Automated, continuous and non-invasive assessment of pulse pressure variations using CNAP®system.
Non-invasive respiratory variations in arterial pulse pressure using infrared-plethysmography (PPVCNAP) are able to predict fluid responsiveness in mechanically ventilated patients. However, they cannot be continuously monitored. The present study evaluated a new algorithm allowing continuous measurements of PPVCNAP(PPVCNAPauto) (CNSystem, Graz, Austria). Thirty-five patients undergoing vascular surgery were studied after induction of general anaesthesia. Stroke volume was measured using the VigileoTM/FloTracTM. Invasive pulse pressure variations were manually calculated using an arterial line (PPVART) and PPVCNAPautowas continuously displayed. PPVARTand PPVCNAPautowere simultaneously recorded before and after volume expansion (500 ml hydroxyethylstarch). Subjects were defined as responders if stroke volume increased by ≥15 %. Twenty-one patients were responders. Before volume expansion, PPVARTand PPVCNAPautoexhibited a bias of 0.1 % and limits of agreement from -7.9 % to 7.9 %. After volume expansion, PPVARTand PPVCNAPautoexhibited a bias of -0.4 % and limits of agreement from -5.3 % to 4.5 %. A 14 % baseline PPVARTthreshold discriminated responders with a sensitivity of 86 % (95 % CI 64-97 %) and a specificity of 100 % (95 % CI 77-100 %). Area under the receiver operating characteristic (ROC) curve for PPVARTwas 0.93 (95 % CI 0.79-0.99). A 15 % baseline PPVCNAPautothreshold discriminated responders with a sensitivity of 76% (95 % CI 53-92 %) and a specificity of 93 % (95 % CI 66-99 %). Area under the ROC curves for PPVCNAPautowas 0.91 (95 % CI 0.76-0.98), which was not different from that for PPVART. When compared with PPVART, PPVCNAPautoperforms satisfactorily in assessing fluid responsiveness in hemodynamically stable surgical patients.
Service d'Anesthésie Réanimation 3, CFXM, CHU de Bordeaux, 33076, Bordeaux Cedex, France. matthieu.biais@chu-bordeaux.fr.|Adaptation cardiovasculaire à l'ischémie, U1034, INSERM, 33600, Pessac, France. matthieu.biais@chu-bordeaux.fr.|Adaptation cardiovasculaire à l'ischémie, U1034, Univ. Bordeaux, 33600, Pessac, France. matthieu.biais@chu-bordeaux.fr.
Matthieu
M
Biais
Service d'Anesthésie réanimation 1, CHU de Bordeaux, 33000, Bordeaux, France.
Laurent
L
Stecken
Service d'Anesthésie réanimation 1, CHU de Bordeaux, 33000, Bordeaux, France.
Aurélie
A
Martin
Service d'Anesthésie réanimation 1, CHU de Bordeaux, 33000, Bordeaux, France.
Stéphanie
S
Roullet
Service d'Anesthésie réanimation 1, CHU de Bordeaux, 33000, Bordeaux, France.
Alice
A
Quinart
Adaptation cardiovasculaire à l'ischémie, U1034, INSERM, 33600, Pessac, France.|Adaptation cardiovasculaire à l'ischémie, U1034, Univ. Bordeaux, 33600, Pessac, France.|Service d'Anesthésie réanimation 1, CHU de Bordeaux, 33000, Bordeaux, France.
François
F
Sztark
D000368:Aged; D000465:Algorithms; D001011:Aorta / Q000601:surgery; D019540:Area Under Curve; D001331:Automation; D001794:Blood Pressure; D002302:Cardiac Output; D016894:Endarterectomy, Carotid; D005260:Female; D005440:Fluid Therapy; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods*; D010991:Plethysmography; D012372:ROC Curve; D012121:Respiration, Artificial; D012680:Sensitivity and Specificity; D013318:Stroke Volume
D006895:Hydroxyethyl Starch Derivatives
Cardiac output; Monitoring; Vascular surgery; i.v. fluids