Does the systolic pressure variation change in the prone position?

Marks, Roger; Silverman, Richard B.; Fernández, R.; Candiotti, Keith A.; Fu, Eugene S.

doi:10.1007/s10877-009-9194-8

Cited by 11 publications

(12 citation statements)

References 13 publications

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“…25 Systolic pressure variation may also be used for fluid status monitoring as it increases during hypovolemia. 27 High-risk patients should be identified so that positioning can be optimized, and adhesive defibrillator pads can be applied prior to surgery. 24 Patients in prone position on the Jackson spine table showed the least change in cardiac function (relative to supine position) compared with other prone position types.…”

Section: Recommendationsmentioning

confidence: 99%

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Kwee

Rozen

2015

International Surgery

210

162

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Surgery in the prone position is often a necessity when access to posterior anatomic structures is required. However, many complications are known to be associated with this type of surgery, as physiologic changes occur with increased pressure to anterior structures. While several studies have discussed postoperative vision loss, much fewer studies with lower levels of evidence have addressed other complications. A systematic literature review was conducted using 2 different databases, and 53 papers were regarded as appropriate for inclusion. Qualitative and quantitative analysis was performed. Thirteen complications were identified. Postoperative vision loss and cardiovascular complications, including hypovolemia and cardiac arrest, had the most number of studies and highest level of evidence. Careful planning for optimal positioning, padding, timing, as well as increased vigilance are evidence-based recommendations where operative prone positioning is required.

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Section: Recommendationsmentioning

confidence: 99%

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Kwee

Rozen

2015

International Surgery

210

162

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“…Our finding of a positive association between non-supine positioning and SPV values offers insight into currently contrasting literature, which have examined alterations in dynamic arterial waveform indices associated with variations in surgical positioning, including prone, 19,24,32 Trendelenburg, 23,50 and reverse Trendelenburg. 50 SVV and PPV demonstrated increases when prone, 19 whereas SPV demonstrated no association.…”

Section: Discussionmentioning

confidence: 66%

“…50 SVV and PPV demonstrated increases when prone, 19 whereas SPV demonstrated no association. 32 With regards to table positioning (e.g. Trendelenburg) as opposed to patient position, a lack of standardized documentation in our intraoperative record precluded this analysis, and thus was a limitation to our study.…”

Section: Discussionmentioning

confidence: 99%

“…Although the anesthesiologist must be aware of the possible effects of surgical positioning on SPV and PPV, current literature is promising in that such indices remain effective measures of predicting fluid-responsiveness in these settings. 19,23,24,32 …”

Section: Discussionmentioning

confidence: 99%

“…BMI, tidal volume, peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), and MAP cutoffs were chosen as used in prior literature. 12,26,32-35 A patient age cutoff was chosen based upon median age of the study population. Fluid administration was converted to crystalloid equivalents (colloids multiplied by a factor of 1.5), 36 with a 1000 mL binary cutoff.…”

Section: Methodsmentioning

confidence: 99%

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Arterial Pressure Variation in Elective Noncardiac Surgery: Identifying Reference Distributions and Modifying Factors

et al. 2017

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Background Assessment of need for intravascular volume resuscitation remains challenging for anesthesiologists. Dynamic waveform indices, including systolic and pulse pressure variation, are demonstrated as reliable measures of fluid responsiveness for mechanically ventilated patients. Despite widespread use, real-world reference distributions for systolic and pulse pressure variation values have not been established for euvolemic intraoperative patients. The authors sought to establish systolic and pulse pressure variation reference distributions and assess the impact of modifying factors. Methods The authors evaluated adult patients undergoing general anesthetics for elective noncardiac surgery. Median systolic and pulse pressure variations during a 50-min postinduction period were noted for each case. Modifying factors including body mass index, age, ventilator settings, positioning, and hemodynamic management were studied via univariate and multivariable analyses. For systolic pressure variation values, effects of data entry method (manually entered vs. automated recorded) were similarly studied. Results Among 1,791 cases, per-case median systolic and pulse pressure variation values formed nonparametric distributions. For each distribution, median values, interquartile ranges, and reference intervals (2.5th to 97.5th percentile) were, respectively, noted: these included manually entered systolic pressure variation (6.0, 5.0 to 7.0, and 3.0 to 11.0 mmHg), automated systolic pressure variation (4.7, 3.9 to 6.0, and 2.2 to 10.4 mmHg), and automated pulse pressure variation (7.0, 5.0 to 9.0, and 2.0 to 16.0%). Nonsupine positioning and preoperative β blocker were independently associated with altered systolic and pulse pressure variations, whereas ventilator tidal volume more than 8 ml/kg ideal body weight and peak inspiratory pressure more than 16 cm H2O demonstrated independent associations for systolic pressure variation only. Conclusions This study establishes real-world systolic and pulse pressure variation reference distributions absent in the current literature. Through a consideration of reference distributions and modifying factors, the authors’ study provides further evidence for assessing intraoperative volume status and fluid management therapies.

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Comparison of ability of pulse pressure variation to predict fluid responsiveness in prone and supine position: an observational study

Ali

Abdullah

Sabancı

et al. 2018

J Clin Monit Comput

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We aimed to compare the ability of pulse pressure variation (PPV) to predict fluid responsiveness in prone and supine positions and investigate effect of body mass index (BMI), intraabdominal pressure (IAP) and static respiratory compliance (CS) on PPV. A total of 88 patients undergoing neurosurgery were included. After standardized anesthesia induction, patients' PPV, stroke volume index (SVI), CS and IAP values were recorded in supine (T1) and prone (T2) positions and after fluid loading (T3). Also, PPV change percentage (PPV) between T2 and T1 times was calculated. Patients whose SVI increased more than 15% after the fluid loading were defined as volume responders. In 10 patients, PPV was ≤ - 20%. All of these patients had CS < 31 ml/cmHO, seven had BMI > 30 kg/m, and two had IAP > 15 mmHg. In 16 patients, PPV was ≥ 20%. In these patients, 10 had CS < 31 ml/cmHO, 10 had BMI > 30 kg/m, and 12 had IAP > 15 mmHg. Thirty-nine patients were volume responder. When all patients were examined for predicting fluid responsiveness, area under curves (AUC) of PPV (0.790, 95%CI 0.690-0.870) was significantly lower than AUC of PPV (0.937, 95%CI 0.878-0.997) with ROC analysis (p = 0.002). When patients whose CS was < 31 ml/cmHO and whose BMI was > 30 kg/m were excluded from analysis separately, AUC of PPV became similar to PPV. PPV in the prone can predict fluid responsiveness as good as PPV in the supine, only if BMI is < 30 kg/m and CS value at prone is > 31 ml/cmHO.

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Does the systolic pressure variation change in the prone position?

Cited by 11 publications

References 13 publications

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Arterial Pressure Variation in Elective Noncardiac Surgery: Identifying Reference Distributions and Modifying Factors

Comparison of ability of pulse pressure variation to predict fluid responsiveness in prone and supine position: an observational study

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