Diagnosis Accuracy of Mean Arterial Pressure Variation during a Lung Recruitment Maneuver to Predict Fluid Responsiveness in Thoracic Surgery with One-Lung Ventilation.

Background . Lung recruitment maneuver (LRM) during thoracic surgery can reduce systemic venous return and resulting drop in systemic blood pressure depends on the patient's fluid status. We hypothesized that changes in systemic blood pressure during the transition in LRM from one-lung ventilation (OLV) to two-lung ventilation (TLV) may provide an index to predict fluid responsiveness. Methods . Hemodynamic parameters were measured before LRM ( T 0); after LRM at the time of the lowest mean arterial blood pressure (MAP) ( T 1) and at 3 minutes ( T 2); before fluid administration ( T 3); and 5 minutes after ending it ( T 4). If the stroke volume index increased by >25% following 10 mL/kg colloid administration for 30 minutes, then the patients were assigned to responder group. Results . Changes in MAP, central venous pressure (CVP), and stroke volume variation (SVV) between T 0 and T 1 were significantly larger in responders. Areas under the curve for change in MAP, CVP, and SVV were 0.852, 0.759, and 0.820, respectively; the optimal threshold values for distinguishment of responders were 9.5 mmHg, 0.5 mmHg, and 3.5%, respectively. Conclusions . The change in the MAP associated with LRM at the OLV to TLV conversion appears to be a useful indicator of fluid responsiveness after thoracic surgery.

TRIAL REGISTRATION: This trial is registered at Clinical Research Information Service with KCT0000774.