Fluid responsiveness and right ventricular function in cardiac surgical patients. A multicenter study

Area of Science:

• Cardiology
• Critical Care Medicine
• Anesthesiology

Background:

• Investigated fluid responsiveness in patients undergoing coronary artery revascularization.
• Focused on the role of right ventricular ejection fraction in predicting response to fluid administration.

Purpose of the Study:

• To determine predictors of fluid responsiveness in patients undergoing coronary artery revascularization.
• To assess the influence of right ventricular ejection fraction on these predictors.

Main Methods:

• Multicenter trial with 65 patients undergoing elective coronary artery revascularization.
• Hemodynamic parameters measured before and after volume expansion (7 ml/kg plasma expander).
• Utilized pulmonary artery catheter and transesophageal echocardiography; responders defined by >20% stroke volume increase.

Main Results:

• Overall population: only change in aortic blood velocity (13%) predicted fluid responsiveness.
• Reduced right ventricular ejection fraction (<0.3): mean pulmonary arterial pressure (18 mmHg) was predictive.
• Preserved right ventricular ejection fraction (≥0.3): predictors included aortic blood velocity (15%), right ventricular end-diastolic volume index (80 ml/m²), and left ventricular end-diastolic area index (9 cm²/m²).

Conclusions:

• Right ventricular systolic function significantly influences fluid responsiveness predictors.
• Depressed right ventricular function impairs left-sided responsiveness predictors.
• Preserved right ventricular function confirms classical fluid responsiveness predictors, highlighting the importance of assessing right ventricular function.