Changes in R-Wave amplitude in DII lead is less sensitive than pulse pressure variation to detect changes in stroke volume after fluid challenge in ICU patients postoperatively to cardiac surgery
The amplitude of R-wave in DII lead (RDII) has been shown to correlate to central blood volume in animal and healthy volunteers. The aim of this study was to assess if change in RDII (ΔRDII) after passive leg rise (PLR) and fluid loading would allow detecting preload dependence in intensive care ventilated patients. This parameter was compared to concomitant changes in pulse arterial pressure (ΔPP).
Observational study in 40 stable sedated and ventilated cardiac surgery patients studied postoperatively. In line with our routine practice we performed a 45° passive leg rise (PLR1) to detect preload dependence. If cardiac index or ΔPP rose more than 12 and 13%, respectively, the patient was declared as non-responder (NR) to fluid loading. If these criteria were not met, they were declared as responders (R) and received a 500 ml of gelatin fluid loading (FL) followed by a second passive leg rise (PLR2). Hemodynamic parameters were assessed during each maneuver using their indwelling Swan-Ganz and radial catheter.
We identified 16 R and 24 NR whose hemodynamic parameters did not differ at basal condition, except ΔPP (19% ± 7 in R vs. 7% ± 4 in NR, P < 0.001). PLR1 did not elicit any hemodynamic change in NR. In R, ΔPP decreased and SV rose, both significantly (P < 0.001) whereas ΔRDII did not vary. FL induced a more pronounced change in these parameters.
ΔRDII in response to PLR does not successfully help identifying preload dependent patients contrarily to ΔPP or change in stroke volume.
KeywordsECG fluid loading cardiac surgery postoperative
Central venous pressure,
Diastolic arterial pressure,
Pulmonary artery occluded pressure,
Plateau airway pressure,
Passive leg rise,
Standard II ECG lead,
Systolic arterial pressure,
Respiratory induced change in pulse pressure,
Change in RDII
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The authors performed this study in the course of their normal duties as full-time salaried employees of publicly funded healthcare institutions. The AFSSAPS provided the data used for the study, free of charge. The clinical department of L. Beydon provided additional funds for the data analysis.
Conflicts of interest
Christophe Soltner, MD. Romain Dantec, MD. Frédéric Lebreton, MD. Julien Huntzinger, MD. Laurent Beydon MD, PhD declare not having any conflict of interest to disclose.
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