title: Dynamic preload indicators decrease when the abdomen is opened.
abstract: BACKGROUND
  Optimizing cardiac stroke volume during major surgery is of interest to many as a therapeutic target to decrease the incidence of postoperative complications. Because dynamic preload indicators are strongly correlated with stroke volume, it is suggested that these indices can be used for goal directed fluid therapy. However, threshold values of these indicators depend on many factors that are influenced by surgery, including opening of the abdomen. The aim of this study was therefore to assess the effect of opening the abdomen on arterial pressure variations in patients undergoing abdominal surgery.
  
  
  METHODS
  Blood pressure and bladder pressure were continuously recorded just before and after opening of the abdomen in patients undergoing elective laparotomy. Based on waveform analysis of the non-invasively derived blood pressure, the stroke volume index, pulse pressure variation (PPV) and stroke volume variation (SVV) were calculated off-line.
  
  
  RESULTS
  Thirteen patients were included. After opening the abdomen, PPV and SVV decreased from 11.5 ± 5.8% to 6.4 ± 2.9% (p < 0.005, a relative decrease of 40 ± 19%) and 12.7 ± 6.1% to 4.8 ± 1.6% (p < 0.05, a relative decrease of 53 ± 26%), respectively. Although mean arterial pressure and stroke volume index tended to increase (41 ± 6 versus 45 ± 4 ml/min/m2, p = 0.14 and 41 ± 6 versus 45 ± 4 ml/min/m2, p = 0.05), and heart rate tended to decrease (73 ± 15 versus 68 ± 11 1/min, p = 0.05), no significant change was found. No significant change was found in respiratory parameter (tidal volume, respiratory rate or inspiratory pressure; p = 0.36, 0.34 and 0.17, respectively) or bladder pressure (6.0 ± 3.7 versus 5.6 ± 2.7 mmHg, p = 0.6) either.
  
  
  CONCLUSIONS
  Opening of the abdomen decreases PPV and SVV. During goal directed therapy, current thresholds for fluid responsiveness should be changed accordingly.
authors.affiliation: University of Twente, MIRA - Institute for Biomedical Technology and Technical Medicine, PO box 217, Enschede, 7500 AE The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: van Lavieren
authors.affiliation: University of Twente, MIRA - Institute for Biomedical Technology and Technical Medicine, PO box 217, Enschede, 7500 AE The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Veelenturf
authors.affiliation: Department of Anaesthesiology, Radboud university medical center, PO Box 9101, Nijmegen, 6500 HB The Netherlands.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hofhuizen
authors.affiliation: Department of Surgery, Radboud university medical center, PO Box 9101, Nijmegen, 6500 HB The Netherlands.
authors.forename: Marion
authors.initials: M
authors.lastname: van der Kolk
authors.affiliation: Department of Intensive Care, Radboud university medical center, PO Box 9101, Nijmegen, 6500 HB The Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: van der Hoeven
authors.affiliation: Department of Intensive Care, Radboud university medical center, PO Box 9101, Nijmegen, 6500 HB The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Pickkers
authors.affiliation: Department of Intensive Care, Radboud university medical center, PO Box 9101, Nijmegen, 6500 HB The Netherlands.
authors.forename: Joris
authors.initials: J
authors.lastname: Lemson
authors.affiliation: University of Twente, MIRA - Institute for Biomedical Technology and Technical Medicine, PO box 217, Enschede, 7500 AE The Netherlands ; Department of Intensive Care, Radboud university medical center, PO Box 9101, Nijmegen, 6500 HB The Netherlands.
authors.forename: Benno
authors.initials: B
authors.lastname: Lansdorp
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000758:Anesthesia; D062186:Arterial Pressure / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D005440:Fluid Therapy / Q000592:standards; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015656:Respiratory Mechanics / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology*