title: Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions.
abstract: OBJECTIVE
  Dynamic preload indicators like pulse pressure variation (PPV) and stroke volume variation (SVV) are increasingly being used for optimizing cardiac preload since they have been demonstrated to predict fluid responsiveness in a variety of perioperative settings. However, in open-chest conditions, the value of these indices has not been systematically examined yet. We, therefore, evaluated the ability of PPV and SVV to predict fluid responsiveness under open- and closed-chest conditions.
  
  
  METHODS
  Prospective, controlled, clinical study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Twenty-two patients scheduled for elective coronary artery bypass graft surgery.
  
  
  METHODS
  Defined volume loads (VL) (10 mL kg-1 hydroxyethyl starch 6%) intra- and postoperatively.
  
  
  RESULTS
  Stroke volume index was measured 1) before and after a VL intraoperatively in open-chest conditions, and 2) under closed-chest conditions within 1 hour after arrival in the intensive care unit. Central venous pressure and global end diastolic volume were assessed as static preload indicators. In addition, PPV and SVV (both obtained with PiCCO system) were recorded. Fluid-responders were defined by an increase in stroke volume index >or=12% subsequent to the VL. Receiver operating characteristic analysis showed that all preload indicators failed to predict fluid responsiveness in open-chest conditions. Under closed-chest conditions, the areas under the receiver operating characteristic curve for PPV and SVV were 0.884 (p = 0.004) and 0.911 (p = 0.003), respectively, whereas the static and volumetric preload parameters failed to predict fluid responsiveness. A PPV of >or=10% identified fluid-responders with a sensitivity of 64% and a specificity of 100%, while a SVV of >8% identified fluid-responders with a sensitivity of 100% and a specificity of 78%.
  
  
  CONCLUSIONS
  Our results suggest that the dynamic preload indicators PPV and SVV are able to predict fluid responsiveness under closed-chest conditions, whereas all static and dynamic preload indicators fail to predict fluid responsiveness under open-chest conditions.
authors.affiliation: Division of Perioperative and Emergency Care, University Medical Center, Utrecht, The Netherlands. e.e.c.dewaal@azu.nl
authors.forename: Eric E C
authors.initials: EE
authors.lastname: de Waal
authors.forename: Steffen
authors.initials: S
authors.lastname: Rex
authors.forename: Cas L J J
authors.initials: CL
authors.lastname: Kruitwagen
authors.forename: Cor J
authors.initials: CJ
authors.lastname: Kalkman
authors.forename: Wolfgang F
authors.initials: WF
authors.lastname: Buhre
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002302:Cardiac Output / Q000502:physiology; D002496:Central Venous Pressure / Q000502:physiology; D001026:Coronary Artery Bypass; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D013815:Thermodilution