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Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge
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Dynamic variables to predict fluid responsiveness in young children.

Ya-Fei Liu1, Lin-Lin Song1, Wei Ma2

  • 1Department of Anesthesiology, Peking University First Hospital, Beijing, China.

Pediatrics International : Official Journal of the Japan Pediatric Society
|January 18, 2023
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Summary

Dynamic variables like respiratory variation in aortic blood flow peak velocity (∆Vpeak) and plethysmographic variability index (PVI) reliably predict fluid responsiveness in young children undergoing neurosurgery.

Keywords:
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Area of Science:

  • Pediatric Anesthesiology
  • Critical Care Medicine
  • Hemodynamic Monitoring

Background:

  • Assessing fluid responsiveness in young children undergoing major neurosurgery is challenging due to limited and conflicting evidence.
  • Dynamic variables are increasingly used to guide fluid therapy, but their reliability in pediatric populations requires further investigation.

Purpose of the Study:

  • To evaluate the predictive accuracy of dynamic hemodynamic variables for fluid responsiveness in pediatric patients undergoing major neurosurgery.
  • To compare the reliability of volume-based (∆Vpeak, PVI) versus pressure-based (SVV, Eadyn, PPV) indices in predicting fluid responsiveness.

Main Methods:

  • Sixty pediatric patients (1-3 years) undergoing major neurosurgery received a fluid bolus (10 mL/kg Ringer's solution).
  • Dynamic variables including ∆Vpeak, PVI, SVV, Eadyn, and PPV were measured before and after fluid loading.
  • Fluid responders were defined as those with a ≥10% increase in cardiac index (CI) post-fluid administration.

Main Results:

  • Twenty-six patients (43.3%) were identified as fluid responders.
  • Baseline ∆Vpeak demonstrated excellent predictive accuracy for CI increase (AUROC 0.982), with a cutoff of 9.6%.
  • PVI showed fair accuracy (AUROC 0.775, cutoff 15%), while SVV, Eadyn, and PPV were poor predictors.

Conclusions:

  • Volume-based indices, specifically ∆Vpeak and PVI, are reliable predictors of fluid responsiveness in young children undergoing major neurosurgery.
  • Pressure-based indices (SVV, Eadyn, PPV) lack predictive value in this specific pediatric population.
  • These findings support the use of ∆Vpeak and PVI for guiding fluid management in pediatric neurosurgery patients.