title: Comparison of positive end-expiratory pressure-induced increase in central venous pressure and passive leg raising to predict fluid responsiveness in patients with atrial fibrillation.
abstract: BACKGROUND
  Positive end-expiratory pressure (PEEP)-induced increase in central venous pressure (CVP) has been suggested to be a robust indicator of fluid responsiveness, with heart rhythm having minimal influence. We compared the ability of PEEP-induced changes in CVP with passive leg raising (PLR)-induced changes in stroke volume index (SVI) in patients with atrial fibrillation after valvular heart surgery.
  
  
  METHODS
  In 43 patients with atrial fibrillation after cardiac surgery, PEEP was increased from 0 to 10 cm H2O for 5 min and changes in CVP were assessed. After returning the PEEP to 0 cm H2O, PLR was performed for 5 min and changes in SVI were recorded. Finally, 300 ml of colloid was infused and haemodynamic variables were assessed 5 min after completion of a fluid challenge. Fluid responsiveness was defined as an increase in SVI ≥10% measured by a pulmonary artery catheter.
  
  
  RESULTS
  Fifteen (35%) patients were fluid responders. There was no correlation between PEEP-induced increases in CVP and changes in SVI after a fluid challenge (β coefficient -0.052, P=0.740), whereas changes in SVI during PLR showed a significant correlation (β coefficient 0.713, P<0.001). The area under the receiver operating characteristic curve of the PEEP-induced increase in CVP and changes in SVI during PLR for fluid responsiveness was 0.556 [95% confidence interval (CI) 0.358-0.753, P=0.549) and 0.771 (95% CI 0.619-0.924, P=0.004), respectively.
  
  
  CONCLUSIONS
  A PEEP-induced increase in CVP did not predict fluid responsiveness in patients with atrial fibrillation after cardiac surgery, but increases in SVI during PLR seem to be a valid predictor of fluid responsiveness in this subset of patients.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: N
authors.initials: N
authors.lastname: Kim
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: J-K
authors.initials: JK
authors.lastname: Shim
authors.affiliation: Department of Anaesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Republic of Korea.
authors.forename: H G
authors.initials: HG
authors.lastname: Choi
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: M K
authors.initials: MK
authors.lastname: Kim
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: J Y
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea ylkwak@yuhs.ac.
authors.forename: Y-L
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D002302:Cardiac Output / Q000502:physiology; D002496:Central Venous Pressure / Q000502:physiology*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011187:Posture / Q000502:physiology*; D012372:ROC Curve; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
keywords: atrial fibrillation; central venous pressure; fluid responsiveness; passive leg raising; positive end-expiratory pressure