BACKGROUND: Cardiac output (CO) is rarely monitored during surgery, and arterial pressure remains the only hemodynamic parameter for assessing the effects of volume expansion (VE). However, whether VE-induced changes in arterial pressure accurately reflect changes in CO has not been demonstrated. The authors studied the ability of VE-induced changes in arterial pressure and in pulse pressure variation to detect changes in CO induced by VE in the perioperative period. METHODS: The authors studied 402 patients in four centers. Hemodynamic variables were recorded before and after VE. Response to VE was defined as more than 15% increase in CO. The ability of VE-induced changes in arterial pressure to detect changes in CO was assessed using a gray zone approach. RESULTS: VE increased CO of more than 15% in 205 patients (51%). Areas under the receiver operating characteristic curves for VE-induced changes in systolic, diastolic, means, and pulse pressure ranged between 0.64 and 0.70, and sensitivity and specificity ranged between 52 and 79%. For these four arterial pressure-derived parameters, large gray zones were found, and more than 60% of the patients lay within this inconclusive zone. A VE-induced decrease in pulse pressure variation of 3% or more allowed detecting a fluid-induced increase in CO of more than 15% with a sensitivity of 90% and a specificity of 77% and a gray zone between 2.2 and 4.7% decrease in pulse pressure variation including 14% of the patients. CONCLUSION: Only changes in pulse pressure variation accurately detect VE-induced changes in CO and have a potential clinical applicability.
BACKGROUND: Cardiac output (CO) is rarely monitored during surgery, and arterial pressure remains the only hemodynamic parameter for assessing the effects of volume expansion (VE). However, whether VE-induced changes in arterial pressure accurately reflect changes in CO has not been demonstrated. The authors studied the ability of VE-induced changes in arterial pressure and in pulse pressure variation to detect changes in CO induced by VE in the perioperative period. METHODS: The authors studied 402 patients in four centers. Hemodynamic variables were recorded before and after VE. Response to VE was defined as more than 15% increase in CO. The ability of VE-induced changes in arterial pressure to detect changes in CO was assessed using a gray zone approach. RESULTS: VE increased CO of more than 15% in 205 patients (51%). Areas under the receiver operating characteristic curves for VE-induced changes in systolic, diastolic, means, and pulse pressure ranged between 0.64 and 0.70, and sensitivity and specificity ranged between 52 and 79%. For these four arterial pressure-derived parameters, large gray zones were found, and more than 60% of the patients lay within this inconclusive zone. A VE-induced decrease in pulse pressure variation of 3% or more allowed detecting a fluid-induced increase in CO of more than 15% with a sensitivity of 90% and a specificity of 77% and a gray zone between 2.2 and 4.7% decrease in pulse pressure variation including 14% of the patients. CONCLUSION: Only changes in pulse pressure variation accurately detect VE-induced changes in CO and have a potential clinical applicability.
Authors: Matthew Lee; Laurence Weinberg; Brett Pearce; Nicholas Scurrah; David A Story; Param Pillai; Peter R McCall; Larry P McNicol; Philip J Peyton Journal: J Clin Monit Comput Date: 2016-02-16 Impact factor: 2.502
Authors: Alexey A Smetkin; Ayyaz Hussain; Evgenia V Fot; Viktor I Zakharov; Natalia N Izotova; Angelika S Yudina; Zinaida A Dityateva; Yanina V Gromova; Vsevolod V Kuzkov; Lars J Bjertnæs; Mikhail Y Kirov Journal: J Clin Monit Comput Date: 2016-03-07 Impact factor: 2.502
Authors: Karim Lakhal; Stephan Ehrmann; Dominique Perrotin; Michel Wolff; Thierry Boulain Journal: Intensive Care Med Date: 2013-09-06 Impact factor: 17.440