Document Detail


The effects of vasoactive drugs on pulse pressure and stroke volume variation in postoperative ventilated patients.
MedLine Citation:
PMID:  21036528     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Although pulse pressure variation (PPV) and stroke volume variation (SVV) during mechanical ventilation have been shown to predict preload responsiveness, the effect of vasoactive therapy on PPV and SVV is unknown.
METHODS: Pulse pressure variation and SVV were measured continuously in 15 cardiac surgery patients for the first 4 postoperative hours. Pulse pressure variation was directly measured from the arterial pressure waveform, and both PPV and SVV were also calculated by LiDCO Plus (LiDCO Ltd, Cambridge, United Kingdom) before and after volume challenges or changes in vasoactive drug infusions done to sustain cardiovascular stability.
RESULTS: Seventy-one paired events were studied (38 vasodilator, 10 vasoconstrictor, 14 inotropes, and 9 volume challenges). The difference between the measured and LiDCO-calculated PPV was 1% ± 7% (1.96 SD, 95% confidence interval, r(2) = 0.8). Volume challenge decreased both PPV and SVV (15% to 10%, P < .05 and 13% to 9%, P = .09, respectively). Vasodilator therapy increased PPV and SVV (13% to 17% and 9% to 15%, respectively, P < .001), whereas increasing inotropes or vasoconstrictors did not alter PPV or SVV. The PPV/SVV ratio was unaffected by treatments.
CONCLUSION: Volume loading decreased PPV and SVV; and vasodilators increased both, consistent with their known cardiovascular effects. Thus, SVV and PPV can be used to drive fluid resuscitation algorithms in the setting of changing vasoactive drug therapy.
Authors:
Mehrnaz Hadian; Donald A Severyn; Michael R Pinsky
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-10-30
Journal Detail:
Title:  Journal of critical care     Volume:  26     ISSN:  1557-8615     ISO Abbreviation:  J Crit Care     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-27     Completed Date:  2011-10-24     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  8610642     Medline TA:  J Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  328.e1-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Blood Pressure / drug effects*
Cardiovascular Surgical Procedures
Female
Humans
Male
Middle Aged
Postoperative Care
Respiration, Artificial*
Stroke Volume / drug effects*
Time Factors
Vasoconstrictor Agents / pharmacology*
Vasodilator Agents / pharmacology*
Grant Support
ID/Acronym/Agency:
HL073198/HL/NHLBI NIH HHS; HL67181/HL/NHLBI NIH HHS; K24 HL067181/HL/NHLBI NIH HHS; K24 HL067181-10/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Vasoconstrictor Agents; 0/Vasodilator Agents
Comments/Corrections

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