Dynamic tests to predict fluid responsiveness after off-pump coronary artery bypass grafting

ABSTRACT Objective To test the hypothesis that positive end-expiratory pressure test and the mini-fluid challenge predict fluid responsiveness in patients after off-pump coronary artery bypass grafting. Design Single-center pilot prospective observational study. Setting City Hospital #1 of Arkhangelsk, Russian Federation. Participants Thirty-two adult patients after off-pump coronary surgery. Interventions To assess fluid responsiveness, after arrival to ICU all patients received test with increase in positive end-expiratory pressure from 5 to 20 cm H2O for 2 min, mini-fluid challenge test with administration of crystalloids 1.5 mL.kg during 2 min and standard fluid challenge test using 7 mL.kg during 10 min. Measurements and main results The patients with an increase in cardiac index by ≥ 15% after standard fluid challenge test were defined as fluid responders. According to receiver operating characteristic analysis, decrease in mean arterial pressure exceeding 5 mm Hg to 120 sec of the positive end-expiratory pressure test identified fluid responsiveness with area under curve (AUC) 0.73 (p = 0.03). The reduction in pulse pressure and stroke volume variations by more than 2% during mini-fluid challenge test predicted positive response to fluid load with AUC 0.77 and 0.75, respectively (p Conclusions Both the positive end-expiratory pressure test and the mini-fluid challenge test are feasible after off-pump coronary artery bypass grafting and can be used to predict fluid responsiveness in these patients.