Automated pulse pressure and stroke volume variations from radial artery: evaluation during major abdominal surgery.

BACKGROUND Off-line calculation of the pulse pressure variation (PPV(ref)) has repeatedly been shown to be a reliable predictor of fluid responsiveness in mechanically ventilated patients. This study was designed to assess the ability of two algorithms for automated calculation of PPV (PPV(auto)) (Intellivue MP 70) and stroke volume variation (SVV(auto)) (FloTrac/Vigileo) to predict fluid responsiveness during abdominal surgery. METHODS We conducted a prospective study of 56 fluid challenges given for haemodynamic instability in 11 patients undergoing major abdominal surgery. Fluid responsiveness was defined as an increase in stroke volume index (SVI) >10%. PPV(ref), PPV(auto), SVV(auto), and SVI (oesophageal Doppler) were recorded simultaneously before and after each fluid challenge. RESULTS PPV(auto) and SVV(auto) both correlated with PPV(ref) [r(corr)=0.87 (P<0.0001) and 0.84 (P<0.0001), respectively; n=77]. All three indices measured before fluid challenges were higher in responder (n=32) than in non-responder (n=24) fluid challenges (P < or = 0.02). The mean areas under the receiver operating characteristic curves were 0.96 (PPV(ref)), 0.96 (PPV(auto)), and 0.95 (SVV(auto)), and the optimal threshold value for each variable was 13%, 13%, and 12%, respectively. All indices correlated with the fluid challenge-induced changes in SVI (PPV(ref): r(corr)=0.65; PPV(auto): r(corr)=0.58; SVV(auto): r(corr)=0.58, P<0.001 for all). CONCLUSIONS PPV(auto) and SVV(auto) predict fluid responsiveness as accurately as off-line PPV(ref) in patients with haemodynamic instability during major abdominal surgery.

[1]  F. Michard,et al.  Online Monitoring of Pulse Pressure Variation to Guide Fluid Therapy After Cardiac Surgery , 2008, Anesthesia and analgesia.

[2]  A. Perel.  Automated assessment of fluid responsiveness in mechanically ventilated patients. , 2008, Anesthesia and analgesia.

[3]  M. Genoni,et al.  Clinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery. , 2007, British journal of anaesthesia.

[4]  M. Aboy,et al.  A novel algorithm to estimate the pulse pressure variation index /spl Delta/PP , 2004, IEEE Transactions on Biomedical Engineering.

[5]  G. Joshi.  Intraoperative Fluid Restriction Improves Outcome After Major Elective Gastrointestinal Surgery , 2005, Anesthesia and analgesia.

[6]  Andreas Zollinger,et al.  Stroke volume and pulse pressure variation for prediction of fluid responsiveness in patients undergoing off-pump coronary artery bypass grafting. , 2005, Chest.

[7]  M. Levy,et al.  Hemodynamic monitoring in shock and implications for management , 2007, Intensive Care Medicine.

[8]  D. Chemla,et al.  Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. , 2000, American journal of respiratory and critical care medicine.

[9]  M. Grocott,et al.  Perioperative Fluid Management and Clinical Outcomes in Adults , 2005, Anesthesia and analgesia.

[10]  C. Richard,et al.  Cardiopulmonary interactions in patients with heart failure , 2007, Current opinion in critical care.

[11]  A. Perel,et al.  Predicting fluid responsiveness in patients undergoing cardiac surgery: functional haemodynamic parameters including the Respiratory Systolic Variation Test and static preload indicators. , 2005, British journal of anaesthesia.

[12]  Feng Gao,et al.  Analyzing Multivariate Longitudinal Data Using SAS ® , 2006 .

[13]  J. Slieker,et al.  The Ability of a Novel Algorithm for Automatic Estimation of the Respiratory Variations in Arterial Pulse Pressure to Monitor Fluid Responsiveness in the Operating Room , 2008, Anesthesia and analgesia.

[14]  W. Auger,et al.  Cardiac output determination from the arterial pressure wave: clinical testing of a novel algorithm that does not require calibration. , 2007, Journal of cardiothoracic and vascular anesthesia.

[15]  K S Panageas,et al.  Statistical issues in analysis of diagnostic imaging experiments with multiple observations per patient. , 2001, Radiology.

[16]  G. Manecke.  Edwards FloTrac™ sensor and Vigileo™ monitor: easy, accurate, reliable cardiac output assessment using the arterial pulse wave , 2005, Expert review of medical devices.

[17]  F. Pruvot,et al.  Non-invasive prediction of fluid responsiveness during major hepatic surgery. , 2006, British journal of anaesthesia.

[18]  J. Teboul,et al.  Volume responsiveness , 2007, Current opinion in critical care.

[19]  N. Secher,et al.  Monitoring of peri‐operative fluid administration by individualized goal‐directed therapy , 2007, Acta anaesthesiologica Scandinavica.

[20]  Stroke volume variation obtained with FloTrac/Vigileo fails to predict fluid responsiveness in coronary artery bypass graft patients. , 2008, British journal of anaesthesia.

[21]  M. Singer,et al.  The validity of trans-esophageal Doppler ultrasonography as a measure of cardiac output in critically ill adults , 2004, Intensive Care Medicine.

[22]  C. Hofer,et al.  Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac™ and PiCCOplus™ system , 2008, Critical care.

[23]  James McNames,et al.  A novel algorithm to estimate the pulse pressure variation index deltaPP. , 2004, IEEE transactions on bio-medical engineering.

[24]  F. Michard,et al.  Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial , 2007, Critical care.

[25]  M. Antonelli,et al.  Functional hemodynamic monitoring and dynamic indices of fluid responsiveness. , 2008, Minerva anestesiologica.