Objective. To test if splenic Doppler resistive index (SDRI) allows noninvasivemonitoring of changes in stroke volume and regional\nsplanchnic perfusion in response to fluid challenge. Design and Setting. Prospective observational study in cardiac intensive care\nunit. Patients. Fifty-three patients requiring mechanical ventilation and fluid challenge for hemodynamic optimization after cardiac\nsurgery. Interventions. SDRI values were obtained before and after volume loading with 500 mL of normal saline over 20 min\nand compared with changes in systemic hemodynamics, determined invasively by pulmonary artery catheter, and arterial lactate\nconcentration as expression of splanchnic perfusion. Changes in stroke volume >10% were considered representative of fluid\nresponsiveness. Results. A <4% SDRI reduction excluded fluid responsiveness, with 100% sensitivity and 100% negative predictive\nvalue. A >9% SDRI reduction was amarker of fluid responsiveness with 100%specificity and 100%positive predictive value. A >4%\nSDRI reductionwas always associatedwithanimprovement of splanchnic perfusionmirrored by an increase in lactate clearance and\na reduction in systemic vascular resistance, regardless of fluid responsiveness. Conclusions. This study shows that SDRI variations\nafter fluid administration is an effective noninvasive tool to monitor systemic hemodynamics and splanchnic perfusion upon\nvolume administration, irrespective of fluid responsiveness in mechanically ventilated patients after cardiac surgery.
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