Prediction of Fluid Responsiveness in Children With Single Ventricle

The purpose of this study is to evaluate predictability of an abdominal compression-induced change of blood pressure for fluid responsiveness in children with single ventricle (bidirectional cavopulmonary shunt and Fontan tract).

When there are clinical signs of hypovolemia, such as hypotension, decreased urine output or decreased central venous pressure, right upper abdomen is gently compressed for 10 seconds. Changes of blood pressure are continuously recorded during this period. About 3 min later, intravenous colloid fluid 10 mL/kg is infused for 20 min.

To evaluate the change of cardiac output, transesophageal or transthoracic echocardiography is performed before and after fluid administration. In addition, hemodynamic parameters including pulse pressure variation, systolic pressure variation, pleth variability index and central venous pressure are also recorded before and after fluid administration.

Finally, patients will be divided into fluid responder group and non-responder group. If cardiac output measured using echocardiography increases over 15% after fluid administration, the patient is fluid responder. Using ROC curve, diagnostic power of abdominal compression-induced blood pressure change for fluid responsiveness will be evaluated

Inclusion criteria

• Pediatric patients undergoing elective surgery, who require invasive blood pressure and central venous pressure monitoring during surgery
• Patients with bidirectional cavopulmonary shunt or fontan tract

Exclusion criteria

• renal, hepatic and pulmonary disease
• preoperative infection: increased CPR, WBC over 10,000, and with fever
• genetic and hematologic disease
• ventricular dysfunction
• increased intracranial pressure