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Assessment of fluid responsiveness in children using respiratory variations in descending aortic flow
Jacob Karlsson1,2, Eric Peters3, André Denault4
1Department of Anesthesia, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
Insights
Respiratory variations in descending aortic flow (ΔVpeak dAo) can predict fluid responsiveness in mechanically ventilated children. However, variations in peak left ventricular outflow tract flow (ΔVpeak LVOT) did not show predictive ability in this study.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular physiology
- Echocardiography
Background:
- Fluid responsiveness assessment is crucial in mechanically ventilated children.
- Predicting fluid responsiveness aids in optimizing hemodynamic management.
- Non-invasive methods for fluid responsiveness prediction are highly sought after.
Purpose of the Study:
- To evaluate the efficacy of respiratory variations in descending aortic flow (ΔVpeak dAo) in predicting fluid responsiveness.
- To assess the predictive value of variations in peak left ventricular outflow tract flow (ΔVpeak LVOT) for fluid responsiveness.
Main Methods:
- A prospective observational study involving 27 anesthetized, mechanically ventilated children.
- Measurements of cardiac output, ΔVpeak dAo, and ΔVpeak LVOT before and after a fluid bolus.
- Classification of patients as responders (stroke volume index increase >15%) or non-responders.
- Analysis using receiver operating characteristic (ROC) curves to determine predictive ability.
Main Results:
- ΔVpeak dAo was significantly higher in responders (14%) versus non-responders (11%) at baseline (p=0.04).
- The area under the ROC curve for ΔVpeak dAo was 0.73 (p=0.02), indicating moderate predictive power.
- ΔVpeak LVOT showed no significant predictive ability (area under ROC curve = 0.56, p=0.3).
Conclusions:
- ΔVpeak dAo demonstrates moderate diagnostic power for identifying fluid responders in mechanically ventilated children.
- ΔVpeak LVOT is not a reliable predictor of fluid responsiveness in this population.
- Respiratory variations in descending aortic flow show promise as a non-invasive tool for hemodynamic management in pediatric critical care.
Background:
The primary aim of the current study was to investigate the ability of respiratory variations in descending aortic flow, measured with two-dimensional echo at the suprasternal notch (ΔVpeak dAo), to predict fluid responsiveness in anesthetized mechanically ventilated children. In addition, variations in peak descending aortic flow measured with apical transthoracic echo (ΔVpeak LVOT) were examined for the same properties.
Methods:
Twenty-seven patients under general anesthesia were investigated in this prospective observational study. Cardiac output, ΔVpeak dAo, and ΔVpeak LVOT were measured at stable conditions after anesthesia induction. The measurements were repeated after a 10 mL kg-1 fluid bolus. Patients were classified as responders if stroke volume index increased by >15% after fluid bolus. The ability of each parameter to predict fluid responsiveness was assessed using receiver operating characteristic curves.
Results:
Twenty-seven patients were analyzed, mean age and weight 43 months and 16 kg, respectively. Twelve responders and 15 non-responders were identified. ΔVpeak dAo was significantly higher in the responder group (14%, 95% confidence interval [CI]: 12%-17%) compared to the non-responder group (11%, 95% CI: 9%-13%) (p = .04) at baseline. Area under the ROC curve for ΔVpeak dAo and ΔVpeak LVOT was 0.73 (95% CI: 0.52-0.89, p = .02) and 0.56 (0.34-0.78, p = .3), respectively. A baseline level of ΔVpeak dAo of >14% predicted fluid responsiveness with a sensitivity of 58% (95% CI: 28%-85%) and specificity of 73% (95% CI: 45%-92%).
Conclusion:
In mechanically ventilated children, ΔVpeak dAo identified fluid responders with moderate diagnostic power in the current study. ΔVpeak LVOT failed to predict fluid responders in the current study.
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