Prediction of fluid responsiveness in septic shock patients: comparing stroke volume variation by FloTrac/Vigileo and automated pulse pressure variation


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Abstract

ObjectivesThe aim of this study was to assess and compare the ability of the automatically and continuously measured stroke volume variation (SVV) obtained by FloTrac/Vigileo, and pulse pressure variation (PPV) measured by an IntelliVue MP monitor, to predict fluid responsiveness in mechanically ventilated septic shock patients.MethodWe conducted a prospective study on 42 septic shock patients. SVV, PPV and other haemodynamic data were recorded before and after fluid administration of 500 ml of 6% hydroxyethyl starch. Responders were defined as patients with an increase in stroke volume index of at least 15% after fluid loading.ResultsTwenty-four (57.1%) patients were classified as fluid responders. The baseline SVV correlated with the baseline PPV (r = 0.96, P < 0.001). SVV and PPV were significantly higher in responders than in nonresponders (15.5 ± 4.5 vs. 8.2 ± 3.3% and 16.4 ± 5.2 vs. 8.3 ± 3.5, respectively, P < 0.001 for both). There was no difference between the area under the receiver operating characteristic curves of SVV [0.92, 95% confidence interval 0.832–1.00] and PPV (0.916, 95% confidence interval 0.829–1.00). The optimal threshold values in predicting fluid responsiveness were 10% for SVV (sensitivity 91.7% and specificity 83.3%) and 12% for PPV (sensitivity 83.3% and specificity 83.3%). Our results were independent of the site of arterial catheterisation.ConclusionThe SVV, obtained by FloTrac/Vigileo, and the automated PPV, obtained by the IntelliVue MP monitor, showed comparable performance in terms of predicting fluid responsiveness in passively ventilated septic shock patients, with a regular cardiac rhythm and a tidal volume not less than 8 ml kg−1.

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