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

Original Article
© 2005 European Society of Anaesthesiology

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Sandham JD, Hull RD, Brant RF et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. New Engl J Med 2003; 348: 514.Google Scholar
Perel A. The value of functional hemodynamic parameters in hemodynamic monitoring of ventilated patients. Anaesthesist 2003; 52: 10031004.Google Scholar
Michard F, Teboul JK. Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation. Crit Care 2000; 4: 282289.Google Scholar
Rex S, Brose S, Metzelder S et al. Prediction of fluid responsiveness in patients during cardiac surgery. Br J Anaesth 2004; 93: 782788.Google Scholar
Reuter DA, Kirchner A, Felbinger TW et al. Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function. Crit Care Med 2003; 31: 13991404.Google Scholar
Tavernier B, Makhotine O, Lebuffe G et al. Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 1998; 89: 13131321.Google Scholar
Tousignant CP, Walsh F, Mazer CD. The use of transesophageal echocardiography for preload assessment in critically ill patients. Anesth Analg 2000; 90: 351355.Google Scholar
Feissel M, Michard F, Mangin I et al. Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 2001; 119: 867873.Google Scholar
Marx G, Cope T, McCrossan L et al. Assessing fluid responsiveness by stroke volume variation in mechanically ventilated patients with severe sepsis. Eur J Anaesthesiol 2004; 21: 132138.Google Scholar
Beaussier M, Coriat P, Perel A et al. Determinants of systolic pressure variation in patients ventilated after vascular surgery. J Cardiothorac Vasc Anesth 1995; 9: 547551.Google Scholar
Denault AY, Gasior TA, Gorscan III J et al. Determinants of aortic pressure variation during positive pressure ventilation in man. Chest 1999; 68: 15321536.Google Scholar
Michard F, Boussat S, Chemla D et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 2000; 162: 134138.Google Scholar
Michard F, Chemla D, Richard C et al. Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP. Am J Respir Crit Care Med 1999; 159: 935939.Google Scholar
Berkenstadt H, Margalit N, Hadani M et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg 2001; 92: 984989.Google Scholar
Reuter DA, Felbinger TW, Kilger E et al. Optimizing fluid therapy in mechanically ventilated patients after cardiac surgery by on-line monitoring of left ventricular stroke volume variations. Comparison with aortic systolic pressure variations. Br J Anaesth 2002; 88: 124126.Google Scholar
Reuter DA, Felbinger TW, Schmidt C et al. Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intens Care Med 2002; 28: 392398.Google Scholar
Pinsky MR. Probing the limits of arterial pulse contour analysis to predict preload responsiveness. Anesth Analg 2003; 96: 12451247.Google Scholar
Wiesenack C, Prasser C, Rödig G, Keyl C. Stroke volume variation as an indicator of fluid responsiveness using pulse contour analysis in mechanically ventilated patients. Anesth Analg 2003; 96: 12541257.Google Scholar
Reuter DA, Goresch T, Goepfert MS, Wildhirt SM, Kilger E, Goetz AE. Effects of mid-line thoracotomy on the interaction between mechanical ventilation and cardiac filling during cardiac surgery. Br J Anaesth 2004; 92: 808813.Google Scholar
Gödje O, Hoeke K, Lichtwarck-Aschoff M et al. Continuous cardiac output by femoral arterial thermodilution calibrated pulse contour analysis: comparison with pulmonary artery thermodilution. Crit Care Med 1999; 27: 24072412.Google Scholar
Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res 1999; 8: 135160.Google Scholar
Bendjelid K, Romand JA. Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intens Care Med 2003; 29: 352360.Google Scholar
Gödje O, Hoke K, Goetz AE et al. Reliability of a new algorithm for continuous cardiac output determination by pulse-contour analysis during hemodynamic instability. Crit Care Med 2002; 30: 5258.Google Scholar
Fujita Y, Yamamoto T, Sano I, Yoshioka N, Hinenoya H. A comparison of changes in cardiac preload variables during graded hypovolemia and hypervolemia in mechanically ventilated dogs. Anesth Analg 2004; 99: 17801786.Google Scholar
Bouchard MJ, Denault A, Couture P et al. Poor correlation between hemodynamic and echocardiographic indexes of left ventricular performance in the operating room and intensive care unit. Crit Care Med 2004; 32: 644648.Google Scholar
Wiesenack C, Prasser C, Keyl C, Rödig G. Assessment of intrathoracic blood volume as an indicator of cardiac preload: single transpulmonary thermodilution technique versus assessment of pressure preload parameters derived from a pulmonary artery catheter. J Cardiothorac Vasc Anesth 2001; 15: 584588.Google Scholar
Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients. Chest 2002; 121: 20002008.Google Scholar
Gödje O, Friedl R, Hannekum A. Accuracy of beat-to-beat cardiac output monitoring by pulse contour analysis in hemodynamical unstable patients. Med Sci Monit 2001; 7: 13441350.Google Scholar
Mahajan A, Shabanie A, Turner J et al. Pulse contour analysis for cardiac output monitoring in cardiac surgery for congenital heart disease. Anesth Analg 2003; 97: 12831288.Google Scholar
Rödig G, Prasser C, Keyl C et al. Continuous cardiac output measurement: pulse contour analysis vs thermodilution technique in cardiac surgical patients. Br J Anaesth 1999; 82: 525530.Google Scholar