title: Comparison of stroke volume and fluid responsiveness measurements in commonly used technologies for goal-directed therapy.
abstract: OBJECTIVE
  To compare stroke volume (SV) and preload responsiveness measurements from different technologies with the esophageal Doppler monitor (EDM).
  
  
  METHODS
  Prospective measurement study.
  
  
  METHODS
  Operating room.
  
  
  METHODS
  20 ASA physical status 3 patients undergoing vascular, major urological, and bariatric surgery.
  
  
  METHODS
  Subjects received fluids using a standard Doppler protocol of 250 mL of colloid administered until SV no longer increased by >10%, and again when the measured SV decreased by 10%.
  
  
  METHODS
  Simultaneous readings of SV, stroke volume variation (SVV) and pulse pressure variation (PPV) from the LiDCOrapid, and SVV from the FloTrac/Vigileo were compared with EDM measurements. The pleth variability index (PVI) also was recorded.
  
  
  RESULTS
  No correlation was seen in percentage SV change as measured by either the LiDCOrapid (r=0.05, P=0.616) or FloTrac (r=0.09, P= 0.363) systems compared with the EDM. Correlation was present between the LiDCOrapid and FloTrac (r=0.515, P<0.0001). Percentage error compared with the EDM was 81% for the FloTrac and 90% for the LiDCOrapid. SVV as measured by LiDCOrapid differed for fluid responders and nonresponders (10% vs 7%; P=0.021). Receiver operator curve analysis to predict a 10% increase in SV from the measured variables showed an area under the curve of 0.57 (95% CI 0.43-0.72) for SVV(FloTrac), 0.64 (95% CI 0.52-0.78) for SVV(LiDCO), 0.61 (95% CI 0.46 -0.76) for PPV, and 0.59 (95% CI 0.46 -0.71) for PVI.
  
  
  CONCLUSIONS
  Stroke volume as measured by the FloTrac and LiDCOrapid systems does not correlate with the esphageal Doppler, has poor concordance, and a clinically unacceptable percentage error. The predictive value of the fluid responsiveness parameters is low, with only SVV measured by the LiDCOrapid having clinical utility.
authors: Department of Anaesthesia, York Hospital, NHS Foundation Trust, Wigginton Rd., York YO31 8HE, UK. Electronic address: simon.davies@york.nhs.uk.
authors: Simon J
authors: SJ
authors: Davies
authors: Simran
authors: S
authors: Minhas
authors: R Jonathan T
authors: RJ
authors: Wilson
authors: David
authors: D
authors: Yates
authors: Simon J
authors: SJ
authors: Howell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015150:Echocardiography, Doppler / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D013318:Stroke Volume / Q000502:physiology*
keywords: Cardiac output; Fluid optimization; Monitoring; Preload responsiveness; Pulse contour analysis