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Open Access Research

Neither dynamic, static, nor volumetric variables can accurately predict fluid responsiveness early after abdominothoracic esophagectomy

Hironori Ishihara*, Eiji Hashiba, Hirobumi Okawa, Junichi Saito, Toshinori Kasai and Toshihito Tsubo

Author Affiliations

Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki-Shi 036-8562, Japan

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Perioperative Medicine 2013, 2:3  doi:10.1186/2047-0525-2-3

Published: 22 February 2013

Abstract

Background

Hypotension is common in the early postoperative stages after abdominothoracic esophagectomy for esophageal cancer. We examined the ability of stroke volume variation (SVV), pulse pressure variation (PPV), central venous pressure (CVP), intrathoracic blood volume (ITBV), and initial distribution volume of glucose (IDVG) to predict fluid responsiveness soon after esophagectomy under mechanical ventilation (tidal volume >8 mL/kg) without spontaneous respiratory activity.

Methods

Forty-three consecutive non-arrhythmic patients undergoing abdominothoracic esophagectomy were studied. SVV, PPV, cardiac index (CI), and indexed ITBV (ITBVI) were postoperatively measured by single transpulmonary thermodilution (PiCCO system) after patient admission to the intensive care unit (ICU) on the operative day. Indexed IDVG (IDVGI) was then determined using the incremental plasma glucose concentration 3 min after the intravenous administration of 5 g glucose. Fluid responsiveness was defined by an increase in CI >15% compared with pre-loading CI following fluid volume loading with 250 mL of 10% low molecular weight dextran.

Results

Twenty-three patients were responsive to fluids while 20 were not. The area under the receiver-operating characteristic (ROC) curve was the highest for CVP (0.690) and the lowest for ITBVI (0.584), but there was no statistical difference between tested variables. Pre-loading IDVGI (r = −0.523, P <0.001), SVV (r = 0.348, P = 0.026) and CVP (r = −0.307, P = 0.046), but not PPV or ITBVI, were correlated with a percentage increase in CI after fluid volume loading.

Conclusions

These results suggest that none of the tested variables can accurately predict fluid responsiveness early after abdominothoracic esophagectomy.

Keywords:
Cardiac preload; Esophagectomy; Fluid responsiveness; Glucose; Intrathoracic blood volume; Stroke volume variation