title: Combination of continuous pulse pressure variation monitoring and cardiac filling pressure to predict fluid responsiveness.
abstract: To assess if combining central venous pressure (CVP) and/or pulmonary capillary wedge pressure (PCWP) information with arterial pulse pressure variation can increase the ability to predict fluid responsiveness in patients under general anesthesia. This study is a retrospective analysis of patients scheduled for coronary artery bypass surgery and monitored with a pulmonary artery catheter who underwent a volume expansion after induction of general anesthesia. Among the 46 patients studied, 31 were responders to volume expansion. CVP similar to PCWP, was a poor predictor of fluid responsiveness, as indicated by low values of areas under the receiver operating characteristic curves [0.585 (95 % CI 0.389-0.780) and 0.563 (95 % CI 0.373-0.753) respectively, p = 0.76]. The area obtained for PPV was 0.897 (95 % CI 0.801-0.992) with a threshold value of 12 %. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio was 83.9 %, 86.7 %, 6.29 and 0.19 respectively. Combining information on right and/or left cardiac filling pressures with PPV did not increase the ability to predict whether a patient will be a responder or a non-responder to volume expansion. The ability to identify a potentially fluid responsive patient was no better using PPV plus cardiac filling pressures when compared to using PPV alone. Therefore, if PPV values are being monitored in a patient, CVP and PCWP values do not provide additional information to predict fluid responsiveness.
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Est, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital, Claude Bernard Lyon 1 University, Lyon, France. kellergeoffray@hotmail.fr
authors.forename: Geoffray
authors.initials: G
authors.lastname: Keller
authors.forename: Karin
authors.initials: K
authors.lastname: Sinavsky
authors.forename: Olivier
authors.initials: O
authors.lastname: Desebbe
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Lehot
mesh_terms: D001794:Blood Pressure; D001810:Blood Volume; D002407:Catheterization, Swan-Ganz; D002496:Central Venous Pressure; D006801:Humans; D008991:Monitoring, Physiologic; D011669:Pulmonary Wedge Pressure; D013318:Stroke Volume