Validity of Pulse Pressure Variation (PPV) Compared with Stroke Volume Variation (SVV) in Predicting Fluid Responsiveness

Abstract

Objective: Static monitors for assessing the fluid status during major surgeries and in critically ill patients have been gradually replaced by more accurate dynamic monitors in modern-day anaesthesia practice. Pulse pressure variation (PPV) and systolic pressure variation (SPV) are the two commonly used dynamic indices for assessing fluid responsiveness. Methods: In this prospective observational study, 50 patients undergoing major surgeries were monitored for PPV and SPV: after the induction of anaesthesia and after the administration of 500 mL of isotonic crystalloid bolus. Following the fluid bolus, patients with a cardiac output increase of more than 15% were classified as responders and those with an increase of less than 15% were classified as non-responders. Results: There were no significant differences in the heart rate (HR), mean arterial pressure (MAP), PPV, SVV, central venous pressure (CVP) and cardiac index (CI) between responders and non-responders. Before fluid bolus, the stroke volume was significantly lower in responders (p=0.030). After fluid bolus, MAP was significantly higher in responders but there were no significant changes in HR, CVP, CI, PPV and SVV. In both responders and non-responders, PPV strongly correlated with SVV before and after fluid bolus. Conclusion: Both PPV and SVV are useful to predict cardiac response to fluid loading. In both responders and non-responders, PPV has a greater association with fluid responsiveness than SVV. Keywords: Fluid management, pulse pressure variation, systolic pressure variation, fluid responsiveness Amaç: Günümüzde anestezi pratiğinde, büyük ameliyatlarda ve ağır hastalarda sıvı durumunun değerlendirilmesi için kullanılan statik izlem yöntemlerinin yerini, daha doğru sonuçlar veren dinamik izlemler almıştır. Nabız basıncı değişimi (PPV) ve sistolik basınç deği-şimi (SPV) sıvı yanıtını değerlendirmek amacıyla yaygın bir şekilde kullanılan dinamik indekslerdir. Yöntemler: Bu prospektif gözlemsel çalışmada, major cerrahi geçire-cek 50 hastada anestezi indüksiyonundan ve 500 mL izotonik verildikten sonra PPV ve SPV monitörize edildi. Bolus sıvı uygulamasını takiben, %15'ten fazla kardiyak debisi artışı olan hastalar yanıt verenler olarak, %15'ten daha az artışı olanlar ise yanıt vermeyenler olarak sınıflandırıldılar. Bulgular: Yanıt verenler ve vermeyenler arasında kalp atım hızı (HR), ortalama arter basıncı (MAP), PPV, SVV, santral venöz basınç (CVP) ve kardiyak indeks (CI) açısından anlamlı bir fark bulunmadı. Bolus sıvı uygulaması öncesinde, atım hacmi yanıt verenlerde anlamlı derecede daha düşüktü (p=0,030). Bolus sıvı uygulaması sonrasında, MAP yanıt verenlerde anlamlı ölçüde daha yüksek bulundu, ancak HR, CVP, CI, PPV ve SVV açısın-dan anlamlı fark gözlenmedi. Bolus sıvı uygulaması öncesinde ve sonrasında, hem yanıt veren hem de yanıt vermeyen hastalarda, PPV değeri ile SVV değeri arasında güçlü bir ilişki saptandı. Sonuç: PPV ve SVV sıvı yüklenmesine verilen kardiyak yanıtı tahmin etmede yararlıdır. Hem yanıt veren hem de vermeyen hastalarda ...

Effects of Human Electro‐Muscular Incapacitation (HEMI) Devices on Cardiovascular Changes in Anesthetized Swine as Measured by Transesophageal Echocardiography (TEE)

“…We are aware of the literature indicating that the absolute, isolated CVP readings might have only a weak correlation with the blood volume. Research has shown that systolic pressure variation (SPV), stroke volume variation (SVV), and pulse pressure variation (PPV) are better predictors of fluid volume (11)(12)(13). We noted a major decrease in CVP into the negative pressure range during spontaneous breaths during and after the HEMI stimulus.…”

Adequate Dosage of Norepinephrine Infusion Combined with Goal-Directed Fluid Therapy During General Anesthesia May Improve Elderly Patients’ Postoperative Outcome Undergoing Lumbar Spinal Fusion

“…The prone position increases abdominal pressure, which results in reduced venous return and lung compliance. Yu et al reported that high predictability of PPV, remained as useful indices for guiding uid therapy in prone patients with minimal alterations in the optimal cutoff values to predict uid responsiveness [19]. Compared to the SVV, PPV does not require additional kits and can reduce the patients' nancial burden and the accuracy is similar [20].…”

Contemporary perioperative haemodynamic monitoring

“…CO monitoring is not sufficient to manage patients with complex haemodynamic disorders because absent knowledge of preloading and afterloading conditions. Besides SV, stroke volume variation (SVV) or arterial pulse pressure variation (PPV) induced by respiratory variation turned out to be a valid dynamic assessment of fluid responsiveness in mechanically ventilated patients [27,28]. Both invasive arterial wave monitoring and non-invasive stroke volume monitoring permit monitoring of PPV or SVV.…”

“…Arterial pressure waveform analysis The Vigileo/FloTrac system provides real-time CO measurements by deriving SV from the arterial pressure waveform recorded from an arterial catheter without any calibration, a technique also called arterial pressure waveform analysis (APCO). On the basis of numerous data, age, gender and BSA, APCO provides information about SV, CI, SVV, PPV and systemic vascular resistance indexed for BSA (SVRI) [27,53]. Goal-directed therapy based on Vigileo/FloTrac system could improve haemodynamics and reduce the duration of respiratory support after cardiac surgery.…”