Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2017.11.003
Brazilian Journal of Anesthesiology
Scientific Article

Behavior of stroke volume variation in hemodynamic stable patients during thoracic surgery with one-lung ventilation periods

Comportamento da variação do volume sistólico em pacientes hemodinamicamente estáveis durante cirurgia torácica com períodos de ventilação monopulmonar

María Lema Tome; Francisco Andrés De la Gala; Patricia Piñeiro; Luis Olmedilla; Ignacio Garutti

http://dx.doi.org/10.1016/j.bjane.2017.11.003 Braz J Anesthesiol, vol.68, n3, p.225-230, 2018
PDF English
PDF Português
Downloads: 1
Views: 864

Abstract

Abstract Introduction: In last few years, emphasis was placed in goal-directed therapy in order to optimize patient's hemodynamic status and improve their prognosis. Parameters based on the interaction between heart and lungs have been questioned in situations like low tidal volume and open chest surgery. The goal of the study was to analyze the changes that one-lung ventilation can produce over stroke volume variation and to assess the possible impact of airway pressures and lung compliance over stroke volume variation. Methods: Prospective observational study, 112 patients undergoing lung resection surgery with one-lung ventilation periods were included. Intravenous fluid therapy with crystalloids was set at 2 mL.g-1. Hypotension episodes were treated with vasoconstrictive drugs. Two-lung Ventilation was implemented with a TV of 8 mL.g-1 and one-lung ventilation was managed with a TV of 6 mL.g-1. Invasive blood pressure was monitored. We recorded the following cardiorespiratory values: heart rate, mean arterial pressure, cardiac index, stroke volume index, airway peak pressure, airway plateau pressure and static lung compliance at 3 different times during surgery: immediately after lung collapse, 30 min after initiating one-lung ventilation and after restoration of two-lung ventilation. Results: Stroke volume variation values were influenced by lung collapse (before lung collapse 14.6 (DS) vs. OLV 9.9% (DS), p < 0.0001); or after restoring two-lung ventilation (11.01 (DS), p < 0.0001). During two-lung Ventilation there was a significant correlation between airway pressures and stroke volume variation, however this correlation lacks during one-lung ventilation. Conclusion: The decrease of stroke volume variation values during one-lung ventilation with protective ventilatory strategies advices not to use the same threshold values to determine fluid responsiveness.

Keywords

Thoracic surgery, One-lung ventilation, Stroke volume variation, Goal-directed therapy, Heart-lung interaction

Resumo

Resumo Introdução: Nos últimos anos, a importância da terapia alvo-dirigida foi enfatizada para aprimorar o estado hemodinâmico do paciente e melhorar seu prognóstico. Os parâmetros baseados na interação entre o coração e os pulmões foram questionados em situações como baixo volume corrente e cirurgia aberta do tórax. O objetivo do estudo foi analisar as alterações que a ventilação monopulmonar pode produzir na variação do volume sistólico e avaliar o possível impacto das pressões da via aérea e da complacência pulmonar sobre a variação do volume sistólico. Métodos: Estudo observacional prospectivo, no qual 112 pacientes submetidos à cirurgia de ressecção pulmonar com períodos de ventilação monopulmonar foram incluídos. A terapia de fluídos intravenosos com cristaloides foi ajustada a 2 mL.kg-1.h-1. Os episódios de hipotensão foram tratados com vasoconstritores. A ventilação dos dois pulmões (VDP) foi implantada com volume corrente de 8 mL.kg-1 e a ventilação monopulmonar foi controlada com volume corrente de 6 mL.kg-1. Foi monitorada a pressão arterial invasiva. Registramos os seguintes valores cardiorrespiratórios: frequência cardíaca, pressão arterial média, índice cardíaco, índice de volume sistólico, pressão de pico das vias aéreas, pressão de platô das vias aéreas e complacência pulmonar estática em três tempos durante a cirurgia: imediatamente após o colapso do pulmão, 30 minutos após o início da ventilação monopulmonar e após a restauração da ventilação dos dois pulmões. Resultados: Os valores de variação do volume sistólico foram influenciados pelo colapso pulmonar (antes do colapso pulmonar 14,6 [DS] vs. ventilação monopulmonar 9,9% [DS], p < 0,0001), ou após o restabelecimento da ventilação dos dois pulmões (11,01 [DS], p < 0,0001). Durante a ventilação dos dois pulmões houve uma correlação significativa entre as pressões das vias aéreas e a variação do volume sistólico, porém, essa correlação não existe durante a ventilação monopulmonar. Conclusão: A diminuição dos valores da variação do volume sistólico durante a ventilação monopulmonar com estratégias ventilatórias protetoras sugere não usar os mesmos valores de limiar para determinar a responsividade aos fluídos.

Palavras-chave

Cirurgia torácica, Ventilação monopulmonar, Variação do volume sistólico, Terapia alvo-dirigida, Interação coração-pulmão

References

Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Ann Intensive Care. 2011;1:1.

Reuter DA, Bayerlein J, Goepfert MS. Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients. Intensive Care Med. 2003;29:476-80.

Haas S, Eichhorn V, Hasbach T. Goal-directed fluid therapy using stroke volume variation does not result in pulmonary fluid overload in thoracic surgery requiring one-lung ventilation. Crit Care Res Pract. 2012;2012:687018.

Magder S. Clinical usefulness of respiratory variations in arterial pressure. Am J Respir Crit Care Med. 2004;169:151-5.

Preisman S, Kogan S, Berkenstadt H. Predicting fluid responsiveness in patients undergoing cardiac surgery: functional haemodynamic parameters including the respiratory systolic variation test and static preload indicators. Br J Anaesth. 2005;95:746-55.

Zhang J, Chen CQ, Lei XZ. Goal-directed fluid optimization based on stroke volume variation and cardiac index during one lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study. Clinics. 2013;68:1065-70.

Reuter DA, Goephfert MSG, Goresch T. Assessing fluid responsiveness during open chest conditions. Br J Anaesth. 2005;94:318-23.

Reuter DA, Kirchner A, Felbinger TW. Usefulness of left ventricular stroke volume variations to assess fluid responsiveness in patients with reduced left ventricular function. Crit Care Med. 2003;31:1399-404.

Monnet X, Rienzo M, Osman D. Esophageal Doppler monitoring predicts fluid responsiveness in critically ill ventilated patients. Intensive Care Med. 2005;31:1195-201.

Licker M, de Perrot M, Spiliopoulos A. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg. 2003;97:1558-65.

Wu CY, Lee TS, Chan KC. Does targeted pre-load optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position. Anaesthesia. 2012;67:760-4.

De Backer D, Heenen S, Piagnerelli M. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med. 2005;31:517-23.

Charron C, Fessenmeyer C, Cosson C. The influence of tidal volume on the dynamic variables of fluid responsiveness in critically ill patients. Anesth Analg. 2006;102:1511-7.

Kim HK, Pinsky M. Effect of tidal volume, sampling duration, and cardiac contractility on pulse pressure and stroke volume variation during positive-pressure ventilation. Crit Care Med. 2008;36:2858-62.

De Backer D, Taccone FS, Holsten R. Influence of respiratory rate on stroke volume variation in mechanically ventilated patients. Anesthesiology. 2009;110:1092-7.

Suehiro K, Okutani R. Influence of tidal volume for stroke volume variation to predict fluid responsiveness in patients undergoing one-lung ventilation. J Anesth. 2011;25:777-80.

Suehiro K, Okutani R. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing one-lung ventilation. J Cardiothorac Vasc Anesth. 2010;24:772-5.

Fu Q, Zhao F, Mi W. Stroke volume variation fail to predict fluid responsiveness in patients undergoing pulmonary lobectomy with one-lung ventilation using thoracotomy. BioScience Trends. 2014;8:59-63.

Lee JH, Jeon Y, Bahk JH. Pulse pressure variation as a predictor of fluid responsiveness during one-lung ventilation for lung surgery using thoracotomy: randomised controlled study. Eur J Anaesthesiol. 2011;28:39-44.

Novak RA, Matuschak GM, Pinsky MR. Effect of ventilatory frequency on regional pleural pressure. J Appl Physiol. 1988;65:1314-23.

Monnet X, Teboul JL. Assessment of volumen responsiveness during mechanical ventilation: recent advances. Crit Care. 2013;17:217.

Slinger PD, Campos JH. Anesthesia for thoracic surgery. Miller's anesthesia. 2009:1819-87.

Trepte C, Hass S, Nitzschke R. Prediction of volume-responsiveness during one-lung ventilation: a comparison of static, volumetric, and dynamic parameters of cardiac preload. J Cardiothorac Vasc Anesth. 2013;27:1094-100.

Mesquida J, Kim HK, Pinsky MR. Effect of tidal volume, intrathoracic pressure and cardiac contractility on variations in pulse pressure, stroke volume and intrathoracic blood volume. Intensive Care Med. 2011;37:1672-9.

Romand JA, Shi W, Pinsky MR. Cardiopulmonary effects of positive pressure ventilation during acute lung injury. Chest. 1995;108:1041-8.

Jardin F, Genevray B, Brun-Ney D. Influence of lung and chest wall compliances on transmission of airway pressure to the pleural space in critically ill patients. Chest. 1985;88:653-8.

Monnet X, Rienzo M, Osman D. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006;34:1402-7.

Monnet X, Bleibtreu A, Ferré A. Passive leg-raising and end-expiratory occlusion tests perform better than pulse pressure variation in patients with low respiratory system compliance. Crit Care Med. 2012;40:152-7.

Kubitz JC, Annecke T, Kemming GI. The influence of positive end-expiratory pressure on stroke volume variation and central blood volume during open and closed chest conditions. Eur J Cardiothorac Surg. 2006;30:90-5.

De Waal EE, Rex S, Kruitwagen CL. Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions. Crit Care Med. 2009;37:510-5.

Whyffels P, Sergeant P, Wouters P. The value of pulse pressure and stroke volume variation as predictors of fluid responsiveness during open chest surgery. Anaesthesia. 2010;65:704-9.

Trepte C, Haas S, Meyer N. Effects of one-lung ventilation on thermodilution-derived assessment of cardiac output. Br J Anaesth. 2012;108:922-8.

5dcc358d0e88255d17bf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections