Respiratory stroke volume variation assessed by oesophageal Doppler monitoring predicts fluid responsiveness during laparoscopy

This study was designed to assess the ability of the stroke volume respiratory variation (respSV) determined by oesophageal Doppler monitoring (ODM) to predict the response to volume expansion (VE) during pneumoperitoneum. The predictive value of respSV was evaluated according to the concept of the grey zone. Patients operated on laparoscopy and monitored by ODM were prospectively included. The exclusion criteria were frequent ectopic beats or preoperative arrhythmia, right ventricular failure, and spontaneous breathing. Haemodynamic parameters and oesophageal Doppler indices [stroke volume (SV), peak velocity (PV), cardiac output (CO), corrected flow time (FTc), respiratory variation of PV (respPV) and SV (respSV)] were collected before and after VE. Responders were defined as a 15 increase in SV after VE. Thirty-eight (64) of the 59 patients were responders. A cut-off of 14 respSV predicted fluid responsiveness with an area under the ROC curve (AUC) of 0.92 [95 confidence interval (CI): 0.820.98, P0.0001]. The grey zone of respSV ranged between 13 and 15. With an AUC of 0.71 (95 CI: 0.560.83, P0.005), respPV fairly accurately predicted fluid responsiveness. FTc was unable to accurately predict fluid responsiveness. respSV and respPV predicted fluid responsiveness during laparoscopy under strict physiological conditions. FTc was not predictive of fluid responsiveness during laparoscopy.