Could the Stroke Volume Variation Predict a Fluid Responsiveness in Thoracotomy?
Condition: Pulmonary Neoplasm; Pulmonary Tuberculosis
MeSH terms: Tuberculosis; Tuberculosis, Pulmonary; Lung Neoplasms
Study type: Observational [Patient Registry]

Summary: 
      There are some risks of pulmonary edema in patients undergoing pulmonary lobectomy with one
      lung ventilation. The overloading of fluid administration could be related to the development
      of pulmonary edema in patents after thoracic surgery. But fluid restriction may cause major
      organ hypoperfusion during the surgery. The purpose of this study is to evaluate the ability
      of stroke volume variation as an indicator for a fluid responsiveness in patient who receives
      pulmonary lobectomy via thoracotomy.
    

Detailed description: 
      Perioperative fluid management during thoracic surgery is a significantly important, because
      it is quite difficult to prevent pulmonary edema due to the fluid overload and compromise
      perfusion of vital organ. So, it is essential to maintain optimal organ perfusion by
      appropriate fluid management during thoracic surgery. Stroke volume variation (SVV) is
      derived from pulse contour analysis and it is known that SVV ≥12~15% correlate with fluid
      responsiveness, defined as a significant increase in cardiac output with fluid loading, dung
      two-lung ventilation. It is a parameter derived from changes in stroke volume (SV) that is
      according to the heart-lung interaction during mechanical ventilation. positive pressure
      ventilation induces cyclic changes in left ventricular SV that are related mainly to the
      expiratory decrease in right ventricular filling and ejection. This is a reflected by
      variations in the SV. However both ventilator issues, such as tidal volume, PEEP, chest and
      lung condition, and the cardiovascular condition, such as heart rate, rhythm, ventricular
      function, cardiac afterload, arterial compliance may affect SVV. Recently some studies
      reported that SVV could predict fluid responsiveness in mechanically ventilated patients
      under various conditions. But it is still unclear whether SVV could predict fluid
      responsiveness during one lung ventilation with the chest open via a thoracotomy. During
      one-lung ventilation, the shunted blood flow through the non-ventilated-lung dose not
      contribute to the generation of SVV. And with the chest opening by thoracotomy, the pressure
      generated by ventilator would not be transmitted to the pulmonary vessels but rather to the
      atmosphere. So, the purpose of this study is to evaluate the ability of SVV as an indicator a
      fluid responsiveness particularly in patients undergoing one-lung ventilation with
      thoracotomy and to found the optimal threshold value of SVV for fluid management during
      thoracic surgery.
    

Intervention name(s): fluid loading; thoracoscopic pulmonary lobectomy; thoracotomy
Intervention type(s): Other; Procedure; Procedure
Intervention description(s): Fluid loading at defined period
500ml colloid solution infusion at 20min after thorax open for 30min. 500ml colloid administration is a kind of routine procedure during pulmonary lobectomy in our hospital. We just control the fluid loading timing for hemodynamic parameter records.; the patient group for scheduled thoracoscopic pulmonary lobectomy; the patient group for scheduled open pulmonary lobectomy
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The patients scheduled for pulmonary lobectomy with one lung ventilation by lung cancer,
        nodule, or pulmonary tuberculosis under thoracoscopy or thoracotomy in our hospital were
        included.
      
Keywords: Stroke volume variation; fluid responsiveness; One-lung ventilation; thoracotomy