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CARDIOVASCULAR ANESTHESIA

Assessing Fluid-Responsiveness by a Standardized Ventilatory Maneuver: The Respiratory Systolic Variation Test

Azriel Perel, MD^*, Leonid Minkovich, MD^*, Sergey Preisman, MD^*, Michel Abiad, MD, Eran Segal, MD^*, and Pierre Coriat, MD

*Departments of Anesthesiology and Intensive Care, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel; and Hôpital de la Pitié-Salpétrière, Université Pierre et Marie Curie, Paris VI, France

Address correspondence to Azriel Perel, MD, Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, 52621, Isreael. Address e-mail to perelao{at}shani.net.

Respiratory-induced changes in arterial blood pressure predict fluid responsiveness. However, the accuracy of these variables is affected by the preset tidal volume and by the early inspiratory increase in arterial blood pressure. We have therefore calculated the slope produced by the minimal systolic blood pressures (plotted against the respective airway pressures) during a ventilatory maneuver consisting of four incremental, successive, pressure-controlled breaths, termed the Respiratory Systolic Variation Test (RSVT). In 14 ventilated patients, after major vascular surgery, the slope of the RSVT decreased significantly after intravascular fluid administration and correlated with the end-diastolic area and with changes in cardiac output better than filling pressures. This preliminary study suggests that a standardized ventilatory maneuver may be useful in guiding fluid therapy in ventilated patients.

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