Use of stepwise lung recruitment maneuver to predict fluid responsiveness under lung protective ventilation in the operating room

TL;DR

This study shows that stepwise lung recruitment maneuvers can help predict which patients will benefit from fluids during surgery when using lung protective ventilation.

Contribution

The study introduces a stepwise lung recruitment method to predict fluid responsiveness under lung protective ventilation.

Findings

Seventeen out of forty-one patients were identified as fluid responders.

Augmented PPV and SVV values showed good predictive ability for fluid responsiveness.

Optimal cut-offs for PPV and SVV were found to be >18% and >13%, respectively.

Abstract

Recent research has revealed that hemodynamic changes caused by lung recruitment maneuvers (LRM) with continuous positive airway pressure can be used to identify fluid responders. We investigated the usefulness of stepwise LRM with increasing positive end-expiratory pressure and constant driving pressure for predicting fluid responsiveness in patients under lung protective ventilation (LPV). Forty-one patients under LPV were enrolled when PPV values were in a priori considered gray zone (4% to 17%). The FloTrac-Vigileo device measured stroke volume variation (SVV) and stroke volume (SV), while the patient monitor measured pulse pressure variation (PPV) before and at the end of stepwise LRM and before and 5 min after fluid challenge (6 ml/kg). Fluid responsiveness was defined as a ≥ 15% increase in the SV or SV index. Seventeen were fluid responders. The areas under the curve for the augmented values of PPV and SVV, as well as the decrease in SV by stepwise LRM to identify fluid responders, were 0.76 (95% confidence interval, 0.61–0.88), 0.78 (0.62–0.89), and 0.69 (0.53–0.82), respectively. The optimal cut-offs for the augmented values of PPV and SVV were > 18% and > 13%, respectively. Stepwise LRM -generated augmented PPV and SVV predicted fluid responsiveness under LPV.

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