Ventilator-induced central venous pressure variation can predict fluid responsiveness in post-operative cardiac surgery patients.
BACKGROUND
Ventilator-induced dynamic hemodynamic parameters such as stroke volume variation (SVV) and pulse pressure variation (PPV) have been shown to predict fluid responsiveness in contrast to static hemodynamic parameters such as central venous pressure (CVP). We hypothesized that the ventilator-induced central venous pressure variation (CVPV) could predict fluid responsiveness.


METHODS
Twenty-two elective cardiac surgery patients were studied post-operatively on the intensive care unit during mechanical ventilation with tidal volumes of 6-8 ml/kg without spontaneous breathing efforts or cardiac arrhythmia. Before and after administration of 500mL hydroxyethyl starch, SVV and PPV were measured using pulse contour analysis by modified Modelflow®, while CVP was obtained from a central venous catheter positioned in the superior vena cava. CVPV was calculated as 100 × (CVPmax-CVPmin)/[(CVPmax+ CVPmin)/2].


RESULTS
Nineteen patients (86%) were fluid responders defined as an increase in cardiac output of ≥ 15% after fluid administration. CVPV decreased upon fluid loading in responders, but not in non-responders. Baseline CVP values showed no correlation with a change in cardiac output in contrast to baseline SVV (r = 0.60, P = 0.003), PPV (r = 0.58, P = 0.005), and CVPV (r = 0.63, P = 0.002). Baseline values of SVV > 9% and PPV > 8% could predict fluid responsiveness with a sensitivity of 89% and 95%, respectively, both with a specificity of 100%. Baseline CVPV could identify all fluid responders and non-responders correctly at a cut-off value of 12%. There was no difference between the area under the receiver operating characteristic curves of SVV, PPV, and CVPV.


CONCLUSIONS
The use of ventilator-induced CVPV could predict fluid responsiveness similar to SVV and PPV in post-operative cardiac surgery patients.
Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands. t.g.cherpanath@amc.uva.nl.
T G V
TG
Cherpanath
Department of Anaesthesiology, Academic Medical Centre, Amsterdam, The Netherlands.
B F
BF
Geerts
Department of Intensive Care Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
J J
JJ
Maas
Department of Intensive Care Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
R B P
RB
de Wilde
Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.
A B
AB
Groeneveld
Department of Intensive Care Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
J R
JR
Jansen
D000368:Aged; D002302:Cardiac Output; D006348:Cardiac Surgical Procedures; D002496:Central Venous Pressure; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D012122:Ventilators, Mechanical