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Prediction of fluid responsiveness based on liver compression-induced blood pressure changes in children after
Ji-Hyun Lee1, In-Kyung Song1, Eun-Hee Kim1
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea.
Insights
Liver compression effectively predicts fluid responsiveness in children after cardiac surgery. Changes in diastolic arterial pressure (DAP) during liver compression can indicate a patient's fluid needs.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Surgery
- Hemodynamic Monitoring
Background:
- Assessing fluid responsiveness is crucial in pediatric cardiac surgery patients.
- Traditional methods may be limited in this population.
- Non-invasive methods for fluid status assessment are needed.
Purpose of the Study:
- To evaluate liver compression-induced blood pressure changes as a predictor of fluid responsiveness.
- To determine if liver compression can guide fluid management in pediatric cardiac surgery.
Main Methods:
- Mechanically ventilated children (<5 years) post-cardiac surgery were studied.
- Liver compression (30 mmHg for 15s) was applied before fluid loading.
- Changes in diastolic arterial pressure (ΔDAP) and respiratory variation in aortic blood flow peak velocity (ΔVpeak) were measured.
Main Results:
- A mean ΔDAP of 10.5% in responders vs. 5.4% in non-responders (P=0.008).
- ΔDAP ≥ 5% predicted fluid responsiveness with an AUC of 0.778.
- ΔVpeak > 12% also predicted fluid responsiveness (AUC=0.765).
Conclusions:
- Liver compression-induced ΔDAP is a simple, practical, and effective method to predict fluid responsiveness.
- ΔDAP and ΔVpeak can guide fluid management in pediatric cardiac surgery patients.
- This technique offers a valuable tool for assessing volume status non-invasively.
Background:
This study evaluated whether liver compression-induced blood pressure changes can predict fluid responsiveness in children after cardiac surgery.
Methods:
Children aged <5 years who were undergoing cardiac surgery were evaluated after the sternum was closed. Before fluid loading, the right upper abdomen was compressed at a pressure of 30 mmHg for 15 seconds and changes in blood pressure waves were recorded. Then, 10 mL/kg of colloid solution was administered. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), central venous pressure (CVP), systolic pressure variation (SPV), stroke volume, and respiratory variation in aortic blood flow peak velocity (ΔVpeak) were measured before and after fluid loading. A volume responder was defined as >15% increase in Stroke Volume Index.
Results:
There were 17 responders and 13 non-responders. During liver compression, mean percent increase in DAP (ΔDAP) was significantly higher in the responder group (10.5%) than in the non-responder group (5.4%) (P=0.008). A ΔDAP of 5% during liver compression and a ΔVpeak of >12% were able to predict fluid responsiveness (P=0.01 and 0.02, respectively). However, changes in SAP during liver compression, SPV, and CVP had no predictive value. The area under the receiver operating characteristic curve of ΔDAP and ΔVpeak were 0.778 and 0.765, respectively.
Conclusions:
ΔDAP induced by liver compression and ΔVpeak can be used to predict fluid responsiveness in mechanically ventilated children. Liver compression can be a simple and practical method to assess volume status in children.
