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Accuracy of dynamic preload variables for predicting fluid responsiveness in patients with pediatric liver cirrhosis:
Pin-Hsin Chen1, Kuang-Cheng Chan1, Min-Hsiu Liao1
1Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Dynamic preload variables do not reliably predict fluid responsiveness in pediatric liver cirrhosis patients. Further research is needed to identify effective methods for guiding fluid therapy in this population.
Area of Science:
- Pediatric critical care medicine
- Hepatology
- Hemodynamics
Background:
- Previous studies indicated dynamic preload variables predict fluid responsiveness in adult liver cirrhosis patients.
- Pediatric patients with cirrhosis may exhibit distinct hemodynamic profiles requiring specific evaluation.
- Clarifying the predictive accuracy of these variables in children is crucial for optimizing fluid management.
Purpose of the Study:
- To assess the accuracy of dynamic preload variables in predicting fluid responsiveness in pediatric patients with liver cirrhosis.
- To determine if established dynamic preload parameters are effective in guiding fluid administration in this specific pediatric cohort.
Main Methods:
- The study included 27 pediatric patients with cirrhosis undergoing liver transplantation.
- Dynamic preload variables (pulse pressure variation, stroke volume variation, plethysmographic variability index) and central venous pressure were measured.
- Fluid responsiveness was assessed by stroke volume index increase (≥15%) after standardized fluid challenges.
Main Results:
- 61 fluid challenges were analyzed, with 15 responders and 46 non-responders.
- Dynamic preload variables showed statistically significant decreases in responders but not non-responders.
- Areas under the ROC curves for pulse pressure variation and stroke volume variation were 0.67 and 0.68, respectively, indicating limited predictive value.
Conclusions:
- Dynamic preload variables demonstrated insufficient accuracy for predicting fluid responsiveness in pediatric liver cirrhosis patients.
- These findings suggest that current dynamic preload monitoring may not be suitable for guiding fluid therapy in this population.
- Further investigation into alternative or modified hemodynamic monitoring strategies is warranted.
Background:
We have previously reported that dynamic preload variables predicted fluid responsiveness in adult patients with liver cirrhosis. However, pediatric patients with cirrhosis may present with unique hemodynamic characteristics, and therefore, the predictive accuracy of these variables in such patients must be clarified.
Aims:
To investigate the accuracy of dynamic preload variables for predicting fluid responsiveness in pediatric patients with cirrhosis.
Methods:
A total of 27 pediatric patients with cirrhosis undergoing orthotopic liver transplantation were enrolled in this study. Patients' pulse pressure variation, stroke volume variation, stroke volume index, and central venous pressure were measured using the calibrated pulse contour cardiac output system. The plethysmographic variability index was measured using a Masimo Radical 7 co-oximeter. During the hepatic dissection phase of the surgery, repeated intraoperative fluid challenges with 10 mL kg-1 of crystalloid within 15 minutes were administered. Fluid responsiveness was defined as an increase in stroke volume index of ≥15% after fluid challenge.
Results:
A total of 61 fluid challenges were administered resulting in 15 fluid responders and 46 fluid nonresponders. Fluid challenge induced significant decreases in all three dynamic preload variables but not in the fluid nonresponders. However, the area under the receiver operating characteristic curves for pulse pressure variation, stroke volume variation, plethysmographic variability index, and central venous pressure for predicting fluid responsiveness were 0.67 (95% confidence interval: 0.52-0.82; P = .0255), 0.68 (95% confidence interval: 0.54-0.83; P = .0140), 0.56 (95% confidence interval: 0.40-0.71; P = .4724), and 0.57 (95% confidence interval: 0.40-0.74; P = .4192), respectively.
Conclusions:
Dynamic preload variables do not predict fluid responsiveness in pediatric patients with liver cirrhosis.
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