J C Kubitz1, H P Richter, C Petersen, A E Goetz, D A Reuter. 1. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, Hamburg-Eppendorf University Hospital, University of Hamburg, Hamburg, Germany - jkubitz@uke.de.
Abstract
BACKGROUND: So far, only left ventricular functional preload indices are used as a routine to assess volume responsiveness. Right ventricular (RV) functional preload indices have been described, but offer no continuous monitoring. METHODS: Following ethical approval, a pressure-induced right ventricular failure (RVF) was induced with continuous infusion of a thromboxane-A2-analogue (U46619) in 15 anesthetized and ventilated pigs. Before and after increasing mean pulmonary artery pressure (MPAP) by 50%, right ventricular stroke volume variation (RVSVV) was assessed with an ultrasonic pulmonary artery flow probe. Measurements were repeated following volume depletion (- 300 mL) and stepwise retransfusion (200 mL of whole blood and 200 mL of a colloid solution). RESULTS: A significant and systematic increase in RVSVV during induction of RVF was observed. Volume depletion led to an increase in RVSVV and re-transfusion led to a decrease in RVSVV. RVSVV was higher and a significant decrease in RVSVV was present in all animals experiencing an increase in CO by more than 5% during retransfusion. CONCLUSION: RVSVV seems to reflect volume requirement of the right ventricle and it might prove a reliable parameter to assess volume responsiveness in RVF.
BACKGROUND: So far, only left ventricular functional preload indices are used as a routine to assess volume responsiveness. Right ventricular (RV) functional preload indices have been described, but offer no continuous monitoring. METHODS: Following ethical approval, a pressure-induced right ventricular failure (RVF) was induced with continuous infusion of a thromboxane-A2-analogue (U46619) in 15 anesthetized and ventilated pigs. Before and after increasing mean pulmonary artery pressure (MPAP) by 50%, right ventricular stroke volume variation (RVSVV) was assessed with an ultrasonic pulmonary artery flow probe. Measurements were repeated following volume depletion (- 300 mL) and stepwise retransfusion (200 mL of whole blood and 200 mL of a colloid solution). RESULTS: A significant and systematic increase in RVSVV during induction of RVF was observed. Volume depletion led to an increase in RVSVV and re-transfusion led to a decrease in RVSVV. RVSVV was higher and a significant decrease in RVSVV was present in all animals experiencing an increase in CO by more than 5% during retransfusion. CONCLUSION: RVSVV seems to reflect volume requirement of the right ventricle and it might prove a reliable parameter to assess volume responsiveness in RVF.
Authors: Michael F Graessler; Karin H Wodack; Hans O Pinnschmidt; Sarah Nishimoto; Christoph R Behem; Daniel A Reuter; Constantin J C Trepte Journal: J Anesth Date: 2021-05-05 Impact factor: 2.078