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Combination of continuous pulse pressure variation monitoring and cardiac filling pressure to predict fluid responsiveness.
MedLine Citation:
PMID:  22552875     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
To assess if combining central venous pressure (CVP) and/or pulmonary capillary wedge pressure (PCWP) information with arterial pulse pressure variation can increase the ability to predict fluid responsiveness in patients under general anesthesia. This study is a retrospective analysis of patients scheduled for coronary artery bypass surgery and monitored with a pulmonary artery catheter who underwent a volume expansion after induction of general anesthesia. Among the 46 patients studied, 31 were responders to volume expansion. CVP similar to PCWP, was a poor predictor of fluid responsiveness, as indicated by low values of areas under the receiver operating characteristic curves [0.585 (95 % CI 0.389-0.780) and 0.563 (95 % CI 0.373-0.753) respectively, p = 0.76]. The area obtained for PPV was 0.897 (95 % CI 0.801-0.992) with a threshold value of 12 %. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio was 83.9 %, 86.7 %, 6.29 and 0.19 respectively. Combining information on right and/or left cardiac filling pressures with PPV did not increase the ability to predict whether a patient will be a responder or a non-responder to volume expansion. The ability to identify a potentially fluid responsive patient was no better using PPV plus cardiac filling pressures when compared to using PPV alone. Therefore, if PPV values are being monitored in a patient, CVP and PCWP values do not provide additional information to predict fluid responsiveness.
Authors:
Geoffray Keller; Karin Sinavsky; Olivier Desebbe; Jean-Jacques Lehot
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-3
Journal Detail:
Title:  Journal of clinical monitoring and computing     Volume:  -     ISSN:  1573-2614     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9806357     Medline TA:  J Clin Monit Comput     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Hospices Civils de Lyon, Groupement Hospitalier Est, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital, Claude Bernard Lyon 1 University, Lyon, France, kellergeoffray@hotmail.fr.
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