Evaluation of augmented pulse pressure variation using the Valsalva manoeuvre as a predictor of fluid responsiveness under open-chest conditions: A prospective observational study.
Eur J Anaesthesiol
; 34(5): 254-261, 2017 May.
Article
em En
| MEDLINE
| ID: mdl-28207430
ABSTRACT
BACKGROUND:
Pulse pressure variation (PPV) is a well known dynamic preload indicator of fluid responsiveness. However, its usefulness in open-chest conditions remains controversial.OBJECTIVE:
We evaluated whether augmented PPV during a Valsalva manoeuvre can predict fluid responsiveness after sternotomy.DESIGN:
A prospective, observational study.SETTING:
Single-centre trial, study period from October 2014 to June 2015. PATIENTS Forty-nine adult patients who underwent off-pump coronary arterial bypass grafting. INTERVENTION After midline sternotomy, haemodynamic parameters were measured before and after volume expansion (6âmlâkg of crystalloids). PPV was calculated both automatically (PPVauto) and manually (PPVmanual). For PPV augmentation, we performed Valsalva manoeuvres with manual holding of the rebreathing bag and constant airway pressure of 30âcmH2O for 10âs before fluid loading and calculated PPV during the Valsalva manoeuvre (PPVVM). MAIN OUTCOMEMEASURES:
The predictive ability of PPVVM for fluid responsiveness using receiver-operating characteristic curve analysis. Responders were identified when an increase in cardiac index of at least 12% occurred after fluid loading.RESULTS:
Twenty-one patients were responders and 28 were nonresponders. PPVVM successfully predicted fluid responsiveness with an area under the curve (AUC) of 0.88 [95% confidence interval (95% CI) 0.75 to 0.95; sensitivity 91%, specificity 79%, Pâ<â0.0001] and a threshold value of 55%. Baseline PPVauto and PPVmanual also predicted fluid responsiveness [AUC 0.75 (0.62 to 0.88); sensitivity 79%, specificity 75%; and 0.76 (0.61 to 0.87]; sensitivity 71%, specificity 71%, respectively). However, only PPVVM showed a significant AUC-difference from that of central venous pressure (Pâ=â0.008) and correlated with the change of cardiac index induced by volume expansion (râ=â0.6, Pâ<â0.001).CONCLUSION:
Augmented PPV using a Valsalva manoeuvre can be used as a clinically reliable predictor of fluid responsiveness under open-chest condition. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02457572.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pressão Sanguínea
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Manobra de Valsalva
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Ponte de Artéria Coronária sem Circulação Extracorpórea
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Esternotomia
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Soluções Isotônicas
Tipo de estudo:
Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Eur J Anaesthesiol
Assunto da revista:
ANESTESIOLOGIA
Ano de publicação:
2017
Tipo de documento:
Article