THE ROLE OF ULTRASONIC CARDIAC OUTPUT MONITOR IN EVALUATING STROKE VOLUME VARIATION TO DETERMINE FLUID RESPONSIVENESS...

Area of Science:

• Critical Care Medicine
• Cardiovascular Physiology
• Medical Devices

Background:

• Dynamic assessment tools like passive leg raise (PLR), stroke volume variation (SVV), and pulse pressure variation (PPV) are crucial for predicting fluid responsiveness in shock.
• The ultrasonic cardiac output monitor (USCOM) 1A device offers a non-invasive method for assessing cardiac output (CO) and SVV.

Purpose of the Study:

• To evaluate the reliability of CO and SVV readings from the USCOM 1A device compared to pulse pressure variation (PPV) in predicting fluid responsiveness in shock patients.
• To assess the diagnostic accuracy of USCOM-derived SVV for fluid responsiveness.

Main Methods:

• A study involving 92 intubated and mechanically ventilated shock patients aged 18-95.
• Fluid responsiveness assessed using PPV from arterial monitoring and CO/SVV via the USCOM 1A device, with data recorded before and after PLR.
• Statistical analysis included Cronbach's alpha, kappa agreement, correlation coefficients, and AUC for SVV compared to PPV.

Main Results:

• The USCOM-derived SVV index demonstrated high sensitivity (85%) and specificity (96%) for identifying fluid responsiveness.
• Substantial agreement was found between USCOM SVV and PPV (Cronbach's alpha: 0.718, kappa: 0.707).
• A moderate correlation (R=0.588) and an AUC of 0.797 for SVV in predicting fluid responsiveness were observed.

Conclusions:

• SVV measured by the USCOM device is a reliable and practical tool for hemodynamic assessment in clinical practice.
• The USCOM 1A device provides a valuable non-invasive alternative for assessing fluid responsiveness, especially when invasive methods are not suitable.