title: Prediction of fluid responsiveness in mechanically ventilated children undergoing neurosurgery.
abstract: BACKGROUND
  The purpose of this study was to evaluate the clinical usefulness of static and dynamic variables for the prediction of fluid responsiveness in children under general anaesthesia.
  
  
  METHODS
  Thirty-three mechanically ventilated children received 10 ml kg(-1) colloid for 10 min while stable during surgery. Arterial pressure, heart rate, central venous pressure (CVP), and pleth variability index (PVI), in addition to variation in systolic pressure, pulse pressure (including Δdown and Δup), respiratory aortic blood flow velocity (ΔVpeak), and inferior vena cava diameter were measured before and after volume expansion. Patients were classified as responders to fluid loading if their stroke volume index (SVI) increased by at least 10%.
  
  
  RESULTS
  There were 15 volume responders and 18 non-responders. Of the variables examined, ΔVpeak (r=0.516, P=0.004) and PVI (r=0.49, P=0.004) before volume expansion were significantly correlated with changes in SVI. The receiver-operating characteristic (ROC) curve analysis showed that PVI and ΔVpeak predicted fluid responsiveness. Areas under the ROC curves of PVI and ΔVpeak were statistically larger than that of CVP (P=0.006 and 0.014, respectively). However, those of other variables were similar to that of CVP.
  
  
  CONCLUSIONS
  ΔVpeak and PVI can be used to predict fluid responsiveness in mechanically ventilated children under general anaesthesia. The other static and dynamic variables assessed in this study were not found to predict fluid responsiveness significantly in children.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT01364103.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Byon
authors.forename: C-W
authors.initials: CW
authors.lastname: Lim
authors.forename: J-H
authors.initials: JH
authors.lastname: Lee
authors.forename: Y-H
authors.initials: YH
authors.lastname: Park
authors.forename: H-S
authors.initials: HS
authors.lastname: Kim
authors.forename: C-S
authors.initials: CS
authors.lastname: Kim
authors.forename: J-T
authors.initials: JT
authors.lastname: Kim
mesh_terms: D000768:Anesthesia, General; D062186:Arterial Pressure / Q000187:drug effects; D002496:Central Venous Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D003326:Coronary Circulation; D005260:Female; D005440:Fluid Therapy; D005544:Forecasting; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000379:methods*; D010991:Plethysmography; D012372:ROC Curve; D012121:Respiration, Artificial; D018401:Sample Size; D013318:Stroke Volume / Q000187:drug effects; D014682:Vena Cava, Inferior / Q000033:anatomy & histology