A comparison between pulse pressure variation and right end diastolic volume index as guides to resuscitation in a model of hemorrhagic shock in pigs.
BACKGROUND
Different hemodynamic parameters including static indicators of cardiac preload as right ventricular end-diastolic volume index (RVEDVI) and dynamic parameters as pulse pressure variation (PPV) have been used in the decision-making process regarding volume expansion in critically ill patients. The objective of this study was to compare fluid resuscitation guided by either PPV or RVEDVI after experimentally induced hemorrhagic shock.


METHODS
Twenty-six anesthetized and mechanically ventilated pigs were allocated into control (group I), PPV (group II), or RVEDVI (group III) group. Hemorrhagic shock was induced by blood withdrawal to target mean arterial pressure of 40 mm Hg, maintained for 60 minutes. Parameters were measured at baseline, time of shock, 60 minutes after shock, immediately after resuscitation with hydroxyethyl starch 6% (130/0.4), 1 hour and 2 hours thereafter. The endpoint of fluid resuscitation was determined as the baseline values of PPV and RVEDVI. Statistical analysis of data was based on analysis of variance for repeated measures followed by the Bonferroni test (p < 0.05).


RESULTS
Volume and time to resuscitation were higher in group III than in group II (group III = 1,305 +/- 331 mL and group II = 965 +/- 245 mL, p < 0.05; and group III = 24.8 +/- 4.7 minutes and group II = 8.8 +/- 1.3 minutes, p < 0.05, respectively). All static and dynamic parameters and biomarkers of tissue oxygenation were affected by hemorrhagic shock and nearly all parameters were restored after resuscitation in both groups.


CONCLUSIONS
In the proposed model of hemorrhagic shock, resuscitation to the established endpoints was achieved within a smaller amount of time and with less volume when guided by PPV than when guided by pulmonary artery catheter-derived RVEDVI.
de Oliveira
Marcos Antonio
MA
LIM08-Anesthesia, Faculdade de Medicina da Universidade de São Paulo, Laboratory of Medical Investigation LIM/08, São Paulo, Brazil.
Otsuki
Denise Aya
DA
Noel-Morgan
Jessica
J
Leite
Victor Figueiredo
VF
Fantoni
Denise Tabacchi
DT
Auler
Jose Otavio Costa
JO
D000704:Analysis of Variance; D000818:Animals; D015415:Biomarkers / Q000032:analysis; D001794:Blood Pressure / Q000502:physiology*; D001810:Blood Volume; D003971:Diastole / Q000502:physiology*; D004195:Disease Models, Animal; D017548:Echocardiography, Transesophageal; D015633:Extravascular Lung Water / Q000502:physiology; D005440:Fluid Therapy / Q000379:methods*; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000503:physiopathology* / Q000628:therapy*; D013552:Swine; D016896:Treatment Outcome
D015415:Biomarkers; D006895:Hydroxyethyl Starch Derivatives