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Br J Anaesth. 2016 Mar;116(3):350-6. doi: 10.1093/bja/aev359. Epub 2015 Nov 17.

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.

Author information

1
Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
2
Department of Anaesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Republic of Korea.
3
Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
4
Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea ylkwak@yuhs.ac.

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.

KEYWORDS:

atrial fibrillation; central venous pressure; fluid responsiveness; passive leg raising; positive end-expiratory pressure

PMID:
26577035
DOI:
10.1093/bja/aev359
[Indexed for MEDLINE]
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