Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac and PiCCOplus system

Christoph K Hofer, Alban Senn, Luc Weibel, Andreas Zollinger, Christoph K Hofer, Alban Senn, Luc Weibel, Andreas Zollinger

Abstract

Introduction: Stroke volume variation (SVV) has repeatedly been shown to be a reliable predictor of fluid responsiveness. Various devices allow automated clinical assessment of SVV. The aim of the present study was to compare prediction of fluid responsiveness using SVV, as determined by the FloTrac/Vigileo system and the PiCCOplus system.

Methods: In patients who had undergone elective cardiac surgery, SVVFloTrac was determined via radial FloTrac sensor, and SVVPiCCO and pulse pressure variation were assessed via a femoral PiCCO catheter. Stroke volume was assessed by transpulmonary thermodilution. All variables were recorded before and after a volume shift induced by a change in body positioning (from 30 degrees head-up position to 30 degrees head-down position). Pearson correlation, t-test, and Bland-Altman analysis were performed. Area under the curve was determined by plotting receiver operating characteristic curves for changes in stroke volume in excess of 25%. P < 0.05 was considered statistically significant.

Results: Body positioning resulted in a significant increase in stroke volume; SVVFloTrac and SVVPiCCO decreased significantly. Correlations of SVVFloTrac and SVVPiCCO with change in stroke volume were similar. There was no significant difference between the areas under the curve for SVVFloTrac and SVVPiCCO; the optimal threshold values given by the receiver operating characteristic curves were 9.6% for SVVFloTrac (sensitivity 91% and specificity 83%) and 12.1% for SVVPiCCO (sensitivity 87% and specificity 76%). There was a clinically acceptable agreement and strong correlation between SVVFloTrac and SVVPiCCO.

Conclusion: SVVs assessed using the FloTrac/Vigileo and the PiCCOplus systems exhibited similar performances in terms of predicting fluid responsiveness. In comparison with SVVPiCCO, SVVFloTrac has a lower threshold value.

Figures

Figure 1
Figure 1
Individual responses of SV, SVVFloTrac and SVVPiCCO to 30° head-down positioning. SV, stroke volume; SVV, stroke volume variation.
Figure 2
Figure 2
Prediction of fluid responsiveness to SV changes > 25% induced by 30° head-down positioning. CVP, central venous pressure; GEDV, global end-diastolic volume; PPV, pulse pressure variation; SVV, stroke volume variation.
Figure 3
Figure 3
Prediction of fluid responsiveness: Pearson correlations. Shown are Pearson correlations between stroke volume variation (SVV) assessed using the FloTrac™/Vigileo™ and the PiCCOplus™ systems in head-up position and stroke volume (SV) changes induced by 30° head-down positioning. ΔSV, stroke volume change (%).
Figure 4
Figure 4
Bland-Altman analysis. Presented is a Bland-Altman analysis comparing stroke volume variation (SVV) assessed using the FloTrac™/Vigileo™ and the PiCCOplus™ system in 30° head-up and 30° head-down positions. 30° head-up: mean bias ± 2 standard deviations (SD; limits of agreement) = -2.5 ± 6.1%; 30° head-down: mean bias ± 2SD = -1.5 ± 3.6%.

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