Prediction of Volume Responsiveness in Presence of Left Ventricular Diastolic Dysfunction

Summary

The ability of the global end-diastolic volume index (GEDVI), stroke volume variation (SVV) and pulse pressure variation (PPV) for prediction of fluid responsiveness in presence of left ventricular diastolic dysfunction is still unknown. The aim of the present study was to challenge the predictive power of GEDVI, SVV and PPV in cardiac surgery patients undergoing aortic valve replacement.

Conditions

• Hemodynamics

Interventions

OTHER

passive leg raising

The passive leg raising maneuver (PLR) involves a leg elevation up to 45° with the trunk in a horizontal position and is performed to induce hemodynamic effects by a volume challenge, turning unstressed blood volume to stressed volume proportional to body size.

OTHER

premedication

patients receive premedication with midazolam 7.5 mg p.o.

OTHER

intubation and mechanical ventilation

After induction of anesthesia with sufentanil (0.5 µg/kg) and propofol (1.5 mg/kg), orotracheal intubation is facilitated with rocuronium (0.6 mg/kg). Anesthesia is maintained with sufentanil (1 µg/kg/h) and propofol (3 mg/kg/h) and patients are ventilated with an oxygen/air mixture in volume-controlled mode, using a tidal volume of 8 ml/kg related to the ideal body weight. Positive end-expiratory pressure is set at 5 cmH2O.

OTHER

central venous catheter

a central venous catheter in the right or left internal jugular vein.

OTHER

arterial catheter

Continuous monitoring is performed including electrocardiogram, radial arterial pressure catheter

OTHER

transesophageal echocardiography

Before placement of a transpulmonary thermodilution catheter a transesophageal echocardiography (TOE) is performed. TOE is used to detect diastolic dysfunction of the left ventricle and to exclude right ventricular dysfunction.

OTHER

transpulmonary thermodilution catheter

In presence of left ventricular dysfunction a transpulmonary thermodilution catheter is placed in the femoral artery and connected to a PiCCO2 monitor (PiCCO2, Pulsion Medical Systems, Munich, Germany).

Sponsors & Collaborators

• University Hospital Schleswig-Holstein

  lead OTHER

Principal Investigators

• Ole Broch, MD · Consultant anesthetist

Study Design

Allocation

NON_RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2015-06-30

Primary Completion

2016-05-31

Completion

2016-06-30

Countries

• Germany

Study Locations