Atrial Fibrillation/therapy* ; Cardiac Output/physiology ; Central Venous Pressure/physiology* ; Female ; Fluid Therapy* ; Humans ; Leg* ; Male ; Middle Aged ; Positive-Pressure Respiration* ; Posture/physiology* ; ROC Curve ; Stroke Volume/physiology ; Treatment Outcome
atrial fibrillation ; central venous pressure ; fluid responsiveness ; passive leg raising ; positive end-expiratory pressure
BACKGROUND: Positive end-expiratory pressure (PEEP)-induced increase in central venous pressure (CVP) has been suggested to be a robust indicator of fluid responsiveness, with heart rhythm having minimal influence. We compared the ability of PEEP-induced changes in CVP with passive leg raising (PLR)-induced changes in stroke volume index (SVI) in patients with atrial fibrillation after valvular heart surgery.
METHODS: In 43 patients with atrial fibrillation after cardiac surgery, PEEP was increased from 0 to 10 cm H2O for 5 min and changes in CVP were assessed. After returning the PEEP to 0 cm H2O, PLR was performed for 5 min and changes in SVI were recorded. Finally, 300 ml of colloid was infused and haemodynamic variables were assessed 5 min after completion of a fluid challenge. Fluid responsiveness was defined as an increase in SVI ≥10% measured by a pulmonary artery catheter.
RESULTS: Fifteen (35%) patients were fluid responders. There was no correlation between PEEP-induced increases in CVP and changes in SVI after a fluid challenge (β coefficient -0.052, P=0.740), whereas changes in SVI during PLR showed a significant correlation (β coefficient 0.713, P<0.001). The area under the receiver operating characteristic curve of the PEEP-induced increase in CVP and changes in SVI during PLR for fluid responsiveness was 0.556 [95% confidence interval (CI) 0.358-0.753, P=0.549) and 0.771 (95% CI 0.619-0.924, P=0.004), respectively.
CONCLUSIONS: A PEEP-induced increase in CVP did not predict fluid responsiveness in patients with atrial fibrillation after cardiac surgery, but increases in SVI during PLR seem to be a valid predictor of fluid responsiveness in this subset of patients.
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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
Kim, Namo(김남오) ORCID logo https://orcid.org/0000-0002-0829-490X
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
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