Stroke Volume Variation As A Predictor Of Fluid Responsiveness In Patients With Intra-abdominal Infection

Objective:To investigate the effectiveness of stroke volume variation (SVV) shown by the Vigileo-FloTracTM system to predict fluid responsiveness in patients with intra-abdominal infection.Methods:All32patients aged22-82yr, APACHE Ⅱ Score15—32.SOFA Score5—16, Intra-abdominal pressure9-12mmHg,intra-abdominal infected in the intensive care unit of our hospital from April to December2012were included in this study. A radial artery catheter was inserted to connect to measurement deviee(FloTraeTM/VigileoTM.EdwardsLifeseienees).6%hydroxyethyl starch130/0.4was administered for30minutes, haemodynamic variables including heart rate (HR), mean arterial pressure(MAP), central venous pressure(CVP)^cardiac output(CO)> cardiac index (CI), stroke volume(SV)、stroke volume index (SVI) and Stroke Volume Variation (SVV) were recorded before and after volume loading.we divided the patients into two groups according to the percentage increases in CI after volume loading with responders defined as those who showed an increase in CI≥15%after volume loading and nonresponders as those with a CI change<15%,to compare haemodynamic parameters before and after volume loading in two groups respectively. To judge the correlations among the△CI and△SVV,△CI and△MAP,△CI and△HR,△CI and△CVP. We made the receiver operating characteristic (ROC) analysis the SVV threshold in determining the volume expansion efficacy, The area under the curve(AUC) for SVV and95%confidence interval were calculated.Results:MAP、HR、CVP、HR、CO、SV and SVI were significantly increased in responders group as compared with before volume expansion (P1<0.05). CI and SVV were significantly decreased in responders group as compared with before volume expansion (P<0.05). CO、CI and SVI were significantly increased in nonresponders group as compared with before volume expansion (P1<0.05).SVV were significantly decreased in nonresponders group as compared with before volume expansion (P1<0.05). There was no significant difference in MAP、HR、CVP and SV in nonresponder group as compared with before volume expansion (P1<0.05).There was significantly negative correlation between ASVV and ACI (r=-0.576, P-0.02). There was no correlation ACI with AMAP. There was no correlation△CI with△HR. There was no correlation△CI with△CVP. Receiver operating characteristic (ROC) curves were generated for SVV and CI by varying the discriminating threshold of the variable and areas under the ROC curves were calculated. The areas under the ROC curves were0.748for SVV (95%confidence interval:0.544-0.952).The optimal threshold value of SVV to discriminate between responders and nonresponders was11%(sensitivity:73%; specificity:67%).Conclusion:We found that SVV was able to predict fluid responsiveness in patients intra-abdominal inflected with acceptable levels of sensitivity and specificity.