title: Predicting fluid responsiveness in mechanically ventilated children under general anaesthesia using dynamic parameters and transthoracic echocardiography.
abstract: BACKGROUND
  Dynamic variables are accurate predictors of fluid responsiveness in adults undergoing mechanical ventilation. They can be determined using respiratory variation in aortic flow peak velocity (▵Vpeak), arterial pulse pressure [▵PP and pulse pressure variation (PPV)], or plethysmographic waveform amplitude [▵POP and pleth variability index (PVI)]. These indices have not been validated in children. We studied the ability of these variables to predict fluid responsiveness in mechanically ventilated children.
  
  
  METHODS
  All results are expressed as median [median absolute deviation (MAD)]. Thirty mechanically ventilated children were studied after undergoing general anaesthesia. Mechanical ventilation was maintained with a tidal volume of 10 ml kg(-1) of body weight. ▵PP, PPV, ▵POP, PVI, ▵Vpeak, and aortic velocity-time integral were recorded before and after volume expansion (VE). Patients were considered to be responders to VE when the aortic velocity-time integral increased more than 15% after VE.
  
  
  RESULTS
  VE induced significant changes in ▵PP [13 (MAD 4) to 9 (5)%], PPV [15 (5) to 9 (5)%], ▵POP [15 (10) to 10 (6)%], PVI [13 (6) to 8 (5)%], and ▵Vpeak [16 (9) to 8 (3)%] (P<0.05 for all). Differences in ▵PP, ▵POP, PPV, and PVI did not reach statistical significance. Only ▵Vpeak was significantly different between responders (R) and non-responders (NR) to VE [22 (3) vs 7 (1)%, respectively; P<0.001]. The threshold ▵Vpeak value of 10% allowed discrimination between R and NR.
  
  
  CONCLUSIONS
  In this study, ▵Vpeak was the most appropriate variable to predict fluid responsiveness.
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Est, Hôpital Neurologique Pierre Wertheimer, Service d' Anesthésie Réanimation, 59 boulevard Pinel, 69677 Bron, Cedex, France. edmundo.pereira-de-souza-neto@chu-lyon.fr
authors.forename: E
authors.initials: E
authors.lastname: Pereira de Souza Neto
authors.forename: S
authors.initials: S
authors.lastname: Grousson
authors.forename: F
authors.initials: F
authors.lastname: Duflo
authors.forename: C
authors.initials: C
authors.lastname: Ducreux
authors.forename: H
authors.initials: H
authors.lastname: Joly
authors.forename: J
authors.initials: J
authors.lastname: Convert
authors.forename: C
authors.initials: C
authors.lastname: Mottolese
authors.forename: F
authors.initials: F
authors.lastname: Dailler
authors.forename: M
authors.initials: M
authors.lastname: Cannesson
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General / Q000379:methods*; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D010991:Plethysmography / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods*; D014463:Ultrasonography