Clin Transplant Res.  2024 Sep;38(3):188-196. 10.4285/ctr.24.0025.

Assessment of fluid responsiveness after tidal volume challenge in renal transplant recipients: a nonrandomized prospective interventional study

• Nimje GR
• Goyal VK
• Singh P
• Shekhrajka P
• Mishra A
• Mittal S

• KMID: 2559804
• DOI: http://doi.org/10.4285/ctr.24.0025

Abstract

Background
When applying lung-protective ventilation, fluid responsiveness cannot be predicted by pulse pressure variation (PPV) or stroke volume variation (SVV). Functional hemodynamic testing may help address this limitation. This study examined whether changes in dynamic indices such as PPV and SVV, induced by tidal volume challenge (TVC), can reliably predict fluid responsiveness in patients undergoing renal transplantation who receive lung-protective ventilation.
Methods
This nonrandomized interventional study included renal transplant recipients with end-stage renal disease. Patients received ventilation with a 6 mL/kg tidal volume (TV), and the FloTrac system was attached for continuous hemodynamic monitoring. Participants were classified as responders or nonresponders based on whether fluid challenge increased the stroke volume index by more than 10%.
Results
The analysis included 36 patients, of whom 19 (52.8%) were responders and 17 (47.2%) were nonresponders. Among responders, the mean ∆PPV _6-8 (calculated as PPV at a TV of 8 mL/kg predicted body weight [PBW] minus that at 6 mL/kg PBW) was 3.32±0.75 and ∆SVV _6-8 was 2.58±0.77, compared to 0.82±0.53 and 0.70±0.92 for nonresponders, respectively. ∆PPV _6-8 exhibited an area under the curve (AUC) of 0.97 95% confidence interval [CI], 0.93–1.00; P≤0.001), with an optimal cutoff value of 1.5, sensitivity of 94.7%, and specificity of 94.1%. ∆SVV _6-8 displayed an AUC of 0.93 (95% CI, 0.84–1.00; P≤0.001) at the same cutoff value of 1.5, with a sensitivity of 94.7% and a specificity of 76.5%.
Conclusions
TVC-induced changes in PPV and SVV are predictive of fluid responsiveness in renal transplant recipients who receive intraoperative lung-protective ventilation.

Keyword

Hemodynamics; Kidney transplantation; Operating room; Tidal volume

Figure

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  Fig. 1 Flowchart of the study population. SAP, systolic arterial pressure.

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  Fig. 2 Error bar charts across various time points for (A) PPV and (B) SVV. PPV, pulse pressure variation; SVV, stroke volume variation; TV, tidal volume; TVC, tidal volume challenge.

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  Fig. 3 Receiver operating characteristic (ROC) curves comparing the capacity of various variables to discriminate between fluid responders and nonresponders. The ROC curves are derived from six diagnostic parameters used to assess fluid responsiveness: (A) baseline-1 TVC PPV, the PPV during ventilation with a tidal volume of 6 mL/kg predicted body weight; 8 mL TVC-PPV, the PPV during ventilation with a tidal volume of 8 mL/kg predicted body weight; ΔPPV6-8, the change in PPV upon transition from 6 to 8 mL/kg predicted body weight tidal volume. (B) Baseline-1 TVC SVV, the SVV during ventilation with a tidal volume of 6 mL/kg predicted body weight; 8 mL TVC-SVV, the SVV during ventilation with a tidal volume of 8 mL/kg predicted body weight; and ΔSVV6-8, the change in SVV upon transition from 6 to 8 mL/kg predicted body weight tidal volume. TVC, tidal volume challenge; PPV, pulse pressure variation; SVV, stroke volume variation.

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