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Trendelenburg maneuver predicts fluid responsiveness in patients on veno-arterial extracorporeal membrane oxygenation.


ABSTRACT:

Background

Evaluation of fluid responsiveness during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support is crucial. The aim of this study was to investigate whether changes in left ventricular outflow tract velocity-time integral (?VTI), induced by a Trendelenburg maneuver, could predict fluid responsiveness during VA-ECMO.

Methods

This prospective study was conducted in patients with VA-ECMO support. The protocol included four sequential steps: (1) baseline-1, a supine position with a 15° upward bed angulation; (2) Trendelenburg maneuver, 15° downward bed angulation; (3) baseline-2, the same position as baseline-1, and (4) fluid challenge, administration of 500 mL gelatin over 15 min without postural change. Hemodynamic parameters were recorded at each step. Fluid responsiveness was defined as ?VTI of 15% or more, after volume expansion.

Results

From June 2018 to December 2019, 22 patients with VA-ECMO were included, and a total of 39 measurements were performed. Of these, 22 measurements (56%) met fluid responsiveness. The R2 of the linear regression was 0.76, between ?VTIs induced by Trendelenburg maneuver and the fluid challenge. The area under the receiver operating characteristic curve of ?VTI induced by Trendelenburg maneuver to predict fluid responsiveness was 0.93 [95% confidence interval (CI) 0.81-0.98], with a sensitivity of 82% (95% CI 60-95%), and specificity of 88% (95% CI 64-99%), at a best threshold of 10% (95% CI 6-12%).

Conclusions

Changes in VTI induced by the Trendelenburg maneuver could effectively predict fluid responsiveness in VA-ECMO patients. Trial registration ClinicalTrials.gov, NCT03553459 (the TEMPLE study). Registered on May 30, 2018.

SUBMITTER: Luo JC 

PROVIDER: S-EPMC7838230 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Trendelenburg maneuver predicts fluid responsiveness in patients on veno-arterial extracorporeal membrane oxygenation.

Luo Jing-Chao JC   Su Ying Y   Dong Li-Li LL   Hou Jun-Yi JY   Li Xin X   Zhang Ying Y   Ma Guo-Guang GG   Zheng Ji-Li JL   Hao Guang-Wei GW   Wang Huan H   Zhang Yi-Jie YJ   Luo Zhe Z   Tu Guo-Wei GW  

Annals of intensive care 20210126 1


<h4>Background</h4>Evaluation of fluid responsiveness during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support is crucial. The aim of this study was to investigate whether changes in left ventricular outflow tract velocity-time integral (ΔVTI), induced by a Trendelenburg maneuver, could predict fluid responsiveness during VA-ECMO.<h4>Methods</h4>This prospective study was conducted in patients with VA-ECMO support. The protocol included four sequential steps: (1) baseline-1, a  ...[more]

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