[Effects of volume resuscitation on venous pressure gradient in hypovolemic patients undergoing mechanical ventilation].
OBJECTIVE
To investigate  the  value  of  venous pressure gradient  [D(c-i)VP]  between  central venous pressure (CVP) and iliac vein pressure (IVP) in assessing the responsiveness to volume resuscitation in hypovolemic patient undergoing mechanical ventilation.


METHODS
Thirty hypovolemic patients undergoing mechanical ventilation, with maintenance of similar ventilation conditions, graded volume loading was performed with 250 ml Ringer  lactate solution  (LR)  for  each  infusion  in  hypovolemic  patients,  until  mean  arterial  pressure  (MAP) ≥65 mm Hg(1 mm Hg = 0.133 kPa), CVP≥8 mm Hg, strong pulse, perfusion improvement (recovery in the end) were reached. Before infusion, 10 minutes after infusion, and at the end of recovery, the heart rate (HR), MAP, CVP, IVP, stroke volume (SV), thoracic fluid content (TFC) and D(c-i)VP were measured and recorded, the correlations between D(c-i)VP  and  TFC, SV  before and after infusion were analyzed.


RESULTS
Before infusion, 10 minutes after infusion, and at the end of recovery, no significant difference was found in HR, MAP, CVP, and IVP,while D(c-i)VP (mm Hg) was obviously lowered (4.89 ± 1.70, 2.80 ± 1.44, 2.10 ± 1.30, respectively), and SV (ml) and TFC (ml) were significantly increased (SV was 42.0 ± 10.5, 49.0 ± 8.3, 58.0 ± 12.1, respectively; TFC was 30.0 ± 9.6, 38.0 ± 8.6, 43.0 ± 11.1, respectively), with statistical differences (P < 0.05 or P < 0.01). Negative correlations were found between D(c-i)VP and TFC, SV [r(1)=-0.580, P(1)=0.004; r(2)=-0.462, P(2) =0.017].


CONCLUSIONS
In the course of fluid resuscitation in hypovolemic patients undergoing mechanical ventilation, the D(c-i)VP was  significantly  reduced with fluid resuscitation. At  the same time, significant correlations  between D(c-i)VP, TFC  and SV were demonstrated. The measurement of D(c-i)VP  could  help  guide  fluid  resuscitation  in  hypovolemic  patients undergoing mechanical ventilation.
Intensive Care Unit, Longgang Central Hospital of Shenzhen, Shenzhen 518116, Guangdong, China.
Rong-lin
RL
Chen
Feng
F
Cao
Xian-fu
XF
Liu
Ru
R
He
D000293:Adolescent; D000328:Adult; D002496:Central Venous Pressure; D005260:Female; D006801:Humans; D020896:Hypovolemia / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012151:Resuscitation / Q000379:methods*; D014690:Venous Pressure; D055815:Young Adult