title: Dynamic variables of fluid responsiveness during pneumoperitoneum and laparoscopic surgery.
abstract: BACKGROUND
  Few data exist on dynamic variables predicting fluid responsiveness during laparoscopic surgery. The aim of this study was to explore the effects of laparoscopy on four dynamic variables: respiratory variations in pulse pressure (ΔPP), stroke volume variation by Vigileo/FloTrac (SVV (Vigileo) ), pleth variability index (PVI) and respiratory variations in pulse oximetry plethysmography waveform amplitude (ΔPOP), and their relation to fluid challenges during laparoscopic surgery.
  
  
  METHODS
  ΔPP, SVV (Vigileo) , PVI and ΔPOP were studied in 20 adult patients before and during pneumoperitoneum (10-12 mmHg). During ongoing laparoscopic surgery, relations between the dynamic variables and changes in stroke volume oesophageal Doppler, (SV(OD) ) after fluid challenges (250 ml colloid) were evaluated.
  
  
  RESULTS
  Pneumoperitoneum changed the dynamic variables as follows {mean [95% confidence interval (CI)]}: ΔPP 0.5 (-1.3, 2.3)%, P = 0.53; SVV (Vigileo) 0.6 (-1.3, 2.5)%, P = 0.52; PVI 2.9 (0.4, 5.3)%, P = 0.025. For ΔPOP, median difference (95% CI) was 2.5 (-0.15, 6.7)%, P = 0.058. During laparoscopic surgery, areas under receiver operating characteristics curves (95% CI) were ΔPP 0.53 (0.31-0.75), SVV (Vigileo) 0.74 (0.51-0.90), PVI 0.61 (0.38-0.81), ΔPOP 0.63 (0.40-0.82). Correlation coefficients (P-values) between changes in dynamic variables and changes in SV(OD) were ΔPP r = -0.65, P = 0.009; SVV (Vigileo) r = -0.73, P = 0.002; PVI r = -0.22, P = 0.44; ΔPOP r = -0.32, P = 0.24.
  
  
  CONCLUSIONS
  ΔPP and SVV (Vigileo) did not change as pneumoperitoneum was established, whereas PVI increased and ΔPOP tended to increase. All four dynamic variables predicted fluid responsiveness relatively poor during ongoing laparoscopic surgery. ΔPP and SVV (Vigileo) tracked changes in stroke volume induced by fluid challenges during ongoing laparascopic surgery, whereas ΔPOP and PVI did not.
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway. lars.oivind.hoiseth@hotmail.com
authors.forename: L Ø
authors.initials: LØ
authors.lastname: Høiseth
authors.forename: I E
authors.initials: IE
authors.lastname: Hoff
authors.forename: K
authors.initials: K
authors.lastname: Myre
authors.forename: S A
authors.initials: SA
authors.lastname: Landsverk
authors.forename: K A
authors.initials: KA
authors.lastname: Kirkebøen
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000379:methods; D019540:Area Under Curve; D001794:Blood Pressure / Q000502:physiology; D002496:Central Venous Pressure / Q000502:physiology; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D018475:Head-Down Tilt; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010991:Plethysmography; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D012372:ROC Curve; D015656:Respiratory Mechanics / Q000502:physiology; D018401:Sample Size; D012815:Signal Processing, Computer-Assisted; D013318:Stroke Volume / Q000502:physiology