title: Detection of right ventricular insufficiency and guidance of volume therapy are facilitated by simultaneous monitoring of static and functional preload parameters.
abstract: OBJECTIVE
  Acute right ventricular failure (RVF) is a life-threatening condition. This study investigated whether the combination of central venous pressure (CVP) and left ventricular functional preload parameters, such as stroke volume variation (SVV) and pulse pressure variation (PPV), can be used for the detection of acute RVF and for guidance of volume therapy.
  
  
  METHODS
  Experimental study in a university laboratory.
  
  
  METHODS
  Fifteen anesthetized and ventilated pigs.
  
  
  RESULTS
  For the induction of RVF, mean pulmonary artery pressure (MPAP) was increased by 50% with a continuous infusion of a thromboxane-A(2) analog (U46619). Then, blood removal (300 mL) and retransfusion (blood 200 mL + colloid solution 200 mL) were performed. An analysis of volume responders and nonresponders was implemented. Increasing MPAP (25.1 to 37.4 mmHg) led to decreases in mean arterial pressure (72.2 to 60.1 mmHg) and cardiac output (2.8 to 2.3 L/min, p < 0.05). CVP (11.3 to 12.6 mmHg), PPV (13% to 17%), and SVV (11 to 14%) increased significantly (p < 0.05). During volume removal, MPAP (37.4 to 34.1 mmHg), mean arterial pressure (60.1 to 53.2 mmHg), and cardiac output (2.3 to 2.1 L/min) decreased (p < 0.05), whereas PPV and SVV remained unchanged. During volume loading, CVP increased in volume responders and nonresponders; however, PPV decreased in responders only.
  
  
  CONCLUSIONS
  Increases of CVP and SVV or PPV are suspicious for RVF. However, SVV and PPV fail to predict volume responsiveness in RVF. Changes in SVV and PPV during a volume-loading maneuver can be used to assess volume responsiveness.
authors.affiliation: Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University of Hamburg, Hamburg, Germany. hans.peter.richter@gmx.net
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Richter
authors.forename: Christian
authors.initials: C
authors.lastname: Petersen
authors.forename: Alwin E
authors.initials: AE
authors.lastname: Goetz
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Reuter
authors.forename: Jens C
authors.initials: JC
authors.lastname: Kubitz
mesh_terms: D019796:15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid / Q000494:pharmacology; D000769:Anesthesia, Inhalation; D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D001803:Blood Transfusion; D002302:Cardiac Output / Q000502:physiology; D002496:Central Venous Pressure / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D008991:Monitoring, Physiologic; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011229:Preanesthetic Medication; D011651:Pulmonary Artery / Q000502:physiology; D012984:Software; D013318:Stroke Volume; D013552:Swine; D014662:Vasoconstrictor Agents / Q000494:pharmacology; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology* / Q000628:therapy*; D016277:Ventricular Function, Left / Q000502:physiology; D016278:Ventricular Function, Right / Q000502:physiology
chemical_list: D010952:Plasma Substitutes; D014662:Vasoconstrictor Agents; D019796:15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid