• Acta Anaesthesiol Scand · May 2020

    Impact of deep breathing on predictability of stroke volume variation in spontaneous breathing patients.

    • Akira Mukai, Koichi Suehiro, Aya Kimura, Sae Kodama, Katsuaki Tanaka, Takashi Mori, and Kiyonobu Nishikawa.
    • Department of Anaesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
    • Acta Anaesthesiol Scand. 2020 May 1; 64 (5): 648-655.

    BackgroundThis study investigated the ability of stroke volume variation (SVV) during deep breathing to discriminate fluid responders among spontaneously breathing patients.MethodsThirty patients undergoing general anaesthesia were enrolled and assessed before anaesthetic induction. Haemodynamic variables, including stroke volume (SV) and SVV, were measured using the ClearSight system during normal breathing. After these measurements, each patient was required to maintain deep breathing (6 breaths min-1 ) and haemodynamic variables were recorded. Then, the table was adjusted to the Trendelenburg position (15°) for 2 minutes, and haemodynamic variables were measured. Receiver operating characteristic curves were created for SVV during normal and deep breathing, and the difference in SVV between normal and deep breathing (ΔSVV) to discriminate fluid responders (SV increase >10% after changing position). The correlation between SV increase and ΔSVV was examined using Pearson's correlation coefficient. The grey zone approach was used to assess the inconclusive range of the haemodynamic variables.ResultsReceiver operating characteristic curve analysis indicated that ΔSVV showed good reliability in predicting fluid responsiveness (AUC: 0.850; 95% CI: 0.672-0.953; threshold: 4%, sensitivity: 75.0%, specificity: 88.9%], while SVV during normal breathing did not (AUC: 0.579; 95% CI: 0.386-0.756)]. Although SVV during deep breathing exhibited acceptable predictability (AUC: 0.778; 95% CI: 0.589-0.908), the sensitivity was not good (58.3%). With the grey zone approach, the inconclusive range of ΔSVV was small with the range of 1.4%-4.2% (23% of patients).ConclusionDeep breathing could improve the reliability of dynamic indices in spontaneously breathing patients.Trial RegistrationUMIN-CTR, identifer: UMIN000027970. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000032040.© 2019 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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