Pulse Pressure Variation Predicts Fluid Responsiveness Following Coronary Artery Bypass Surgery

Kramer, A A; Zygun, David; Hawes, Harvey G.; Easton, Paul A.; Ferland, André

doi:10.1378/chest.126.5.1563

Cited by 167 publications

(93 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…ventilated canine model of ALI, shows that over a wide range of filling pressures and levels of PEEP, SPV was very closely related to LV preload during the ventilation cycle. In keeping with previous studies, SPV was also closely associated with LV output [1][2][3][12][13][14][15][16]. Despite the differences in our animal model and the patients studied by Kramer et al [3], there was close agreement in the relative threshold in SPV that was predictive of volume responsiveness.…”

Section: Discussionsupporting

confidence: 89%

“…Increased PEEP decreased SV and increased SPV at each filling pressure. The normal range of SPV was defined as ≤ 5% [3]. As is apparent in the figure, this defines the decrease in SV corresponding to SPV ≤ 5%, which equaled ~15% (100 − 85%).…”

Section: Resultsmentioning

confidence: 99%

“…Cyclical changes in left ventricular (LV) preload during mechanical ventilation and the resultant changes in stroke volume are related to complex cardiopulmonary interactions including changes in external constraint and LV afterload, as well as systemic and pulmonary venous return through series and direct ventricular interaction [4][5][6][7][8][9][10][11]. The magnitude of SPV has been shown to predict responsiveness to a volume challenge [1][2][3][12][13][14][15][16]. One might anticipate that as LV and right ventricular (RV) preload increase during volume loading, changes in intrathoracic pressure would affect ventricular filling (and output) less and thus, SPV would be less.…”

Section: Distress; Preloadmentioning

confidence: 99%

“…The ability to predict the hemodynamic response to a volume challenge should facilitate patient management and might help to avoid harm in those who are unlikely to benefit from volume loading.Systolic arterial pressure variation (SPV) during mechanical ventilation is more pronounced in hypovolemic than in euvolemic patients [1][2][3]. Cyclical changes in left ventricular (LV) preload during mechanical ventilation and the resultant changes in stroke volume are related to complex cardiopulmonary interactions including changes in external constraint and LV afterload, as well as systemic and pulmonary venous return through series and direct ventricular interaction [4][5][6][7][8][9][10][11].…”

mentioning

confidence: 99%

See 3 more Smart Citations

Left Ventricular Preload Determines Systolic Pressure Variation during Mechanical Ventilation in Acute Lung Injury

Mitchell¹,

Doig²,

Whitelaw³

2011

J Clinic Experiment Cardiol

View full text Add to dashboard Cite

Although volume is commonly administered to patients with hemodynamic compromise during mechanical ventilation to improve cardiac output, excessive amounts may precipitate or aggravate pulmonary edema, especially in patients with predisposing pulmonary or cardiac conditions. The ability to predict the hemodynamic response to a volume challenge should facilitate patient management and might help to avoid harm in those who are unlikely to benefit from volume loading.Systolic arterial pressure variation (SPV) during mechanical ventilation is more pronounced in hypovolemic than in euvolemic patients [1][2][3]. Cyclical changes in left ventricular (LV) preload during mechanical ventilation and the resultant changes in stroke volume are related to complex cardiopulmonary interactions including changes in external constraint and LV afterload, as well as systemic and pulmonary venous return through series and direct ventricular interaction [4][5][6][7][8][9][10][11]. The magnitude of SPV has been shown to predict responsiveness to a volume challenge [1][2][3][12][13][14][15][16]. One might anticipate that as LV and right ventricular (RV) preload increase during volume loading, changes in intrathoracic pressure would affect ventricular filling (and output) less and thus, SPV would be less. Alternatively stated, at higher filling pressures, the ventricles are on a flatter part of the Starling curve (fiber length cannot be increased further by increasing the filling pressure further). Therefore, a given airway pressure is less likely to reduce fiber length at higher filling pressures than at lower pressures where the Starling curve is steeper.We therefore assessed the relations between LV preload, output and SPV in an oleic acid (OA) induced acute lung injury (ALI) model in which LV filling pressures and positive end-expiratory pressures (PEEP) were systematically varied. We also assessed the potential value of estimated transmural LV end-diastolic pressure [left atrial enddiastolic pressure (P LAED ) -RV end-diastolic pressure (P RVED )], which reflects LV preload, in predicting volume responsiveness in our model. MethodsThis study was approved by the institutional animal care committee whose criteria are consistent with those of the American Physiological Society. Animal preparationIn 8 mongrel dogs of either sex (20-30 kg, mean 24 kg), anesthesia was induced with thiopental sodium (25 mg/kg i.v.) and midazolam (5 mg/ml bolus) and was maintained with fentanyl citrate (0.04 mg/ml i.v., initially, followed by an infusion of 4 mg/h), which was adjusted AbstractBackground: Systolic pressure variation (SPV) predicts responsiveness to volume loading during mechanical ventilation and may be related to changes in LV preload and the resultant changes in stroke volume (SV). We, therefore, tested the relations between LV preload, output and SPV in an acute lung injury (ALI) model during mechanical ventilation.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Distress; Preloadmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Left Ventricular Preload Determines Systolic Pressure Variation during Mechanical Ventilation in Acute Lung Injury

Mitchell¹,

Doig²,

Whitelaw³

2011

J Clinic Experiment Cardiol

View full text Add to dashboard Cite

show abstract

“…The measurement of intravascular volume status to optimize the cardiac preload for the purpose of improving cardiac output and tissue perfusion is very important in caring critically ill patients (1,2). But before the administration of fluids, assessment of patients' response to increased fluid volume is necessary to prevent an unnecessary and harmful fluid imbalance.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Pulse Pressure Variation Compared to Thoracic Fluid Content in Mechanically Ventilated Patients after Cardiac Surgery

Ghadrdoost

Bakhshandeh

Ziyaeifard

et al. 2017

Multidiscip Cardio Annal

View full text Add to dashboard Cite

Background: In clinical area, assessment of body fluid and determination of the intravascular volume after major surgeries such as heart surgery is a significant challenge. The initial purpose of intravascular volume assessment in patients with hemodynamic instability is to determine whether they would benefit from fluid administration or not. Objectives: This study aims to compare pulse pressure variation (PPV) compared to thoracic fluid content in checking out and optimizing fluid volume in mechanically ventilated patients admitted to intensive care unit after cardiac surgery. Methods: In the present study a prospective descriptive-analytic design was used. Thirty mechanically ventilated patients admitted to intensive care units of Rajaie heart center, Tehran, Iran, were recruited in the current study after cardiac surgery based on inclusion criteria. Data collection tools included demographic and clinical data sheets. Hemodynamic parameters such as CVP and pulse pressure were recorded by bedside monitoring. Thoracic fluid content (TFC) was measured by non-invasive continuous cardiac output monitoring (NICCOMO) system. Data were analyzed in SPSS version 15, using statistical tests.

show abstract

Cardiovascular Management

2020

Manual of Perioperative Care in Adult Cardiac Surgery

View full text Add to dashboard Cite

Pulse Pressure Variation Predicts Fluid Responsiveness Following Coronary Artery Bypass Surgery

Cited by 167 publications

References 26 publications

Left Ventricular Preload Determines Systolic Pressure Variation during Mechanical Ventilation in Acute Lung Injury

Left Ventricular Preload Determines Systolic Pressure Variation during Mechanical Ventilation in Acute Lung Injury

Diagnostic Accuracy of Pulse Pressure Variation Compared to Thoracic Fluid Content in Mechanically Ventilated Patients after Cardiac Surgery

Cardiovascular Management

Contact Info

Product

Resources

About