Predictive value of trendelenburg position and carotid ultrasound for fluid responsiveness in patients on VV-ECMO with acute respiratory distress syndrome in the prone position
Abstract Fluid administration is widely used to treat hypotension in patients undergoing veno-venous extracorporeal membrane oxygenation (VV-ECMO). However, excessive fluid administration may lead to fluid overload can aggravate acute respiratory distress syndrome (ARDS) and increase patient mortali...
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Nature Portfolio
2024-12-01
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| author | Junjie Zhao Yong Sun Jing Tang Kai Guo Jiancheng Zhuge Honglong Fang |
| author_facet | Junjie Zhao Yong Sun Jing Tang Kai Guo Jiancheng Zhuge Honglong Fang |
| author_sort | Junjie Zhao |
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| description | Abstract Fluid administration is widely used to treat hypotension in patients undergoing veno-venous extracorporeal membrane oxygenation (VV-ECMO). However, excessive fluid administration may lead to fluid overload can aggravate acute respiratory distress syndrome (ARDS) and increase patient mortality, predicting fluid responsiveness is of great significance for VV-ECMO patients. This prospective single-center study was conducted in a medical intensive care unit (ICU) and finally included 51 VV-ECMO patients with ARDS in the prone position (PP). Stroke volume index variation (ΔSVI), pulse pressure variation (PPV), stroke volume variation (SVV), baseline carotid corrected flow time (FTcBaseline), and respirophasic variation in carotid artery blood flow peak velocity (ΔVpeakCA) were taken before and after the Trendelenburg position or volume expansion. Fluid responsiveness was defined as a 15% or more increase in stroke volume index as assessed by transthoracic echocardiography after the volume expansion (VE). In our study, 33 patients (64.7%) were identified as fluid responders. Stroke volume index variation induced by the Trendelenburg position (ΔSVITrend), FTcBaseline, and ΔVpeakCA demonstrated superior predictive performance of fluid responsiveness. ΔSVITrend had an AUC of 0.89 (95% CI, 0.80–0.98) with an optimal threshold of 14.5% (95% CI, 12.5–21.5%), with the sensitivity and specificity were 82% (95% CI, 66–91%) and 83% (95% CI, 61–94%). FTcBaseline had an AUC of 0.87 (95% CI, 0.76–0.98) with an optimal threshold of 332ms (95% CI, 318-335ms), the sensitivity and specificity were 85% (95% CI, 69–93%) and 83% (95% CI, 61–94%), respectively. ΔVpeakCA showed an AUC of 0.83 (95% CI, 72–95), with a 10% optimal threshold (95% CI, 9–13%), sensitivity was 82% (95% CI, 66–91%) and specificity 78% (95% CI, 55–91%). ΔSVITrend, FTcBaseline and ΔVpeakCA could effectively predict fluid responsiveness in VV-ECMO patients with ARDS in the PP. Compared to ΔSVITrend and ΔVpeakCA, FTcBaseline is easier and more direct to acquire, and it does not require Trendelenburg position or VE, making it a more accessible and efficient option for assessing fluid responsiveness. |
| format | Article |
| id | doaj-art-41db23901f9a4e838d70d072c8d01121 |
| institution | Kabale University |
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| publishDate | 2024-12-01 |
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| spelling | doaj-art-41db23901f9a4e838d70d072c8d011212025-01-05T12:27:04ZengNature PortfolioScientific Reports2045-23222024-12-0114111410.1038/s41598-024-83038-7Predictive value of trendelenburg position and carotid ultrasound for fluid responsiveness in patients on VV-ECMO with acute respiratory distress syndrome in the prone positionJunjie Zhao0Yong Sun1Jing Tang2Kai Guo3Jiancheng Zhuge4Honglong Fang5Zhejiang Chinese Medical UniversityZhejiang Chinese Medical UniversityZhejiang Chinese Medical UniversityZhejiang Chinese Medical UniversityQuzhou Hospital of Traditional Chinese MedicineDepartment of Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s HospitalAbstract Fluid administration is widely used to treat hypotension in patients undergoing veno-venous extracorporeal membrane oxygenation (VV-ECMO). However, excessive fluid administration may lead to fluid overload can aggravate acute respiratory distress syndrome (ARDS) and increase patient mortality, predicting fluid responsiveness is of great significance for VV-ECMO patients. This prospective single-center study was conducted in a medical intensive care unit (ICU) and finally included 51 VV-ECMO patients with ARDS in the prone position (PP). Stroke volume index variation (ΔSVI), pulse pressure variation (PPV), stroke volume variation (SVV), baseline carotid corrected flow time (FTcBaseline), and respirophasic variation in carotid artery blood flow peak velocity (ΔVpeakCA) were taken before and after the Trendelenburg position or volume expansion. Fluid responsiveness was defined as a 15% or more increase in stroke volume index as assessed by transthoracic echocardiography after the volume expansion (VE). In our study, 33 patients (64.7%) were identified as fluid responders. Stroke volume index variation induced by the Trendelenburg position (ΔSVITrend), FTcBaseline, and ΔVpeakCA demonstrated superior predictive performance of fluid responsiveness. ΔSVITrend had an AUC of 0.89 (95% CI, 0.80–0.98) with an optimal threshold of 14.5% (95% CI, 12.5–21.5%), with the sensitivity and specificity were 82% (95% CI, 66–91%) and 83% (95% CI, 61–94%). FTcBaseline had an AUC of 0.87 (95% CI, 0.76–0.98) with an optimal threshold of 332ms (95% CI, 318-335ms), the sensitivity and specificity were 85% (95% CI, 69–93%) and 83% (95% CI, 61–94%), respectively. ΔVpeakCA showed an AUC of 0.83 (95% CI, 72–95), with a 10% optimal threshold (95% CI, 9–13%), sensitivity was 82% (95% CI, 66–91%) and specificity 78% (95% CI, 55–91%). ΔSVITrend, FTcBaseline and ΔVpeakCA could effectively predict fluid responsiveness in VV-ECMO patients with ARDS in the PP. Compared to ΔSVITrend and ΔVpeakCA, FTcBaseline is easier and more direct to acquire, and it does not require Trendelenburg position or VE, making it a more accessible and efficient option for assessing fluid responsiveness.https://doi.org/10.1038/s41598-024-83038-7Fluid responsivenessTrendelenburg positionVV-ECMOCarotid ultrasound |
| spellingShingle | Junjie Zhao Yong Sun Jing Tang Kai Guo Jiancheng Zhuge Honglong Fang Predictive value of trendelenburg position and carotid ultrasound for fluid responsiveness in patients on VV-ECMO with acute respiratory distress syndrome in the prone position Scientific Reports Fluid responsiveness Trendelenburg position VV-ECMO Carotid ultrasound |
| title | Predictive value of trendelenburg position and carotid ultrasound for fluid responsiveness in patients on VV-ECMO with acute respiratory distress syndrome in the prone position |
| title_full | Predictive value of trendelenburg position and carotid ultrasound for fluid responsiveness in patients on VV-ECMO with acute respiratory distress syndrome in the prone position |
| title_fullStr | Predictive value of trendelenburg position and carotid ultrasound for fluid responsiveness in patients on VV-ECMO with acute respiratory distress syndrome in the prone position |
| title_full_unstemmed | Predictive value of trendelenburg position and carotid ultrasound for fluid responsiveness in patients on VV-ECMO with acute respiratory distress syndrome in the prone position |
| title_short | Predictive value of trendelenburg position and carotid ultrasound for fluid responsiveness in patients on VV-ECMO with acute respiratory distress syndrome in the prone position |
| title_sort | predictive value of trendelenburg position and carotid ultrasound for fluid responsiveness in patients on vv ecmo with acute respiratory distress syndrome in the prone position |
| topic | Fluid responsiveness Trendelenburg position VV-ECMO Carotid ultrasound |
| url | https://doi.org/10.1038/s41598-024-83038-7 |
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