Tidal volume challenge-induced hemodynamic changes can predict fluid responsiveness during one-lung ventilation: an...

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Cardiovascular Physiology

Background:

• One-lung ventilation (OLV) presents unique hemodynamic challenges.
• Predicting fluid responsiveness is crucial for optimizing hemodynamics during OLV.

Purpose of the Study:

• To assess the efficacy of tidal volume challenge (VTC)-induced hemodynamic changes in predicting fluid responsiveness.
• To evaluate the predictive capability of stroke volume (SV) and velocity time integral (VTI) changes during VTC.

Main Methods:

• 80 patients undergoing OLV for thoracoscopic surgery were enrolled.
• Hemodynamic variables including LVOT diameter, aortic VTI, and SV were monitored.
• Changes in SV, VTI, and mean arterial pressure (MAP) were calculated during VTC (5 to 8 mL/kg).
• Fluid responsiveness was defined as an increase in SV ≥10% after fluid administration.

Main Results:

• 58 patients were analyzed, with 32 responders (55%) and 26 nonresponders (45%).
• The area under the curve (AUC) for ΔSV-VTC was 0.81 and for ΔVTI-VTC was 0.79.
• Optimal thresholds were -16.1% for ΔSV-VTC (sensitivity 78.1%, specificity 84.6%) and -14.5% for ΔVTI-VTC (sensitivity 78.1%, specificity 80.8%).

Conclusions:

• Tidal volume challenge-induced changes in SV and VTI are reliable predictors of fluid responsiveness during OLV.
• This method aids in guiding fluid management in patients undergoing OLV.