Splenic Doppler Resistive Index Variation Mirrors Cardiac Responsiveness and Systemic Hemodynamics upon Fluid Challenge Resuscitation in Postoperative Mechanically Ventilated Patients

Claudia Brusasco, Guido Tavazzi, Chiara Robba, Gregorio Santori, Antonella Vezzani, Tullio Manca, Francesco Corradi

Research output: Contribution to journalArticle

Abstract

Objective: To test if splenic Doppler resistive index (SDRI) allows noninvasive monitoring of changes in stroke volume and regional splanchnic perfusion in response to fluid challenge. Design and Setting. Prospective observational study in cardiac intensive care unit.

Patients: Fifty-three patients requiring mechanical ventilation and fluid challenge for hemodynamic optimization after cardiac surgery.

Interventions: SDRI values were obtained before and after volume loading with 500 mL of normal saline over 20 min and compared with changes in systemic hemodynamics, determined invasively by pulmonary artery catheter, and arterial lactate concentration as expression of splanchnic perfusion. Changes in stroke volume >10% were considered representative of fluid responsiveness.

Results: A <4% SDRI reduction excluded fluid responsiveness, with 100% sensitivity and 100% negative predictive value. A >9% SDRI reduction was a marker of fluid responsiveness with 100% specificity and 100% positive predictive value. A >4% SDRI reduction was always associated with an improvement of splanchnic perfusion mirrored by an increase in lactate clearance and a reduction in systemic vascular resistance, regardless of fluid responsiveness.

Conclusions: This study shows that SDRI variations after fluid administration is an effective noninvasive tool to monitor systemic hemodynamics and splanchnic perfusion upon volume administration, irrespective of fluid responsiveness in mechanically ventilated patients after cardiac surgery.

Original languageEnglish
Pages (from-to)1978968
JournalBioMed Research International
Volume2018
DOIs
Publication statusPublished - 2018

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Resuscitation
Viscera
Hemodynamics
Mirrors
Perfusion
Fluids
Stroke Volume
Thoracic Surgery
Lactic Acid
Surgery
Artificial Respiration
Vascular Resistance
Pulmonary Artery
Observational Studies
Intensive Care Units
Catheters
Intensive care units
Prospective Studies
Monitoring

Keywords

  • Aged
  • Aged, 80 and over
  • Female
  • Fluid Therapy
  • Hemodynamics
  • Humans
  • Male
  • Prospective Studies
  • Respiration, Artificial
  • Stroke Volume

Cite this

Splenic Doppler Resistive Index Variation Mirrors Cardiac Responsiveness and Systemic Hemodynamics upon Fluid Challenge Resuscitation in Postoperative Mechanically Ventilated Patients. / Brusasco, Claudia; Tavazzi, Guido; Robba, Chiara; Santori, Gregorio; Vezzani, Antonella; Manca, Tullio; Corradi, Francesco.

In: BioMed Research International, Vol. 2018, 2018, p. 1978968.

Research output: Contribution to journalArticle

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abstract = "Objective: To test if splenic Doppler resistive index (SDRI) allows noninvasive monitoring of changes in stroke volume and regional splanchnic perfusion in response to fluid challenge. Design and Setting. Prospective observational study in cardiac intensive care unit.Patients: Fifty-three patients requiring mechanical ventilation and fluid challenge for hemodynamic optimization after cardiac surgery.Interventions: SDRI values were obtained before and after volume loading with 500 mL of normal saline over 20 min and compared with changes in systemic hemodynamics, determined invasively by pulmonary artery catheter, and arterial lactate concentration as expression of splanchnic perfusion. Changes in stroke volume >10{\%} were considered representative of fluid responsiveness.Results: A <4{\%} SDRI reduction excluded fluid responsiveness, with 100{\%} sensitivity and 100{\%} negative predictive value. A >9{\%} SDRI reduction was a marker of fluid responsiveness with 100{\%} specificity and 100{\%} positive predictive value. A >4{\%} SDRI reduction was always associated with an improvement of splanchnic perfusion mirrored by an increase in lactate clearance and a reduction in systemic vascular resistance, regardless of fluid responsiveness.Conclusions: This study shows that SDRI variations after fluid administration is an effective noninvasive tool to monitor systemic hemodynamics and splanchnic perfusion upon volume administration, irrespective of fluid responsiveness in mechanically ventilated patients after cardiac surgery.",
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AU - Tavazzi, Guido

AU - Robba, Chiara

AU - Santori, Gregorio

AU - Vezzani, Antonella

AU - Manca, Tullio

AU - Corradi, Francesco

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N2 - Objective: To test if splenic Doppler resistive index (SDRI) allows noninvasive monitoring of changes in stroke volume and regional splanchnic perfusion in response to fluid challenge. Design and Setting. Prospective observational study in cardiac intensive care unit.Patients: Fifty-three patients requiring mechanical ventilation and fluid challenge for hemodynamic optimization after cardiac surgery.Interventions: SDRI values were obtained before and after volume loading with 500 mL of normal saline over 20 min and compared with changes in systemic hemodynamics, determined invasively by pulmonary artery catheter, and arterial lactate concentration as expression of splanchnic perfusion. Changes in stroke volume >10% were considered representative of fluid responsiveness.Results: A <4% SDRI reduction excluded fluid responsiveness, with 100% sensitivity and 100% negative predictive value. A >9% SDRI reduction was a marker of fluid responsiveness with 100% specificity and 100% positive predictive value. A >4% SDRI reduction was always associated with an improvement of splanchnic perfusion mirrored by an increase in lactate clearance and a reduction in systemic vascular resistance, regardless of fluid responsiveness.Conclusions: This study shows that SDRI variations after fluid administration is an effective noninvasive tool to monitor systemic hemodynamics and splanchnic perfusion upon volume administration, irrespective of fluid responsiveness in mechanically ventilated patients after cardiac surgery.

AB - Objective: To test if splenic Doppler resistive index (SDRI) allows noninvasive monitoring of changes in stroke volume and regional splanchnic perfusion in response to fluid challenge. Design and Setting. Prospective observational study in cardiac intensive care unit.Patients: Fifty-three patients requiring mechanical ventilation and fluid challenge for hemodynamic optimization after cardiac surgery.Interventions: SDRI values were obtained before and after volume loading with 500 mL of normal saline over 20 min and compared with changes in systemic hemodynamics, determined invasively by pulmonary artery catheter, and arterial lactate concentration as expression of splanchnic perfusion. Changes in stroke volume >10% were considered representative of fluid responsiveness.Results: A <4% SDRI reduction excluded fluid responsiveness, with 100% sensitivity and 100% negative predictive value. A >9% SDRI reduction was a marker of fluid responsiveness with 100% specificity and 100% positive predictive value. A >4% SDRI reduction was always associated with an improvement of splanchnic perfusion mirrored by an increase in lactate clearance and a reduction in systemic vascular resistance, regardless of fluid responsiveness.Conclusions: This study shows that SDRI variations after fluid administration is an effective noninvasive tool to monitor systemic hemodynamics and splanchnic perfusion upon volume administration, irrespective of fluid responsiveness in mechanically ventilated patients after cardiac surgery.

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KW - Hemodynamics

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KW - Respiration, Artificial

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