Extrasystoles for fluid responsiveness prediction in critically ill patients

Journal of Intensive Care
S T VistisenChristoffer Sølling

Abstract

Fluid responsiveness prediction with continuously available monitoring is an unsettled matter for the vast majority of critically ill patients, and development of new and reliable methods is desired. We hypothesized that the post-ectopic beat, which is associated with increased preload, could be analyzed in relation to preceding sinus beats and that the change in cardiac performance (e.g., systolic blood pressure) at the post-ectopic beat could predict fluid responsiveness. Critically ill patients were observed when scheduled for a 500-ml volume expansion. The 30-min ECG prior to volume expansion was analyzed for the occurrence of extrasystoles. Classification variables were defined as the change in a variable (e.g., systolic blood pressure or pre-ejection period) from the median of ten preceding sinus beats to extrasystolic post-ectopic beat. A stroke volume increase > 10% following volume expansion defined fluid responsiveness. Twenty-six patients were included. The change in systolic blood pressure predicted fluid responsiveness with receiver operating characteristic (ROC) area 0.79 (CI [0.52:1.00]), specificity 100%, sensitivity 67%, positive predictive value 100%, and negative predictive value 91% (threshold: 5%). The chan...Continue Reading

References

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Citations

Nov 11, 2018·Journal of Clinical Monitoring and Computing·Simon T VistisenThomas W L Scheeren

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Clinical Trials Mentioned

NCT02520037

Software Mentioned

Philips Research Data Export
R studio
R
NICOM®
Matlab
pROC
PLR

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