title: Pulse pressure variation-guided fluid therapy after cardiac surgery: a pilot before-and-after trial.
abstract: OBJECTIVE
  The aim of this study is to study the feasibility, safety, and physiological effects of pulse pressure variation (PPV)-guided fluid therapy in patients after cardiac surgery.
  
  
  METHODS
  We conducted a pilot prospective before-and-after study during mandatory ventilation after cardiac surgery in a tertiary intensive care unit. We introduced a protocol to deliver a fluid bolus for a PPV≥13% for at least >10 minutes during the intervention period.
  
  
  RESULTS
  We studied 45 control patients and 53 intervention patients. During the intervention period, clinicians administered a fluid bolus on 79% of the defined PPV trigger episodes. Median total fluid intake was similar between 2 groups during mandatory ventilation (1297 mL [interquartile range 549-1968] vs 1481 mL [807-2563]; P=.17) and the first 24 hours (3046 mL [interquartile range 2317-3982] vs 3017 mL [2192-4028]; P=.73). After adjusting for several baseline factors, PPV-guided fluid management significantly increased fluid intake during mandatory ventilation (P=.004) but not during the first 24 hours (P=.47). Pulse pressure variation-guided fluid therapy, however, did not significantly affect hemodynamic, renal, and metabolic variables. No serious adverse events were noted.
  
  
  CONCLUSIONS
  Pulse pressure variation-guided fluid management was feasible and safe during mandatory ventilation after cardiac surgery. However, its advantages may be clinically small.
authors.affiliation: Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia.
authors.forename: Nicholas C Z
authors.initials: NC
authors.lastname: Woinarski
authors.affiliation: Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
authors.forename: Miklos
authors.initials: M
authors.lastname: Lipcsey
authors.affiliation: Department of Intensive Care, Hospital Universitari Mutua Terrassa, Barcelona, Spain.
authors.forename: Cristina Lluch
authors.initials: CL
authors.lastname: Candal
authors.affiliation: Intensive Care Medicine, Universite de Lausanne, Lausanne, Switzerland.
authors.forename: Antoine G
authors.initials: AG
authors.lastname: Schneider
authors.affiliation: Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Glassford
authors.affiliation: Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Eastwood
authors.affiliation: Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: rinaldo.bellomo@austin.org.au.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology*; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D065187:Controlled Before-After Studies; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011674:Pulse; D012121:Respiration, Artificial
keywords: Cardiac output; Cardiac surgery; Fluid therapy; Intensive care; Pulse pressure variation