title: Dynamic and volumetric variables reliably predict fluid responsiveness in a porcine model with pleural effusion.
abstract: BACKGROUND
  The ability of stroke volume variation (SVV), pulse pressure variation (PPV) and global end-diastolic volume (GEDV) for prediction of fluid responsiveness in presence of pleural effusion is unknown. The aim of the present study was to challenge the ability of SVV, PPV and GEDV to predict fluid responsiveness in a porcine model with pleural effusions.
  
  
  METHODS
  Pigs were studied at baseline and after fluid loading with 8 ml kg(-1) 6% hydroxyethyl starch. After withdrawal of 8 ml kg(-1) blood and induction of pleural effusion up to 50 ml kg(-1) on either side, measurements at baseline and after fluid loading were repeated. Cardiac output, stroke volume, central venous pressure (CVP) and pulmonary occlusion pressure (PAOP) were obtained by pulmonary thermodilution, whereas GEDV was determined by transpulmonary thermodilution. SVV and PPV were monitored continuously by pulse contour analysis.
  
  
  RESULTS
  Pleural effusion was associated with significant changes in lung compliance, peak airway pressure and stroke volume in both responders and non-responders. At baseline, SVV, PPV and GEDV reliably predicted fluid responsiveness (area under the curve 0.85 (p<0.001), 0.88 (p<0.001), 0.77 (p = 0.007). After induction of pleural effusion the ability of SVV, PPV and GEDV to predict fluid responsiveness was well preserved and also PAOP was predictive. Threshold values for SVV and PPV increased in presence of pleural effusion.
  
  
  CONCLUSIONS
  In this porcine model, bilateral pleural effusion did not affect the ability of SVV, PPV and GEDV to predict fluid responsiveness.
authors: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schleswig-Holstein, Germany. ole.broch@uksh.de
authors: Ole
authors: O
authors: Broch
authors: Matthias
authors: M
authors: Gruenewald
authors: Jochen
authors: J
authors: Renner
authors: Patrick
authors: P
authors: Meybohm
authors: Jan
authors: J
authors: Schöttler
authors: Katharina
authors: K
authors: Heß
authors: Markus
authors: M
authors: Steinfath
authors: Berthold
authors: B
authors: Bein
mesh_terms: D000818:Animals; D002302:Cardiac Output / Q000502:physiology*; D002496:Central Venous Pressure / Q000502:physiology*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006895:Hydroxyethyl Starch Derivatives; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010996:Pleural Effusion / Q000139:chemically induced / Q000503:physiopathology*; D011651:Pulmonary Artery / Q000503:physiopathology; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000502:physiology*; D013552:Swine; D013815:Thermodilution / Q000379:methods
chemical_list: D006895:Hydroxyethyl Starch Derivatives