Arm occlusion pressure is a useful predictor of an increase in cardiac output after fluid loading following cardiac surgery.
Eur J Anaesthesiol
; 28(11): 802-6, 2011 Nov.
Article
em En
| MEDLINE
| ID: mdl-21799416
BACKGROUND AND OBJECTIVE: In pharmacological research, arm occlusion pressure is used to study haemodynamic effects of drugs. However, arm occlusion pressure might be an indicator of static filling pressure of the arm. We hypothesised that arm occlusion pressure can be used to predict fluid loading responsiveness. METHODS: Twenty-four patients who underwent cardiac surgery were studied during their first 2âh in the ICU. The lungs were ventilated mechanically and left ventricular function was supported as necessary. Arm occlusion pressure was defined as the radial artery pressure after occluding arterial flow for 35âs by a blood pressure cuff inflated to 50âmmHg above SBP. The cuff was positioned around the arm in which a radial artery catheter had been inserted. Measurements were performed before (baseline) and after fluid loading (500âml hydroxyethyl starch 6%). Patients whose cardiac output increased by at least 10% were defined as responders. RESULTS: In responders (nâ=â17), arm occlusion pressure, mean arterial pressure and central venous pressure increased and stroke volume variation and pulse pressure variation decreased. In non-responders (nâ=â7), arm occlusion pressure and central venous pressure increased, and pulse pressure variation decreased. Mean arterial pressure, stroke volume variation and heart rate did not change significantly. The area under the curve to predict fluid loading responsiveness for arm occlusion pressure was 0.786 (95% confidence interval 0.567-1.000), at a cut-off of 21.9âmmHg, with sensitivity of 71% and specificity of 88% in predicting fluid loading responsiveness. Prediction of responders with baseline arm occlusion pressure was as good as baseline stroke volume variation and pulse pressure variation. CONCLUSION: Arm occlusion pressure was a good predictor of fluid loading responsiveness in our group of cardiac surgery patients and offers clinical advantages over stroke volume variation and pulse pressure variation.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Braço
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Pressão Sanguínea
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Débito Cardíaco
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Derivados de Hidroxietil Amido
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Substitutos do Plasma
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Artéria Radial
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Hidratação
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Procedimentos Cirúrgicos Cardíacos
Tipo de estudo:
Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Eur J Anaesthesiol
Assunto da revista:
ANESTESIOLOGIA
Ano de publicação:
2011
Tipo de documento:
Article
País de afiliação:
Holanda