Document Detail


Validation of pulse contour derived stroke volume variation during modifications of cardiac afterload.
MedLine Citation:
PMID:  17456489     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Left ventricular stroke volume variation (SVV) or its surrogates are useful tools to assess fluid responsiveness in mechanically ventilated patients. So far it is unknown, how changes in cardiac afterload affect SVV. Therefore, this study compared left ventricular SVV derived by pulse contour analysis with SVV measured using an ultrasonic flow probe and investigated the influence of cardiac afterload on left ventricular SVV. METHODS: In 13 anaesthetized, mechanically ventilated pigs [31(SD 6) kg], we compared cardiac output (CO), stroke volume (SV), and SVV determined by pulse contour analysis and by an ultrasonic aortic flow signal (Bland-Altman analysis). After obtaining baseline measurements, cardiac afterload was increased using phenylephrine and decreased using adenosine (both continuously administered). Measurements were performed with a constant tidal volume (12 ml kg-1) without PEEP. RESULTS: Neither increasing mean arterial pressure (MAP) [from 59 (7) to 116 (19)] nor decreasing MAP [from 63 (7) to 39 (4)] affected CO, SV, and SVV (both methods). Method comparison revealed a bias for SVV of 0.1% [standard error of the mean (SE) 0.8] at baseline, -1.2% (SE 0.8) during decreased and 4.0% (SE 0.7) during increased afterload, the latter being significantly different from the others (P<0.05). Thereby, pulse contour analysis tended to underestimate SVV during decreased afterload and to overestimate SVV during increased afterload. Limits of agreement were approximately 6% for all points of measurement. CONCLUSIONS: Left ventricular SVV is not affected by changes in cardiac afterload. There is a good agreement of pulse contour with flow derived SVV. The agreement decreases, if afterload is extensively augmented.
Authors:
J C Kubitz; T Annecke; S Forkl; G I Kemming; N Kronas; A E Goetz; D A Reuter
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  British journal of anaesthesia     Volume:  98     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-25     Completed Date:  2007-06-18     Revised Date:  2007-11-19    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  591-7     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Insitute for Surgical Research, Ludwig Maximillians University Munich, and Hamburg-Eppendorf University Hospital, Hamburg, Germany.
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MeSH Terms
Descriptor/Qualifier:
Animals
Blood Pressure / physiology
Cardiac Output / physiology*
Fluid Therapy / methods
Monitoring, Physiologic / methods*
Positive-Pressure Respiration
Pulse
Signal Processing, Computer-Assisted
Stroke Volume / physiology*
Swine
Thermodilution
Ventricular Function, Left / physiology
Comments/Corrections
Comment In:
Br J Anaesth. 2007 Nov;99(5):745-6; author reply 746   [PMID:  17933802 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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