Κατεύθυνση Αναπνευστική Ανεπάρκεια και Μηχανικός Αερισμός
Library of the School of Health Sciences

2025-01-16

2025

Pilakouta-Depaskouale Myrto

Βαπορίδη Αικατερίνη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, Πανεπιστήμιο Κρήτης
Ποντίκης Κωνσταντίνος, Εξωτερικός Συνεργάτης, Ιατρική Σχολή, ΕΚΠΑ
Ντάγανου Μαρία, Εξωτερικός Συνεργάτης, Ιατρική Σχολή, ΕΚΠΑ

Μελέτη της μεταβολής του δείκτη Pulse Pressure Variation κατά την εφαρμογή Tidal Volume Challenge σε πρηνή και ύπτια θέση σε ασθενείς που υποβάλλονται σε επεμβάσεις σπονδυλοδεσίας

Greek

Study of changes in the Pulse Pressure Variation during the application of Tidal Volume Challenge in the prone and supine positions in patients undergoing spinal fusion surgery

The assessment of preload and fluid responsiveness (FR) is important for maintaining normovolemia. Normovolemia is particularly important in spinal fusion surgery performed in the prone position, as, in addition to the prolonged duration and increased hemorrhagic risk, the position itself may pose a hemodynamic burden on the patient. Dynamic preload indices (Pulse Pressure Variation - PPV, Stroke Volume Variation - SVV) are used to guide fluid administration; however, mechanical ventilation with low tidal volumes (VT) can compromise their accuracy. The tidal volume challenge (VTC) has been proposed as a method to address this limitation, but data on its application in the prone position remain limited.
The purpose of this study is to determine the sensitivity and specificity of PPV changes during a tidal volume challenge (VTC) for predicting FR in both prone and supine positions in patients undergoing mechanical ventilation with a tidal volume of 6 ml/kg.
The sample consists of 23 adult patients who underwent spinal fusion surgery in the prone position lasting more than two hours under general anesthesia. Volume control ventilation at 6 ml/kg was applied. Minimally invasive hemodynamic monitoring using cardiac output monitoring with pulse contour analysis was performed. Four tests were conducted (2 in the supine and 2 in the prone position), which included VTC followed by a mini fluid challenge, and assessment of the hemodynamic response by monitoring of the changes in cardiac output.
Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of the indices’ changes. The main finding of the study was that PPV changes after VTC had a higher predictive value compared to SVV in terms of FR. The value of VTC as a predictive tool in our sample is limited and may possibly be used as a tool to exclude FR but not confirm it. The design of studies with strict and uniform methodology could provide more information regarding the usefulness of the test.

Health Sciences

Fluid responsiveness, Tidal volume challenge, Dynamic indices, Fluid challenge

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File access is restricted until 2025-07-10.

https://pergamos.lib.uoa.gr/uoa/dl/object/3447981