Diastolic Function and Peripheral Venous Pressure as Indices for Fluid Responsiveness in Cardiac Surgical Patients
| Autor: | Daniel C. Jupiter, Johannes De Riese, Michael P. Kinsky, Christopher K. McQuitty, Korey Willmann, Nicole Ribeiro Marques, Bryan C. Yelverton, William E. Johnston, Michael Salter |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Resuscitation 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Bolus (medicine) Diastole 030202 anesthesiology Internal medicine Myocardial Revascularization medicine Humans Prospective Studies Cardiac Surgical Procedures Coronary Artery Bypass Aged Receiver operating characteristic business.industry Albumin Stroke volume Middle Aged Confidence interval Peripheral Anesthesiology and Pain Medicine Cardiology Fluid Therapy Female Cardiology and Cardiovascular Medicine business Venous Pressure Perfusion |
| Zdroj: | Journal of Cardiothoracic and Vascular Anesthesia. 33:2208-2215 |
| ISSN: | 1053-0770 |
| Popis: | Objective Identifying fluid responsiveness is critical to optimizing perfusion while preventing fluid overload. An experimental study of hypovolemic shock resuscitation showed the importance of ventricular compliance and peripheral venous pressure (PVP) on fluid responsiveness. The authors tested the hypothesis that reduced ventricular compliance measured using transesophageal echocardiography results in decreased fluid responsiveness after a fluid bolus. Design Prospective observational study. Setting Two-center, university hospital study. Participants The study comprised 29 patients undergoing elective coronary revascularization. Intervention Albumin 5%, 7 mL/kg, was infused over 10 minutes to characterize fluid responders (>15% increase in stroke volume) from nonresponders. Measurements and Main Results Invasive hemodynamics and the ratio of mitral inflow velocity (E-wave)/annular relaxation (e’), or E/e’ ratio, were measured using transesophageal echocardiography to assess left ventricular (LV) compliance at baseline and after albumin infusion. Fifteen patients were classified as responders and 14 as nonresponders. The E/e’ ratio in responders was 7.4 ± 1.9 at baseline and 7.1 ± 1.8 after bolus. In contrast, E/e’ was significantly higher in nonresponders at baseline (10.7 ± 4.6; p = 0.04) and further increased after bolus (12.6 ± 5.5; p = 0.002). PVP was significantly greater in the nonresponders at baseline (14 ± 4 mmHg v 11 ± 3 mmHg; p = 0.02) and increased in both groups after albumin infusion. Fluid responsiveness was tested using the area under the receiver operating characteristic curve and was 0.74 for the E/e’ ratio (95% confidence interval 0.55-0.93; p = 0.029) and 0.72 for the PVP (95% confidence interval 0.52-0.92; p = 0.058). Conclusion Fluid responders had normal LV compliance and lower PVP at baseline. In contrast, nonresponders had reduced LV compliance, which worsened after fluid bolus. E/e,’ more than PVP, may be a useful clinical index to predict fluid responsiveness. |
| Databáze: | OpenAIRE |
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