Dynamic Arterial Elastance as a Predictor of Intraoperative Fluid Responsiveness in Elderly Patient over 70 Years of Age Undergoing Spine Surgery in the Prone Position Under General Anesthesia: A Validation Study

被引：0
作者：
Oh, Eun Jung [1 ]
Cho, Eun Ah [1 ]
Jun, Joohyun [1 ]
Lee, Sung Hyun [1 ]
Lee, Seunghyeon [1 ]
Ahn, Jin Hee [1 ]
机构：
[1] Sungkyunkwan Univ, Kangbuk Samsung Med Ctr, Dept Anesthesiol & Pain Med, Sch Med, Seoul 03063, South Korea
来源：
JOURNAL OF CLINICAL MEDICINE | 2025年 / 14卷 / 04期
关键词：
general anesthesia; fluid responsiveness; arterial elastance; PULSE PRESSURE; STROKE VOLUME; CARDIAC-OUTPUT; MANAGEMENT; HEART; SHOCK;
D O I：
10.3390/jcm14041247
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Background: Optimizing fluid therapy is critical for maintaining hemodynamic stability in elderly patients undergoing major surgeries. Dynamic arterial elastance (Eadyn), defined as the ratio of pulse pressure variation (PPV) to stroke volume variation (SVV), has been proposed as a predictor of fluid responsiveness, especially in challenging conditions like prone-positioned spine surgery under general anesthesia. Methods: Hemodynamic parameters were measured before and after fluid loading with 500 mL of crystalloid solution. Patients were classified as responders or non-responders based on a >= 15% increase in mean arterial pressure (MAP) post-fluid administration. Predictive performance of these parameters was assessed using receiver operating characteristic (ROC) analysis. Results: Of the 37 patients, 15 were classified as responders and 22 as non-responders. Eadyn demonstrated poor predictive performance (AUC = 0.508). In contrast, SVV (AUC = 0.808), PPV (AUC = 0.738), and C (AUC = 0.741) exhibited moderate to high predictive ability. Responders exhibited significantly higher baseline SVV, PPV, and net arterial compliance compared to non-responders. Conclusions: Dynamic arterial elastance (Eadyn) showed limited predictive ability for fluid responsiveness in elderly patients undergoing spine surgery in the prone position. In contrast, stroke volume variation (SVV), pulse pressure variation (PPV), and net arterial compliance (C) demonstrated superior reliability, with SVV emerging as the most accurate predictor.
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页数：11
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  • [1] Dellinger R.P., Levy M.M., Carlet J.M., Bion J., Parker M.M., Jaeschke R., Reinhart K., Angus D.C., Brun-Buisson C., Beale R., Et al., Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, Intensive Care Med, 34, pp. 17-60, (2008)
  • [2] Cecconi M., De Backer D., Antonelli M., Beale R., Bakker J., Hofer C., Jaeschke R., Mebazaa A., Pinsky M.R., Teboul J.L., Et al., Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine, Intensive Care Med, 40, pp. 1795-1815, (2014)
  • [3] Pearse R.M., Harrison D.A., MacDonald N., Gillies M.A., Blunt M., Ackland G., Grocott M.P., Ahern A., Griggs K., Scott R., Et al., Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: A randomized clinical trial and systematic review, Jama, 311, pp. 2181-2190, (2014)
  • [4] Le Manach Y., Hofer C.K., Lehot J.J., Vallet B., Goarin J.P., Tavernier B., Cannesson M., Can changes in arterial pressure be used to detect changes in cardiac output during volume expansion in the perioperative period?, Anesthesiology, 117, pp. 1165-1174, (2012)
  • [5] Garcia M.I., Romero M.G., Cano A.G., Aya H.D., Rhodes A., Grounds R.M., Cecconi M., Dynamic arterial elastance as a predictor of arterial pressure response to fluid administration: A validation study, Crit. Care, 18, (2014)
  • [6] Monge Garcia M.I., Gil Cano A., Gracia Romero M., Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients, Crit. Care, 15, (2011)
  • [7] Biais M., Bernard O., Ha J.C., Degryse C., Sztark F., Abilities of pulse pressure variations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery, Br. J. Anaesth, 104, pp. 407-413, (2010)
  • [8] Ali A., Abdullah T., Sabanci P.A., Dogan L., Orhan-Sungur M., Akinci I.O., Comparison of ability of pulse pressure variation to predict fluid responsiveness in prone and supine position: An observational study, J. Clin. Monit. Comput, 33, pp. 573-580, (2019)
  • [9] Mesquida J., Kim H.K., Pinsky M.R., Effect of tidal volume, intrathoracic pressure, and cardiac contractility on variations in pulse pressure, stroke volume, and intrathoracic blood volume, Intensive Care Med, 37, pp. 1672-1679, (2011)
  • [10] Kamenskiy A.V., Pipinos I.I., Carson J.S., MacTaggart J.N., Baxter B.T., Age and disease-related geometric and structural remodeling of the carotid artery, J. Vasc. Surg, 62, pp. 1521-1528, (2015)
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