title: Pulse pressure variation predicts fluid responsiveness in elderly patients after coronary artery bypass graft surgery.
abstract: OBJECTIVE
  To assess the ability of pulse pressure variation to predict fluid responsiveness in mechanically ventilated elderly patients after coronary artery bypass graft surgery.
  
  
  METHODS
  A prospective, interventional study.
  
  
  METHODS
  An academic, tertiary referral hospital.
  
  
  METHODS
  Sixty patients >70 years old and mechanically ventilated after coronary artery bypass graft surgery.
  
  
  METHODS
  Intravascular volume expansion using 6% hydroxyethyl starch solution, 7 mL/kg over 20 minutes.
  
  
  RESULTS
  Heart rate, arterial blood pressure, pulse pressure variation, central venous pressure, pulmonary artery occlusion pressure, and stroke volume index were measured immediately before and after volume expansion. Fluid responsiveness was defined as an increase in stroke volume index ≥ 15% after volume expansion. Forty-one patients were fluid responders and 19 patients were nonresponders. In contrast to central venous pressure or pulmonary artery occlusion pressure, pulse pressure variation was higher in the responders than in the nonresponders (22 ± 6% v 9.3 ± 3%, p = 0.001) and correlated with the percent changes in the stroke volume index after volume expansion (r = 0.47, p = 0.001). The area under the receiver operating characteristic curve for pulse pressure variation was 0.85 (95% confidence interval 0.75-0.94). The threshold value of 11.5% allowed the discrimination between responders and nonresponders with a sensitivity of 80% and a specificity of 74%.
  
  
  CONCLUSIONS
  Pulse pressure variation is a reliable predictor of fluid responsiveness in mechanically ventilated elderly patients after coronary artery bypass graft surgery.
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon. ritalama@idm.net.lb
authors.forename: Alexandre
authors.initials: A
authors.lastname: Yazigi
authors.forename: Eliane
authors.initials: E
authors.lastname: Khoury
authors.forename: Sani
authors.initials: S
authors.lastname: Hlais
authors.forename: Samia
authors.initials: S
authors.lastname: Madi-Jebara
authors.forename: Fadia
authors.initials: F
authors.lastname: Haddad
authors.forename: Gemma
authors.initials: G
authors.lastname: Hayek
authors.forename: Khalil
authors.initials: K
authors.lastname: Jabbour
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001026:Coronary Artery Bypass; D003422:Critical Care / Q000379:methods; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D016896:Treatment Outcome
chemical_list: D006895:Hydroxyethyl Starch Derivatives