Rippen, M.W. (2012) De voorspellende waarde van dynamische parameters voor de respons op vloeistoftoediening bij kinderen opgenomen op de kinderintensive na een cardiochirurgische ingreep. thesis, Medicine.
Full text available on request.Abstract
Objective: Although dynamic variables have gained popularity as predictors of fluid responsiveness in mechanically ventilated adults, only a few studies have been done to investigate the value of these parameters in children. The purpose of this study is to investigate the predictive value of the dynamic variables stroke volume variation (SVV) and pulse pressure variation (PPV) and various static parameters for the response to volume expansion (VE) in mechanically ventilated children after heart surgery. Methods: Thirteen patients have been included between the ages of 5 months and 12 years undergoing heart surgery under general anesthesia. During the first 6 hours after admission to the pediatric intensive care unit, transpulmonary thermodilution measurements were performed every two hours using the PiCCO monitoring system, with additional measurements before and after VE. Using this technology several continuous variables were obtained including: pulse contour cardiac output (PCCO), stroke volume (SV), systemic vascular resistance (SVR), stroke volume variation (SVV), pulse pressure variation (PPV), global end-diastolic volume (GEDV), intrathoracic blood volume (ITBV) and extravascular lung water (EVLW). The central venous pressure (CVP) was measured using a central venous line. A patient with an increase in cardiac output of ≥ 10% after VE was considered a responder. The various parameters prior to VE were compared between the group responders and the group non-responders using a Mann-Whitney U test; a p-value of <0.05 was considered statistically significant. The effect of VE on the various hemodynamic parameters was analyzed using the Wilcoxon signed rank test. Results: Fluid was at least 1 time administered to eight of the included patients. There have been 15 moments of VE during the period in which the patients were mechanically ventilated; 10 have been defined non-responders and 5 responders. No significant difference was found between the groups of responders and non-responders for the CVP (p=0.097) and the dynamic parameter SVV (p=0.077) prior to VE. The PPV was significantly lower for responders (p=0.001) when compared to non-responders prior to VE. In addition the results showed that there is a significant increase in EVLW (p=0.000), EVLWI (p=0.000), MAD (p=0.006) and SV (p=0.000) for responders after VE. Non-responders showed a significant increase in MAP (p=0.000), SVR (p=0.000), and a decrease in SVV (p=0.026) and PPV (p=0.003). Conclusion: This study demonstrated that postoperatively none of the static or dynamic parameters SVV and PPV were accurate predictors of fluid responsiveness in mechanically ventilated children after heart surgery.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Kneyber dr. M.C.J. kinder-intensivist and Beatrix Kinderziekenhuis UMCG, kinder intensive care |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1066 |
Actions (login required)
 |
View Item |