Application of variation of internal jugular vein respiration for predicting fluid responsiveness in patients undergoing laparo- scopic surgery

Abstract

Objective To evaluate the application of variation of internal jugular vein respiration (VIJVR) for predicting fluid responsiveness in patients undergoing laparoscopic surgery. Methods A total of 44 patients, aged 40- 65, with body mass index (BMI) of 18-25 kg/m2, American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ , were selected who received laparoscopic radical resection for rectal cancer from November 2016 to March 2017 in Northern Jiangsu People's Hospital. After patients entered into the room, their electrocardiogram (ECG), heart rate, pulse oxygen saturation (SpO2) and noninvasive blood pressure (NIBP), central vein pressure (CVP), cardiac output (CO), cardiac index (CI), stroke volume variation (SVV), and stroke volume index (SVI) were monitored. The max-imum and minimum diameters of the internal jugular vein (DIJVmax and DIJVmin) were measured by ultrasound within three respiratory cycles and VIJVR was calculated as the following formula: VIJVR=[(DIJVmax-DIJVmin)/DIJVmin] ×100%. Then, 10 min after the beginning of laparoscopy, 6% hydroxyethyl starch 130/0.4 (HES130/0.4, 500 ml) in sodium chloride injection water was infused at a dose of 7 ml/kg within 15 min. Meanwhile, heart rate, blood pressure, CO, CI, SVV, SVI and VIJVR were recorded 10 min after tracheal intubation (T1), 10 min after the beginning of pneumoperitoneum (T2) and 10 min after the end of infusion of 6% HES130/0.4 (T3). According to the increase of stroke volume index (△SVI) after volume challenge, the patients were divided into responders (group R, △SVI≥15%, n=29) and non-responders (group N, △SVI<15%, n=15). The relationship between VIJVR and fluid responsiveness was analyzed by receiver operating characteristic (ROC) curve. Results The VIJVR before volume challenge was negatively related with △SVI in the presence of pneumoperitoneum (r=-0.451, P<0.05). The area under the ROC curve (AUC) of VIJVR to predict volume responsiveness was 0.83 (95%CI 0.705-0.950, P<0.05), with a sensitivity of 65.5% and a specificity of 93.3% when the cut-off value of VIJVR was 21% for predicting volume responsiveness. Conclusions VIJVR can well predict fluid responsiveness in patients undergoing laparoscopic surgery. Key words: Variation of internal jugular vein respiration; Therapeutic laparoscopy; Fluid responsiveness