Right ventricular end-diastolic volume in the postoperative care of cardiac surgery patients: a marker of the hemodynamic response to a fluid challenge.
BACKGROUND
This study evaluated the right ventricular end-diastolic volume index (RVEDVI) as a marker of the hemodynamic response to a fluid challenge in the postoperative care of cardiac surgery patients.


RESULTS
Continuous RVEDVI and other hemodynamic parameters were analyzed during and after 17 fluid challenges with 480-500 ml colloids (5% albumin, fresh frozen plasma or 6% hydroxyethyl starch) given over 30-60 min following cardiac surgery. Changes in stroke volume index (SVI) were assessed to indicate fluid responsiveness. Responders were defined as those who experienced a 10% or greater increase in SVI. Fluid challenges with simultaneous changing of vasoactive agents were excluded. Linear regression analysis between the percentage change in SVI and baseline RVEDVI revealed a statistically significant but weak correlation (r(2)=0.249; p=0.041). Although the baseline RVEDVI was higher in non-responders than in responders (112.4+/-6.1 vs 104.4+/-5.8 ml/m(2); p=0.05), there was a marked overlap of baseline RVEDVI values, which did not allow identification of the threshold value of RVEDVI discriminating responders.


CONCLUSIONS
After cardiac surgery, RVEDVI reflected fluid responsiveness only to a limited degree. Patients should not be resuscitated to an absolute RVEDVI alone and empirical fluid challenge should still be required.
Tokuda
Yoshiyuki
Y
Department of Cardiovascular Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan. tokuda@mxb.mesh.ne.jp
Song
Min-Ho
MH
Mabuchi
Norifumi
N
Usui
Akihiko
A
Ueda
Yuichi
Y
D015415:Biomarkers; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D013318:Stroke Volume; D016278:Ventricular Function, Right; D014882:Water-Electrolyte Balance
D015415:Biomarkers