Stroke output variations calculated by esophageal Doppler is a reliable predictor of fluid response.
OBJECTIVE
Esophageal Doppler allows continuous monitoring of stroke volume index (SVI) and corrected flow time (FTc). We hypothesized that variations in stroke output index SOI (SVI/FTc) during volume expansion can predict the hemodynamic response to subsequent fluid loading better than the static values.


METHODS
Prospective study in the intensive care unit of a university hospital.


METHODS
Fifty-one patients with circulatory failure were monitored by esophageal Doppler.


METHODS
Patients who responded to a first fluid challenge received a second one. Patients who responded to both were classified as responders-responders, and those who did not respond to the second as responders-nonresponders. In these two groups we compared DeltaSVI, DeltaFTc, and DeltaSOI during each fluid challenge and also static values at the end of each fluid challenge.


RESULTS
After the first fluid challenge DeltaSOI and DeltaSVI were significantly higher in patients who responded to subsequent volume expansion than in patients who no longer responded. ROC curves showed that DeltaSOI was a better predictor of fluid responsiveness than DeltaSVI. During volume expansion a DeltaSOI value of 11% discriminated between responders and nonresponders to subsequent volume expansion with a sensitivity of 91% and a specificity of 97%. There was no significant difference between the two groups for FTc value at the end of first fluid challenge.


CONCLUSIONS
Analysis of DeltaSOI during fluid challenge predicts response to subsequent fluid challenge and FTc is not a reliable indicator of cardiac preload.
Vallée
Fabrice
F
Anesthesia and Intensive Care Unit Department, Purpan University Hospital, Place du Dr Baylac, Toulouse Cedex 9, France.
Fourcade
Olivier
O
De Soyres
Olivier
O
Angles
Olivier
O
Sanchez-Verlaan
Pascale
P
Pillard
Fabien
F
Smail
Nadia
N
Olivier
Michel
M
Genestal
Michèle
M
Samii
Kamran
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011097:Polygeline / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D012769:Shock / Q000145:classification / Q000628:therapy*; D013318:Stroke Volume
D010952:Plasma Substitutes; D011097:Polygeline