nach oben

Journal of Clinical Monitoring and Computing

Erschienen in:

01.03.2022 | Original Research

Right ventricular and pulmonary artery pulse pressure variation and systolic pressure variation for the prediction of fluid responsiveness: an interventional study in coronary artery bypass surgery patients

verfasst von: Moritz Flick, Ulrike Sand, Alina Bergholz, Karim Kouz, Beate Reiter, Doris Flotzinger, Bernd Saugel, Jens Christian Kubitz

Erschienen in: Journal of Clinical Monitoring and Computing | Ausgabe 6/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Predicting fluid responsiveness is essential when treating surgical or critically ill patients. When using a pulmonary artery catheter, pulse pressure variation and systolic pressure variation can be calculated from right ventricular and pulmonary artery pressure waveforms.

Methods

We conducted a prospective interventional study investigating the ability of right ventricular pulse pressure variation (PPV_RV) and systolic pressure variation (SPV_RV) as well as pulmonary artery pulse pressure variation (PPV_PA) and systolic pressure variation (SPV_PA) to predict fluid responsiveness in coronary artery bypass (CABG) surgery patients. Additionally, radial artery pulse pressure variation (PPV_ART) and systolic pressure variation (SPV_ART) were calculated. The area under the receiver operating characteristics (AUROC) curve with 95%-confidence interval (95%-CI) was used to assess the capability to predict fluid responsiveness (defined as an increase in cardiac index of > 15%) after a 500 mL crystalloid fluid challenge.

Results

Thirty-three patients were included in the final analysis. Thirteen patients (39%) were fluid-responders with a mean increase in cardiac index of 25.3%. The AUROC was 0.60 (95%-CI 0.38 to 0.81) for PPV_RV, 0.63 (95%-CI 0.43 to 0.83) for SPV_RV, 0.58 (95%-CI 0.38 to 0.78) for PPV_PA, and 0.71 (95%-CI 0.52 to 0.89) for SPV_PA. The AUROC for PPV_ART was 0.71 (95%-CI 0.53 to 0.89) and for SPV_ART 0.78 (95%-CI 0.62 to 0.94). The correlation between pulse pressure variation and systolic pressure variation measurements derived from the different waveforms was weak.

Conclusions

Right ventricular and pulmonary artery pulse pressure variation and systolic pressure variation seem to be weak predictors of fluid responsiveness in CABG surgery patients.

Teboul JL, Monnet X, Chemla D, Michard F. Arterial Pulse Pressure Variation with Mechanical Ventilation. Am J Respir Crit Care Med. 2019;199(1):22–31. doi:https://doi.org/10.1164/rccm.201801-0088CI.CrossRefPubMed

Alvarado Sanchez JI, Caicedo Ruiz JD, Diaztagle Fernandez JJ, Amaya Zuniga WF, Ospina-Tascon GA, Cruz Martinez LE. Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: systematic review and meta-analysis. Ann Intensive Care. 2021;11(1):28. doi:https://doi.org/10.1186/s13613-021-00817-5.CrossRefPubMedPubMedCentral

Kubitz JC, Forkl S, Annecke T, Kronas N, Goetz AE, Reuter DA. Systolic pressure variation and pulse pressure variation during modifications of arterial pressure. Intensive Care Med. 2008;34(8):1520–4. doi:https://doi.org/10.1007/s00134-008-1114-8.CrossRefPubMed

Mathis MR, Schechtman SA, Engoren MC, Shanks AM, Thompson A, Kheterpal S, Tremper KK. Arterial Pressure Variation in Elective Noncardiac Surgery: Identifying Reference Distributions and Modifying Factors. Anesthesiology. 2017;126(2):249–59. doi:https://doi.org/10.1097/aln.0000000000001460.CrossRefPubMed

Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL. 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(1):134–8. doi:https://doi.org/10.1164/ajrccm.162.1.9903035.CrossRefPubMed

Wyler von Ballmoos M, Takala J, Roeck M, Porta F, Tueller D, Ganter CC, Schröder R, Bracht H, Baenziger B, Jakob SM. Pulse-pressure variation and hemodynamic response in patients with elevated pulmonary artery pressure: a clinical study. Crit Care. 2010;14(3):R111. doi:https://doi.org/10.1186/cc9060.CrossRef

De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med. 2005;31(4):517–23. doi:https://doi.org/10.1007/s00134-005-2586-4.CrossRefPubMed

Pinsky MR. The right ventricle: interaction with the pulmonary circulation. Crit Care. 2016;20(1):266. doi:https://doi.org/10.1186/s13054-016-1440-0.CrossRefPubMedPubMedCentral

Thenappan T, Prins KW, Pritzker MR, Scandurra J, Volmers K, Weir EK. The Critical Role of Pulmonary Arterial Compliance in Pulmonary Hypertension. Ann Am Thorac Soc. 2016;13(2):276–84. doi:https://doi.org/10.1513/AnnalsATS.201509-599FR.CrossRefPubMedPubMedCentral

10.

Kubitz JC, Annecke T, Kemming GI, Forkl S, Kronas N, Goetz AE, Reuter DA. The influence of positive end-expiratory pressure on stroke volume variation and central blood volume during open and closed chest conditions. Eur J Cardiothorac Surg. 2006;30(1):90–5. doi:https://doi.org/10.1016/j.ejcts.2006.04.008.CrossRefPubMed

11.

Bellofiore A, Chesler NC. Methods for measuring right ventricular function and hemodynamic coupling with the pulmonary vasculature. Ann Biomed Eng. 2013;41(7):1384–98. doi:https://doi.org/10.1007/s10439-013-0752-3.CrossRefPubMedPubMedCentral

12.

Zong W, Heldt T, Moody GB, Mark RG An open-source algorithm to detect onset of arterial blood pressure pulses. In: Computers in Cardiology, 2003, 21–24 Sept. 2003 2003. pp 259–262. doi:https://doi.org/10.1109/CIC.2003.1291140.

13.

Miller TE, Mythen M, Shaw AD, Hwang S, Shenoy AV, Bershad M, Hunley C. Association between perioperative fluid management and patient outcomes: a multicentre retrospective study. Br J Anaesth. 2021;126(3):720–9. doi:https://doi.org/10.1016/j.bja.2020.10.031.CrossRefPubMed

14.

Kouz K, Michard F, Bergholz A, Vokuhl C, Briesenick L, Hoppe P, Flick M, Schon G, Saugel B. Agreement between continuous and intermittent pulmonary artery thermodilution for cardiac output measurement in perioperative and intensive care medicine: a systematic review and meta-analysis. Crit Care. 2021;25(1):125. doi:https://doi.org/10.1186/s13054-021-03523-7.CrossRefPubMedPubMedCentral

15.

Berger D, Hobi J, Möller PW, Haenggi M, Takala J, Jakob SM. Right ventricular stroke volume assessed by pulmonary artery pulse contour analysis. Intensive Care Med Exp. 2020;8(1):58. doi:https://doi.org/10.1186/s40635-020-00347-7.CrossRefPubMedPubMedCentral

16.

Kubitz JC, Richter HP, Petersen C, Goetz AE, Reuter DA. Right ventricular stroke volume variation: a tool to assess right ventricular volume responsiveness. Minerva Anestesiol. 2014;80(9):992–5.PubMed

17.

Magder S, Georgiadis G, Cheong T. Respiratory variations in right atrial pressure predict the response to fluid challenge. J Crit Care. 1992;7(2):76–85. doi:https://doi.org/10.1016/0883-9441(92)90032-3.CrossRef

18.

Fischer MO, Pelissier A, Bohadana D, Gérard JL, Hanouz JL, Fellahi JL. Prediction of responsiveness to an intravenous fluid challenge in patients after cardiac surgery with cardiopulmonary bypass: a comparison between arterial pulse pressure variation and digital plethysmographic variability index. J Cardiothorac Vasc Anesth. 2013;27(6):1087–93. doi:https://doi.org/10.1053/j.jvca.2013.02.024.CrossRefPubMed

19.

Vistisen ST, Struijk JJ, Larsson A. Automated pre-ejection period variation indexed to tidal volume predicts fluid responsiveness after cardiac surgery. Acta Anaesthesiol Scand. 2009;53(4):534–42. doi:https://doi.org/10.1111/j.1399-6576.2008.01893.x.CrossRefPubMed

20.

Rajaram SS, Desai NK, Kalra A, Gajera M, Cavanaugh SK, Brampton W, Young D, Harvey S, Rowan K. (2013) Pulmonary artery catheters for adult patients in intensive care. Cochrane Database Syst Rev (2):CD003408. doi:https://doi.org/10.1002/14651858.CD003408.pub3.

21.

Futier E, Constantin J-M, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, Marret E, Beaussier M, Gutton C, Lefrant J-Y, Allaouchiche B, Verzilli D, Leone M, De Jong A, Bazin J-E, Pereira B, Jaber S. A Trial of Intraoperative Low-Tidal-Volume Ventilation in Abdominal Surgery. N Engl J Med. 2013;369(5):428–37. doi:https://doi.org/10.1056/NEJMoa1301082.CrossRefPubMed

22.

Ma GG, Hao GW, Yang XM, Zhu DM, Liu L, Liu H, Tu GW, Luo Z. Internal jugular vein variability predicts fluid responsiveness in cardiac surgical patients with mechanical ventilation. Ann Intensive Care. 2018;8(1):6. doi:https://doi.org/10.1186/s13613-017-0347-5.CrossRefPubMedPubMedCentral

23.

Cherpanath TG, Geerts BF, Maas JJ, de Wilde RB, Groeneveld AB, Jansen JR. Ventilator-induced central venous pressure variation can predict fluid responsiveness in post-operative cardiac surgery patients. Acta Anaesthesiol Scand. 2016;60(10):1395–403. doi:https://doi.org/10.1111/aas.12811.CrossRefPubMed

24.

Perel P, Roberts I, Ker K. (2013) Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev (2):Cd000567. doi:https://doi.org/10.1002/14651858.CD000567.pub6.

25.

Monnet X, Teboul J-L. Passive leg raising: five rules, not a drop of fluid! Crit Care. 2015;19(1):18. doi:https://doi.org/10.1186/s13054-014-0708-5.CrossRefPubMedPubMedCentral

Titel: Right ventricular and pulmonary artery pulse pressure variation and systolic pressure variation for the prediction of fluid responsiveness: an interventional study in coronary artery bypass surgery patients
verfasst von: Moritz Flick
Ulrike Sand
Alina Bergholz
Karim Kouz
Beate Reiter
Doris Flotzinger
Bernd Saugel
Jens Christian Kubitz
Publikationsdatum: 01.03.2022
Verlag: Springer Netherlands
Erschienen in: Journal of Clinical Monitoring and Computing / Ausgabe 6/2022
Print ISSN: 1387-1307
Elektronische ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-022-00830-4

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Right ventricular and pulmonary artery pulse pressure variation and systolic pressure variation for the prediction of fluid responsiveness: an interventional study in coronary artery bypass surgery patients