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Assessment of fluid responsiveness in mechanically ventilated cardiac surgical patients

Published online by Cambridge University Press:  26 August 2005

C. Wiesenack ,
C. Fiegl ,
A. Keyser ,
C. Prasser  and
C. Keyl
C. Wiesenack
Affiliation:
University Hospital of Regensburg, Department of Anaesthesiology, Regensburg, Germany
C. Fiegl
Affiliation:
University Hospital of Regensburg, Department of Anaesthesiology, Regensburg, Germany
A. Keyser
Affiliation:
University Hospital of Regensburg, Department of Cardiothoracic and Vascular Surgery, Regensburg, Germany
C. Prasser
Affiliation:
University Hospital of Regensburg, Department of Anaesthesiology, Regensburg, Germany
C. Keyl
Affiliation:
Heart-Center Bad Krozingen, Department of Anaesthesiology, Bad Krozingen, Germany
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Summary

Background and objective: Accurate assessment of preload responsiveness is an important goal of the clinician to avoid deleterious volume replacement associated with increased morbidity and mortality in mechanically ventilated patients. This study was designed to evaluate the accuracy of simultaneously assessed stroke volume variation and pulse pressure variation using an improved algorithm for pulse contour analysis (PiCCO plus®, V 5.2.2), compared to the respiratory changes in transoesophageal echo-derived aortic blood velocity (ΔVpeak), intrathoracic blood volume index, central venous pressure and pulmonary capillary wedge pressure to predict the response of stroke volume index to volume replacement in normoventilated cardiac surgical patients. Methods: We studied 20 patients undergoing elective coronary artery bypass grafting. After induction of anaesthesia, haemodynamic measurements were performed before and after volume replacement by infusion of 6% hydroxyethyl starch 200/0.5 (7 mL kg−1) with a rate of 1 mL kg−1 min−1. Results: Baseline stroke volume variation correlated significantly with changes in stroke volume index (ΔSVI) (r2 = 0.66; P < 0.05) as did baseline pulse pressure variation (r2 = 0.65; P < 0.05), whereas baseline values of ΔVpeak, intrathoracic blood volume index, central venous pressure and pulmonary artery wedge pressure showed no correlation to ΔSVI. Pulse contour analysis underestimated the volume-induced increase in cardiac index measured by transpulmonary thermodilution (P < 0.05). Conclusions: The results of our study suggest that stroke volume variation and its surrogate pulse pressure variation derived from pulse contour analysis using an improved algorithm can serve as indicators of fluid responsiveness in normoventilated cardiac surgical patients. Whenever changes in systemic vascular resistance are expected, the PiCCO plus® system should be recalibrated.

Keywords

CARDIAC SURGICAL PROCEDURES, coronary artery bypass graftingHAEMODYNAMIC PHENOMENA, fluid response, stroke volume variation, pulse pressure variation, aortic blood velocity, pulse contour analysisCRITICAL CARECARDIAC OUTPUT
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 9 , September 2005 , pp. 658 - 665
Copyright
© 2005 European Society of Anaesthesiology

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