title: Using extra systoles to predict fluid responsiveness in cardiothoracic critical care patients.
abstract: Fluid responsiveness prediction is an unsettled matter for most critical care patients and new methods relying only on the continuous basic monitoring are desired. It was hypothesized that the post-ectopic beat, which is associated with increased preload, could be analyzed in relation to preceding sinus beats and that the change in cardiac performance (e.g. systolic blood pressure) at the post-ectopic beat could predict fluid responsiveness. Cardiothoracic critical care patients scheduled for a 500 ml volume expansion were observed. In the 30 min prior to volume expansion, the ECG was analyzed for occurrence of extra systoles preceded by at least 10 sinus beats. Classification variables, were defined as the change in a variable (e.g. systolic blood pressure or pre-ejection period) from the median of 10 preceding sinus beats to extra systolic post-ectopic beat. A stroke volume increase >15 % following volume expansion defined fluid responsiveness. Thirty patients were included. The change in systolic blood pressure predicted fluid responsiveness in 24 patients correctly with 83 % specificity and 75 % sensitivity (optimal threshold: 5 % systolic blood pressure increase), receiver operating characteristic (ROC) area: 0.81 (CI [0.64;0.98]). The change in pre-ejection period predicted fluid responsiveness in 22 patients correctly with 67 % specificity and 83 % sensitivity (optimal threshold: 19 ms pre-ejection period decrease), ROC area: 0.81 (CI [0.66;0.96]). Pulse pressure variation had ROC area of 0.57 (CI [0.39;0.75]). Based on standard critical care monitoring, analysis of the extra systolic post-ectopic beat predicts fluid responsiveness in cardiothoracic critical care patients with good accuracy.
authors.affiliation: Research Centre for Emergency Medicine, Aarhus University, Nørrebrogade 44, Building 30, 1st floor, 8000, Aarhus C, Denmark. vistisen@clin.au.dk.
authors.forename: Simon Tilma
authors.identifier: http://orcid.org/0000-0002-1297-1459
authors.initials: ST
authors.lastname: Vistisen
mesh_terms: D000368:Aged; D001795:Blood Pressure Determination; D002302:Cardiac Output; D006348:Cardiac Surgical Procedures; D002496:Central Venous Pressure; D015331:Cohort Studies; D003422:Critical Care; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012372:ROC Curve; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors
keywords: Cardiac output; Cardiac surgery; Fluid responsiveness; Fluid therapy; Stroke volume; Volume responsiveness