INTRODUCTION: Although pulse pressure variation (PPV) and stroke volume variation (SVV) during mechanical ventilation have been shown to predict preload responsiveness, the effect of vasoactive therapy on PPV and SVV is unknown. METHODS: Pulse pressure variation and SVV were measured continuously in 15 cardiac surgery patients for the first 4 postoperative hours. Pulse pressure variation was directly measured from the arterial pressure waveform, and both PPV and SVV were also calculated by LiDCO Plus (LiDCO Ltd, Cambridge, United Kingdom) before and after volume challenges or changes in vasoactive drug infusions done to sustain cardiovascular stability. RESULTS: Seventy-one paired events were studied (38 vasodilator, 10 vasoconstrictor, 14 inotropes, and 9 volume challenges). The difference between the measured and LiDCO-calculated PPV was 1% ± 7% (1.96 SD, 95% confidence interval, r(2) = 0.8). Volume challenge decreased both PPV and SVV (15% to 10%, P < .05 and 13% to 9%, P = .09, respectively). Vasodilator therapy increased PPV and SVV (13% to 17% and 9% to 15%, respectively, P < .001), whereas increasing inotropes or vasoconstrictors did not alter PPV or SVV. The PPV/SVV ratio was unaffected by treatments. CONCLUSION: Volume loading decreased PPV and SVV; and vasodilators increased both, consistent with their known cardiovascular effects. Thus, SVV and PPV can be used to drive fluid resuscitation algorithms in the setting of changing vasoactive drug therapy.
INTRODUCTION: Although pulse pressure variation (PPV) and stroke volume variation (SVV) during mechanical ventilation have been shown to predict preload responsiveness, the effect of vasoactive therapy on PPV and SVV is unknown. METHODS: Pulse pressure variation and SVV were measured continuously in 15 cardiac surgery patients for the first 4 postoperative hours. Pulse pressure variation was directly measured from the arterial pressure waveform, and both PPV and SVV were also calculated by LiDCO Plus (LiDCO Ltd, Cambridge, United Kingdom) before and after volume challenges or changes in vasoactive drug infusions done to sustain cardiovascular stability. RESULTS: Seventy-one paired events were studied (38 vasodilator, 10 vasoconstrictor, 14 inotropes, and 9 volume challenges). The difference between the measured and LiDCO-calculated PPV was 1% ± 7% (1.96 SD, 95% confidence interval, r(2) = 0.8). Volume challenge decreased both PPV and SVV (15% to 10%, P < .05 and 13% to 9%, P = .09, respectively). Vasodilator therapy increased PPV and SVV (13% to 17% and 9% to 15%, respectively, P < .001), whereas increasing inotropes or vasoconstrictors did not alter PPV or SVV. The PPV/SVV ratio was unaffected by treatments. CONCLUSION: Volume loading decreased PPV and SVV; and vasodilators increased both, consistent with their known cardiovascular effects. Thus, SVV and PPV can be used to drive fluid resuscitation algorithms in the setting of changing vasoactive drug therapy.
Authors: Daniel A Reuter; Thomas W Felbinger; Christian Schmidt; Erich Kilger; Oliver Goedje; Peter Lamm; Alwin E Goetz Journal: Intensive Care Med Date: 2002-03-20 Impact factor: 17.440
Authors: Daniel A Reuter; Julian Bayerlein; Matthias S G Goepfert; Florian C Weis; Erich Kilger; Peter Lamm; Alwin E Goetz Journal: Intensive Care Med Date: 2003-02-11 Impact factor: 17.440
Authors: Anand Kumar; Ramon Anel; Eugene Bunnell; Kalim Habet; Sergio Zanotti; Stephanie Marshall; Alex Neumann; Amjad Ali; Mary Cheang; Clifford Kavinsky; Joseph E Parrillo Journal: Crit Care Med Date: 2004-03 Impact factor: 7.598
Authors: Sebastian Mair; Julia Tschirdewahn; Simon Götz; Johanna Frank; Veit Phillip; Benedikt Henschel; Caroline Schultheiss; Ulrich Mayr; Sebastian Noe; Matthias Treiber; Roland M Schmid; Bernd Saugel; Wolfgang Huber Journal: J Clin Monit Comput Date: 2016-11-05 Impact factor: 2.502