title: Hemodynamic pressure waveform analysis in predicting fluid responsiveness.
abstract: OBJECTIVE
  To assess the usefulness of central venous pressure (CVP), diastolic right ventricular pressure, and pulmonary capillary wedge pressure (PCWP) waveform analysis in predicting fluid responsiveness.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  Tertiary care university hospital.
  
  
  METHODS
  Forty-four patients undergoing coronary artery bypass grafting.
  
  
  METHODS
  Analysis of the a/v wave ratio of the PCWP, CVP, and right ventricular dP/dt to predict an increase in stroke volume >15% after the administration of 500 mL of colloid.
  
  
  RESULTS
  Forty-four patients were enrolled in this study and 7 were excluded. There were 24 responders and 13 nonresponders. No differences in mean CVP and PCWP values between the responders and the nonresponders were found. The only parameter associated with a significant response to volume infusion was the ratio of the a/v waves of the PCWP tracing (p = 0.0001). The performance of the a/v wave ratio>1 of the PCWP tracing in predicting fluid responsiveness was evaluated by constructing a receiver operating characteristic curve. The area under the receiver operating characteristic curve was 0.89 (95% confidence interval, 0.79-0.99; p<0.05).
  
  
  CONCLUSIONS
  The a/v ratio measured on the PCWP tracing is a predictor of fluid responsiveness in patients with preserved left ventricular function undergoing coronary artery bypass grafting.
authors.affiliation: Department of Anesthesiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Roy
authors.forename: Pierre
authors.initials: P
authors.lastname: Couture
authors.forename: Baqir
authors.initials: B
authors.lastname: Qizilbash
authors.forename: Francis
authors.initials: F
authors.lastname: Toupin
authors.forename: Sylvie
authors.initials: S
authors.lastname: Levesque
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.forename: Jean
authors.initials: J
authors.lastname: Lambert
authors.forename: André Y
authors.initials: AY
authors.lastname: Denault
mesh_terms: D000368:Aged; D002302:Cardiac Output / Q000502:physiology; D002407:Catheterization, Swan-Ganz; D002496:Central Venous Pressure / Q000502:physiology; D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D005440:Fluid Therapy / Q000379:methods* / Q000706:statistics & numerical data; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012372:ROC Curve; D013318:Stroke Volume / Q000502:physiology; D013815:Thermodilution; D016278:Ventricular Function, Right / Q000502:physiology; D058067:Wavelet Analysis
keywords: a/c waves; cardiac surgery; hemodynamic monitoring; preload responsiveness; pulmonary artery pressures