scholarly journals Assessing the Diagnostic Accuracy of Pulse Pressure Variations for the Prediction of Fluid Responsiveness

2011 ◽  
Vol 115 (2) ◽  
pp. 231-241 ◽  
Author(s):  
Maxime Cannesson ◽  
Yannick Le Manach ◽  
Christoph K. Hofer ◽  
Jean Pierre Goarin ◽  
Jean-Jacques Lehot ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Central Venous Pressure ◽  
General Anesthesia ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Predictive Value ◽  
Venous Pressure ◽  
Gray Zone ◽  
Central Venous ◽  
The Impact

Background Respiratory arterial pulse pressure variations (PPV) are the best predictors of fluid responsiveness in mechanically ventilated patients during general anesthesia. However, previous studies were performed in a small number of patients and determined a single cutoff point to make clinical discrimination. The authors sought to test the predictive value of PPV in a large, multicenter study and to express it using a gray zone approach. Methods The authors studied 413 patients during general anesthesia and mechanical ventilation in four centers. PPV, central venous pressure, and cardiac output were recorded before and after volume expansion (VE). Response to VE was defined as more than 15% increase in cardiac output after VE. The following approaches were used to determine the gray zones: resampled and two-graph receiver operator characteristic curves. The impact of changes in the benefit-risk balance of VE on the gray zone was also evaluated. Results The authors observed 209 responders (51%) and 204 nonresponders (49%) to VE. The area under receiver operating characteristic curve was 0.89 (95% CI: 0.86-0.92) for PPV, compared with 0.57 (95% CI: 0.54-0.59) for central venous pressure (P < 10). The gray zone approach identified a range of PPV values (between 9% and 13%) for which fluid responsiveness could not be predicted reliably. These PPV values were seen in 98 (24%) patients. Changes in the cost ratio of VE moderately affected the gray zone limits. Conclusion Despite a strong predictive value, PPV may be inconclusive (between 9% and 13%) in approximately 25% of patients during general anesthesia.

Central venous pressure measurements improve the accuracy of leg raising-induced change in pulse pressure to predict fluid responsiveness

2010 ◽  
Vol 36 (6) ◽  
pp. 940-948 ◽  
Author(s):  
Karim Lakhal ◽  
Stephan Ehrmann ◽  
Isabelle Runge ◽  
Dalila Benzekri-Lefèvre ◽  
Annick Legras ◽  
...  
Keyword(s):  
Central Venous Pressure ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Venous Pressure ◽  
Pressure Measurements ◽  
Central Venous ◽  
Predict Fluid Responsiveness

scholarly journals Should we stop using the determination of central venous pressure as a way to estimate cardiac preload?

2012 ◽  
pp. 181-184 ◽  
Author(s):  
Johann Smith Ceron Arias ◽  
Manuel Felipe Muñoz Nañez
Keyword(s):  
Central Venous Pressure ◽  
Blood Volume ◽  
Pulse Pressure ◽  
Venous Pressure ◽  
Pressure Change ◽  
Cardiac Preload ◽  
Central Venous ◽  
End Diastolic Volume ◽  
Dynamic Variables

The determination of the values of central venous pressure has long been used as a guideline for volumetric therapy in the resuscitation of the critical patient, but the performance of such parameter is currently being questioned as an effective measurement of cardiac preload. This has aroused great interest in the search for more accurate parameters to determine cardiac preload and a patient’s blood volume. Goals and Methodology: Based on literature currently available, we aim to discuss the performance of central venous pressure as an effective parameter to determine cardiac preload. Results and Conclusion: Estimating variables such as end-diastolic ventricular area and global end-diastolic volume have a better performance than central venous pressure in determining cardiac preload. Despite the best performance of these devices, central venous pressure is still considered in our setting as the most practical and most commonly available way to assess the patient’s preload. Only dynamic variables such as pulse pressure change are superior in determining an individual’s blood volume.

Alteration in heart rate response to hemorrhage in conscious dogs with volume overload

1978 ◽  
Vol 235 (4) ◽  
pp. H422-H428
Author(s):  
M. M. LeWinter ◽  
J. S. Karliner ◽  
J. W. Covell
Keyword(s):  
Heart Rate ◽  
Central Venous Pressure ◽  
Pulse Pressure ◽  
Pressure Pulse ◽  
Heart Rate Response ◽  
Parasympathetic Nervous System ◽  
Venous Pressure ◽  
Volume Overload ◽  
Conscious Dogs ◽  
Central Venous

The heart rate response to hemorrhage was studied in conscious dogs before and up to 2 mo after the establishment of volume overload due to systemic arteriovenous (a-v) fistulas. Before a-v fistula, heart rate increased markedly during hemorrhage. When hemorrhage was preceded by dextran infusion, bleeding resulted in a gradual reduction in heart rate. The a-v fistula caused marked increases in resting heart rate, central venous pressure, pulse pressure, and blood volume. During hemorrhage, heart rate initially remained constant, but then declined abruptly from the resting value of 121 +/- 3.7 beats/min to a nadir of 89 +/- 6.5 beats/min (P less than 0.01). Although mean arterial pressure decreased markedly, there was no significant change in pulse pressure, and central venous pressure tended to stabilize with the heart rate decline. The abrupt heart rate decline was prevented by atropine but unaltered by propranolol. The response was observed as early as 5 days after a-v fistula. We conclude that an alteration in the heart rate response to hemorrhage appears early during volume overload. This alteration appears to be reflex in nature and to be mediated by the parasympathetic nervous system.

Cardiovascular actions of histamine and potassium

1959 ◽  
Vol 197 (5) ◽  
pp. 1005-1007 ◽  
Author(s):  
Calvin Hanna ◽  
Patricia B. McHugo ◽  
William H. MacMillan
Keyword(s):  
Cardiac Output ◽  
Central Venous Pressure ◽  
Potassium Chloride ◽  
Venous Pressure ◽  
Plasma Potassium ◽  
Dilution Method ◽  
Cardiac Rate ◽  
Central Venous ◽  
Arterial Blood ◽  
Cardiovascular Actions

The cardiovascular actions of intravenous histamine, in doses from 2.5 to 20 µg/kg of the free base, were studied in the pentobarbitalized dog using the dye dilution method. With the small dose there was a consistent but small initial increase in cardiac output and with the larger doses there was a biphasic change in output. Cardiac rate, central venous pressure, central blood volume, hematocrit and the mean circulation time were essentially unchanged. Infusions of histamine and of potassium chloride at the rate of 1 µg and 1 mg/kg/min., respectively, moderately increased the cardiac output. Potassium chloride had no effect on the arterial blood pressure, cardiac rate and central venous pressure. Both the infusion of potassium chloride and injection of histamine produced a comparable elevation of the plasma potassium. It is possible that the actions of histamine to increase the plasma potassium contribute to the cardiovascular actions of this amine, especially on the cardiac output.

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