title: Respiratory variation in peak aortic velocity accurately predicts fluid responsiveness in children undergoing neurosurgery under general anesthesia.
abstract: The determination of fluid responsiveness in the critically ill child is of vital importance, more so as fluid overload becomes increasingly associated with worse outcomes. Dynamic markers of volume responsiveness have shown some promise in the pediatric population, but more research is needed before they can be adopted for widespread use. Our aim was to investigate effectiveness of respiratory variation in peak aortic velocity and pulse pressure variation to predict fluid responsiveness, and determine their optimal cutoff values. We performed a prospective, observational study at a single tertiary care pediatric center. Twenty-one children with normal cardiorespiratory status undergoing general anesthesia for neurosurgery were enrolled. Respiratory variation in peak aortic velocity (ΔVpeak ao) was measured both before and after volume expansion using a bedside ultrasound device. Pulse pressure variation (PPV) value was obtained from the bedside monitor. All patients received a 10 ml/kg fluid bolus as volume expansion, and were qualified as responders if stroke volume increased >15% as a result. Utility of ΔVpeak ao and PPV and to predict responsiveness to volume expansion was investigated. A baseline ΔVpeak ao value of greater than or equal to 12.3% best predicted a positive response to volume expansion, with a sensitivity of 77%, specificity of 89% and area under receiver operating characteristic curve of 0.90. PPV failed to demonstrate utility in this patient population. Respiratory variation in peak aortic velocity is a promising marker for optimization of perioperative fluid therapy in the pediatric population and can be accurately measured using bedside ultrasonography. More research is needed to evaluate the lack of effectiveness of pulse pressure variation for this purpose.
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of New Jersey, Newark Beth Israel Medical Center, 201 Lyons Avneue, Newark, NJ, USA. kavita.morparia@rwjbh.org.
authors.forename: Kavita G
authors.initials: KG
authors.lastname: Morparia
authors.affiliation: Division of Anesthesiology, Children's National Medical Center, George Washington University, NW, Washington, DC, USA.
authors.forename: Srijaya K
authors.initials: SK
authors.lastname: Reddy
authors.affiliation: Division of Cardiology, Children's National Medical Center, George Washington University, 111 Michigan Avenue NW, Washington, DC, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Olivieri
authors.affiliation: Division of Pediatric Critical Care Medicine, UVA Children's Hospital, University of Virginia, Charlottesville, VA, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Spaeder
authors.affiliation: Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Schuette
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General / Q000379:methods*; D001011:Aorta / Q000502:physiology*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004452:Echocardiography; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D016343:Monitoring, Intraoperative / Q000379:methods; D019635:Neurosurgical Procedures; D010372:Pediatrics / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012119:Respiration; D012121:Respiration, Artificial; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D062606:Tertiary Care Centers
keywords: Bedside ultrasound; Cardiopulmonary interaction; Echocardiography; Fluid responsiveness; Respiratory variation in aortic velocity