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Pulse pressure variation is not a valid predictor of fluid responsiveness in patients with elevated left ventricular filling pressure

Authors
 Jae-Kwang Shim  ;  Jong-Wook Song  ;  Young Song  ;  Ji-Ho Kim  ;  Hye-Min Kang  ;  Young-Lan Kwak 
Citation
 JOURNAL OF CRITICAL CARE, Vol.29(6) : 987-991, 2014 
Journal Title
 JOURNAL OF CRITICAL CARE 
ISSN
 0883-9441 
Issue Date
2014
MeSH
Aged ; Blood Pressure/physiology* ; Colloids/administration & dosage ; Coronary Artery Bypass, Off-Pump ; Female ; Fluid Therapy* ; Heart Ventricles/physiopathology ; Hemodynamics/physiology ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Pulse ; ROC Curve ; Stroke Volume/physiology*
Keywords
Filling pressure ; Fluid responsiveness ; Left ventricle ; Pulse pressure variation
Abstract
PURPOSE: The purpose of this study was to test the hypothesis that the predictive ability of pulse pressure variation (PPV) for fluid responsiveness would be altered in patients with elevated left ventricular (LV) filling pressure. MATERIALS AND METHODS: According to the preoperative echocardiographic assessment of the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/E'), patients undergoing surgical coronary revascularization were classified into normal (n=34, E/E'<8) and high (n=34, E/E'>15) LV filling pressure group. After anesthetic induction, PPV and hemodynamic data were measured before and after 6 mL/kg of colloid administration. Fluid responsiveness was defined as 12% or more increase in stroke volume index assessed by pulmonary artery catheter and tested by the area under the receiver operating characteristic curve (AUROC). RESULTS: The AUROCs of PPV in the normal and high filling pressure group were 0.829 (95% confidence interval [CI], 0.661-0.963; P<.001) and 0.583 (95% CI, 0.402-0.749; P=.110), respectively. The AUROCs of cardiac filling pressures and right ventricular end-diastolic volume index did not show statistical significance in both groups. CONCLUSIONS: None of the assessed preload indices including PPV were able to predict fluid responsiveness in patients with elevated LV filling pressure.
Full Text
http://www.sciencedirect.com/science/article/pii/S0883944114002809
DOI
10.1016/j.jcrc.2014.07.005
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Song, Young(송영) ORCID logo https://orcid.org/0000-0003-4597-387X
Song, Jong Wook(송종욱) ORCID logo https://orcid.org/0000-0001-7518-2070
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/100057
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