Use of the cardiac power index to predict fluid responsiveness in the prone position: a proof-of-concept study
Uso do índice de potência cardíaca para prever a responsividade a fluidos na posição prona: um estudo de prova de conceito
Ji Young Min, Joon Pyo Jeon, Mee Young Chung, Chang Jae Kim
Abstract
Background
The primary aim of this proof-of-concept study was to investigate whether the Cardiac Power Index (CPI) could be a novel alternative method to assess fluid responsiveness in the prone position.
Methods
Patients undergoing scheduled elective lumbar spine surgery in the prone position under general anesthesia were enrolled in the criteria of patients aged 19–75 years with American Society of Anesthesiologists (ASA) physical status I–II. The hemodynamic variables were evaluated before and after changes in posture after administering a colloid bolus (5 mL.kg−1) in the prone position. Fluid responsiveness was defined as an increase in the Stroke Volume Index (SVI) ≥ 10%.
Results
A total of 28 patients were enrolled. In responders, the CPI (median [1/4Q–3/4Q]) decreased to 0.34 [0.28–0.39] W.m−2 (p = 0.035) after the prone position. After following fluid loading, CPI increased to 0.48 [0.37–0.52] W.m−2 (p < 0.008), and decreased SVI (median [1/4Q–3/4Q]) after prone increased from 26.0 [24.5–28.0] mL.m−2 to 33.0 [31.0–37.5] mL.m−2 (p = 0.014). Among non-responders, CPI decreased to 0.43 [0.28–0.53] W.m−2 (p = 0.011), and SVI decreased to 29.0 [23.5–34.8] mL.m−2 (p < 0.009). CPI exhibited predictive capabilities for fluid responsiveness as a receiver operating characteristic curve of 0.78 [95% Confidence Interval, 0.60–0.95; p = 0.025].
Conclusion
This study suggests the potential of CPI as an alternative method to existing preload indices in assessing fluid responsiveness in clinical scenarios, offering potential benefits for responders and non-responders.
Keywords
Resumo
Introdução
O objetivo principal deste estudo de prova de conceito foi investigar se o Índice de Potência Cardíaca (IPC) poderia ser um novo método alternativo para avaliar a responsividade a fluidos na posição prona.
Métodos
Pacientes submetidos a cirurgia eletiva programada da coluna lombar na posição prona sob anestesia geral foram inscritos nos critérios de pacientes com idade entre 19 e 75 anos com estado físico I–II da Sociedade Americana de Anestesiologistas (ASA). As variáveis hemodinâmicas foram avaliadas antes e depois de mudanças na postura após a administração de um bolus coloidal (5 mL.kg−1) na posição prona. A responsividade a fluidos foi definida como um aumento no Índice de Volume Sistólico (IVS) ≥ 10%.
Resultados
Um total de 28 pacientes foram inscritos. Nos respondedores, o IPC (mediana [1/4Q–3/4Q]) diminuiu para 0,34 [0,28–0,39] W.m−2 (p = 0,035) após a posição prona. Após a carga de fluidos, o IPC aumentou para 0,48 [0,37–0,52] W.m−2 (p < 0,008) e o IVS diminuiu (mediana [1/4Q–3/4Q]) após a posição prona aumentou de 26,0 [24,5–28,0] mL.m−2 para 33,0 [31,0–37,5] mL.m−2 (p = 0,014). Entre os não respondedores, o IPC diminuiu para 0,43 [0,28–0,53] W.m−2 (p = 0,011) e o IVS diminuiu para 29,0 [23,5–34,8] mL.m−2 (p < 0,009). O IPC exibiu capacidades preditivas para responsividade a fluidos como uma curva característica de operação do receptor de 0,78 [Intervalo de confiança de 95%, 0,60–0,95; p = 0,025].
Conclusão
Este estudo sugere o potencial do CPI como um método alternativo aos índices de pré-carga existentes na avaliação da responsividade a fluidos em cenários clínicos, oferecendo benefícios potenciais para respondedores e não respondedores.
Palavras-chave
Referências
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Submetido em:
08/04/2024
Aceito em:
23/07/2024
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