Department of Anesthesia and Intensive Care, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan.
J Anesth. 2023 Dec;37(6):930-937. doi: 10.1007/s00540-023-03256-7. Epub 2023 Sep 21.
It remains unknown whether stroke volume variation (SVV), pulse pressure variation (PPV), and dynamic arterial elastance (Ea) are suitable for monitoring fluid management during thoracoscopic esophagectomy (TE) in the prone position with one-lung ventilation and artificial pneumothorax. Our study aimed to evaluate the accuracy of SVV, PVV, and Ea in predicting the fluid responsiveness in these patients.
We recruited 24 patients who had undergone TE. Patients with a mean arterial blood pressure ≤ 65 mmHg received a 200-ml bolus of 6% hydroxyethyl starch over 10 min. Fluid responders showed the stroke volume index ≥ 15% 5 min after the fluid bolus. Receiver operating characteristic (ROC) curves were generated and area under the ROC curve (AUROC) was calculated.
We obtained 61 fluid bolus data points, of which 20 were responders and 41 were non-responders. The median SVV before the fluid bolus in responders was significantly higher than that in non-responders (18% [interquartile range (IQR) 13-21] vs. 12% [IQR 8-15], P = 0.001). Ea was significantly lower in responders than in non-responders (0.55 [IQR 0.45-0.78] vs. 0.91 [IQR 0.67-1.00], P < 0.001). There was no difference in the PPV between the groups. The AUROC was 0.76 for SVV (95% confidence interval [CI] 0.62-0.89, P = 0.001), 0.56 for PPV (95% CI 0.41-0.71, P = 0.44), and 0.82 for Ea (95% CI 0.69-0.95, P < 0.001).
SVV and Ea are reliable parameters for predicting fluid responsiveness in patients undergoing TE.
目前尚不清楚每搏变异度（SVV）、脉压变异度（PPV）和动态动脉顺应性（Ea）是否适用于监测单肺通气和人工气胸下俯卧位胸腔镜食管切除术（TE）期间的液体管理。我们的研究旨在评估 SVV、PVV 和 Ea 预测这些患者液体反应性的准确性。
我们招募了 24 名接受 TE 的患者。平均动脉血压≤65mmHg 的患者接受 6%羟乙基淀粉 200ml 静脉推注，持续 10min。液体反应者在液体推注后 5min 内显示每搏指数≥15%。生成受试者工作特征（ROC）曲线并计算 ROC 曲线下面积（AUROC）。
我们获得了 61 个液体推注数据点，其中 20 个为反应者，41 个为非反应者。反应者在液体推注前的 SVV 中位数明显高于非反应者（18%[四分位距（IQR）13-21]比 12%[IQR 8-15]，P=0.001）。Ea 在反应者中明显低于非反应者（0.55[IQR 0.45-0.78]比 0.91[IQR 0.67-1.00]，P<0.001）。两组间 PPV 无差异。SVV 的 AUROC 为 0.76（95%置信区间[CI]0.62-0.89，P=0.001），PPV 的 AUROC 为 0.56（95%CI 0.41-0.71，P=0.44），Ea 的 AUROC 为 0.82（95%CI 0.69-0.95，P<0.001）。
SVV 和 Ea 是预测 TE 患者液体反应性的可靠参数。
