title: Effective evaluation of arterial pulse waveform analysis by two-dimensional stroke volume variation-stroke volume index plots.
abstract: Arterial pulse waveform analysis (APWA) with a semi-invasive cardiac output monitoring device is popular in perioperative hemodynamic and fluid management. However, in APWA, evaluation of hemodynamic data is not well discussed. In this study, we analyzed how we visually interpret hemodynamic data, including stroke volume variation (SVV) and stroke volume (SV) derived from APWA. We performed arithmetic estimation of the SVV-SV relationship and applied measured values to this estimation. We then collected measured values in six anesthesia cases, including three liver transplantations and three other types of surgeries, to apply them to this SVV-SVI (stroke volume variation index) plot. Arithmetic analysis showed that the relationship between SVV and SV can be drawn as hyperbolic curves. Plotting SVV-SV values in the semi-logarithmic scale showed linear correlations, and the slopes of the linear regression lines theoretically represented average mean cardiac contractility. In clinical measurements in APWA, plotting SVV and SVI values in the linear scale and the semi-logarithmic scale showed the correlations represented by hyperbolic curves and linear regression lines. The plots approximately shifted on the rectangular hyperbolic curves, depending on blood loss and blood transfusion. Arithmetic estimation is close to real measurement of the SVV-SV interaction in hyperbolic curves. In APWA, using SVV as an index of preload and the cardiac index or SVI derived from arterial pressure-based cardiac output as an index of cardiac function, is likely to be appropriate for categorizing hemodynamic stages as a substitute for Forrester subsets.
authors: Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan. anesth@koto.kpu-m.ac.jp.
authors: Teiji
authors: T
authors: Sawa
authors: Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
authors: Mao
authors: M
authors: Kinoshita
authors: Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
authors: Atsushi
authors: A
authors: Kainuma
authors: Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
authors: Koichi
authors: K
authors: Akiyama
authors: Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
authors: Yoshifumi
authors: Y
authors: Naito
authors: Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
authors: Hideya
authors: H
authors: Kato
authors: Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
authors: Fumimasa
authors: F
authors: Amaya
authors: Department of Anesthesiology and Reanimatology, School of Medicine, University of Fukui, Fukui, 910-1193, Japan.
authors: Keiji
authors: K
authors: Shigemi
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia; D062186:Arterial Pressure; D001158:Arteries; D001794:Blood Pressure; D002302:Cardiac Output; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D012372:ROC Curve; D012121:Respiration, Artificial; D012815:Signal Processing, Computer-Assisted; D013318:Stroke Volume; D013990:Tidal Volume; D055986:Vital Signs; D055815:Young Adult
keywords: FloTrac/Vigileo system; Fluid responsiveness; Goal-directed therapy; Hemodynamics