Effect of fluid loading on left ventricular volume and stroke volume variability in patients with end-stage renal disease: a pilot study
Authors Kanda H, Hirasaki Y, Iida T, Kanao-Kanda M, Toyama Y, Kunisawa T, Iwasaki H
Received 27 June 2015
Accepted for publication 8 September 2015
Published 20 October 2015 Volume 2015:11 Pages 1619—1625
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Garry Walsh
Hirotsugu Kanda,1 Yuji Hirasaki,2 Takafumi Iida,1 Megumi Kanao-Kanda,1 Yuki Toyama,1 Takayuki Kunisawa,1 Hiroshi Iwasaki1
1Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan; 2Department of Anatomy, The Jikei University Graduate School of Medicine, Minato-ku, Tokyo, Japan
Purpose: The aim of this study was to investigate fluid loading-induced changes in left ventricular end-diastolic volume (LVEDV) and stroke volume variability (SVV) in patients with end-stage renal disease (ESRD) using real-time three-dimensional transesophageal echocardiography and the Vigileo-FloTrac system.
Patients and methods: After obtaining ethics committee approval and informed consent, 28 patients undergoing peripheral vascular procedures were studied. Fourteen patients with ESRD on hemodialysis (HD) were assigned to the HD group and 14 patients without ESRD were assigned to the control group. Institutional standardized general anesthesia was provided in both groups. SVV was measured using the Vigileo-FloTrac system. Simultaneously, a full-volume three-dimensional transesophageal echocardiography dataset was acquired to measure LVEDV, left ventricular end-systolic volume, and left ventricular ejection fraction. Measurements were obtained before and after loading 500 mL hydroxyethyl starch over 30 minutes in both groups.
Results: In the control group, intravenous colloid infusion was associated with a significant decrease in SVV (13.8%±2.6% to 6.5%±2.6%, P<0.001) and a significant increase in LVEDV (83.6±23.4 mL to 96.1±28.8 mL, P<0.001). While SVV significantly decreased after infusion in the HD group (16.2%±6.0% to 6.2%±2.8%, P<0.001), there was no significant change in LVEDV.
Conclusion: Our preliminary data suggest that fluid responsiveness can be assessed not by LVEDV but also by SVV due to underlying cardiovascular pathophysiology in patients with ESRD.
Keywords: stroke volume variability, end-stage renal disease, three-dimensional transesophageal echocardiography, hemodialysis, goal-directed fluid therapy
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