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Ventilator‐induced central venous pressure variation can predict fluid responsiveness in post‐operative cardiac surgery patients
Author(s) -
Cherpanath T. G. V.,
Geerts B. F.,
Maas J. J.,
Wilde R. B. P.,
Groeneveld A. B.,
Jansen J. R.
Publication year - 2016
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12811
Subject(s) - medicine , central venous pressure , anesthesia , cardiac surgery , venous pressure , blood pressure , hemodynamics , surgery , cardiology , heart rate
Background Ventilator‐induced dynamic hemodynamic parameters such as stroke volume variation ( SVV ) and pulse pressure variation ( PPV ) have been shown to predict fluid responsiveness in contrast to static hemodynamic parameters such as central venous pressure ( CVP ). We hypothesized that the ventilator‐induced central venous pressure variation ( CVPV ) could predict fluid responsiveness. Methods Twenty‐two elective cardiac surgery patients were studied post‐operatively on the intensive care unit during mechanical ventilation with tidal volumes of 6–8 ml/kg without spontaneous breathing efforts or cardiac arrhythmia. Before and after administration of 500mL hydroxyethyl starch, SVV and PPV were measured using pulse contour analysis by modified Modelflow ® , while CVP was obtained from a central venous catheter positioned in the superior vena cava. CVPV was calculated as 100 × ( CVP max − CVP min )/[( CVP max + CVP min) /2]. Results Nineteen patients (86%) were fluid responders defined as an increase in cardiac output of ≥ 15% after fluid administration. CVPV decreased upon fluid loading in responders, but not in non‐responders. Baseline CVP values showed no correlation with a change in cardiac output in contrast to baseline SVV ( r = 0.60, P = 0.003), PPV ( r = 0.58, P = 0.005), and CVPV ( r = 0.63, P = 0.002). Baseline values of SVV > 9% and PPV > 8% could predict fluid responsiveness with a sensitivity of 89% and 95%, respectively, both with a specificity of 100%. Baseline CVPV could identify all fluid responders and non‐responders correctly at a cut‐off value of 12%. There was no difference between the area under the receiver operating characteristic curves of SVV , PPV , and CVPV . Conclusion The use of ventilator‐induced CVPV could predict fluid responsiveness similar to SVV and PPV in post‐operative cardiac surgery patients.