Stroke volume variation as a predictor of fluid responsiveness in patientsundergoing brain surgery

Changes in arterial blood pressure induced by mechanical ventilation allow assessment of cardiac preload. In this study, stroke volume variation (SW), which is the percentage change between the maximal and minimal stroke volu mes (SV) divided by the average of the minimum and maximum over a floating period of 30 s, continuously displayed by the PiCCO continuous cardiac outp ut monitor, was evaluated as a predictor of fluid responsiveness. Fifteen p atients undergoing brain surgery were included. During surgery, graded volu me loading was performed with each volume loading step (VLS) consisting of 100 mL of 6% hydroxyethylstarch given for 2 min. Successive responsive VLSs were performed (increase in SV > 5% after a VLS) until a change in SV of < 5% was reached (nonresponsive). A total of 140 VLSs were performed. Respons ive and nonresponsive VLSs differed in their pre-VLS values of systolic blo od pressure, SV, and SW, but not in the values of heart rate and central ve nous pressure. By using receiver operating characteristic analysis, the are a under the curve for SW (0.870, 95% confidence interval [CI]: 0.809 to 0.9 03) was statistically more than those for central venous pressure (0.493, 9 5% CI: 0.397 to 0.590, P = 7 x 10(-10)), heart rate (0.593, 95% CI: 0.443 t o 0.635, P = 5.7 x 10-10), and systolic blood pressure (0.729, 95% CI: 0.64 5 to 0.813, P = 4.3 x 10(-3)). An SW value of 9.5% or more, will predict an increase in the SV of at least 5% in response to a 100-mL volume load, wit h a sensitivity of 79% and a specificity of 93%.