Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions

Critical Care Medicine
Eric E C de WaalWolfgang F Buhre

Abstract

Dynamic preload indicators like pulse pressure variation (PPV) and stroke volume variation (SVV) are increasingly being used for optimizing cardiac preload since they have been demonstrated to predict fluid responsiveness in a variety of perioperative settings. However, in open-chest conditions, the value of these indices has not been systematically examined yet. We, therefore, evaluated the ability of PPV and SVV to predict fluid responsiveness under open- and closed-chest conditions. Prospective, controlled, clinical study. University hospital. Twenty-two patients scheduled for elective coronary artery bypass graft surgery. Defined volume loads (VL) (10 mL kg-1 hydroxyethyl starch 6%) intra- and postoperatively. Stroke volume index was measured 1) before and after a VL intraoperatively in open-chest conditions, and 2) under closed-chest conditions within 1 hour after arrival in the intensive care unit. Central venous pressure and global end diastolic volume were assessed as static preload indicators. In addition, PPV and SVV (both obtained with PiCCO system) were recorded. Fluid-responders were defined by an increase in stroke volume index >or=12% subsequent to the VL. Receiver operating characteristic analysis showed that al...Continue Reading

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