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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

Authors
 N. Kim  ;  J.-K. Shim  ;  H. G. Choi  ;  M. K. Kim  ;  J. Y. Kim  ;  Y.-L. Kwak 
Citation
 British Journal of Anaesthesia, Vol.116(3) : 350-356, 2016 
Journal Title
 British Journal of Anaesthesia 
ISSN
 0007-0912 
Issue Date
2016
MeSH
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
Keywords
atrial fibrillation ; central venous pressure ; fluid responsiveness ; passive leg raising ; positive end-expiratory pressure
Abstract
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.
Full Text
http://bja.oxfordjournals.org/content/116/3/350
DOI
10.1093/bja/aev359
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
곽영란(Kwak, Young Lan) ORCID logo https://orcid.org/0000-0002-2984-9927
김남오(Kim, Namo) ORCID logo https://orcid.org/0000-0002-0829-490X
심재광(Shim, Jae Kwang) ORCID logo https://orcid.org/0000-0001-9093-9692
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146372
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