title: Predicting Fluid Responsiveness in Children Undergoing Cardiac Surgery After Cardiopulmonary Bypass.
abstract: Dynamic parameters of fluid responsiveness (FR), namely aortic blood flow velocity variation (delta Vpeak), left ventricular velocity-time integral variation (delta VTI), stroke volume variation, and pulse pressure variation (PPV) have demonstrated good diagnostic performance for the prediction of response to fluid loading in mechanically ventilated critically ill adult patients. We aimed to evaluate these parameters in children undergoing cardiac surgery. A retrospective observational study of mechanically ventilated patients weighing less than 20 kg who received a volume expansion (VE) of 10 ml/kg after sternal closure was conducted. A 10% cardiac index (CI) increase divided patients into 7 responders (R) and 9 non-responders (NR). Transesophageal echocardiography and Pressure Recording Analytical Method data were retrieved. The percentage CI increase was 18.6 (12)% in R and 2.9 (5.7)% in NR (p = 0.037). Prior to VE, delta Vpeak, delta VTI, PPV, and SPV differed between R and NR (p = 0.045, 0.043, 0.048, 0,037 and 0.044, respectively). Systolic (p = 0.004), diastolic (p = 0.002), mean blood pressure (p = 0.003), delta Vpeak(p = 0.03), delta VTI (p = 0.04), CI (p = 0.01), PPV (p = 0.04), SPV (p = 0.04), and dP/dtmax(maximal pressure-to-time ratio) (p = 0.02) changed the following VE in R patients. Delta Vpeakdecreased after VE in NR patients (p = 0.004). Delta VTI and PPV showed the highest predictive values, with area under receiver operator characteristic curves of 0.76 (p = 0.049) and 0.76 (p = 0.045), respectively. Delta VTI and PPV were revealed to be potential predictors of FR in ventilated children after cardiac surgery. Their combined evaluation could be useful for fluid management after sternal closure.
authors.affiliation: Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S.Onofrio 4, 00165, Rome, Italy. isabella.favia@gmail.com.
authors.forename: Isabella
authors.identifier: http://orcid.org/0000-0003-0186-8568
authors.initials: I
authors.lastname: Favia
authors.affiliation: Department of Health Science, University of Florence, Florence, Italy.|Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Largo G. Alessandro Brambilla 3, 50134, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Romagnoli
authors.affiliation: Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S.Onofrio 4, 00165, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Di Chiara
authors.affiliation: Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S.Onofrio 4, 00165, Rome, Italy.
authors.forename: Zaccaria
authors.initials: Z
authors.lastname: Ricci
mesh_terms: D001783:Blood Flow Velocity; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005440:Fluid Therapy; D006330:Heart Defects, Congenital / Q000503:physiopathology* / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left
keywords: Cardiac surgery; Children; Echocardiography; Fluid responsiveness