Can a central blood volume deficit be detected by systolic pressure variation during spontaneous breathing?

BMC Anesthesiology

Research Article

Chris Hayes¹  Michael Dahl¹  Bodil Steen Rasmussen¹  Niels H. Secher²  Anders Larsson³ 

[1] Department of Anesthesiology and Intensive Care Medicine, Aalborg University Hospital, Hobrovej 18-21, DK-9000, Aalborg, Denmark;Department of Anesthesiology, The Copenhagen Muscle Research Center Rigshospitalet 2043, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark;Hedenstierna laboratory, Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, ANIVA Ing. 70, 1. tv., S-75643, Uppsala, Sweden;

关键词: Fluid responsiveness;    Spontaneous breathing;    Head-up tilt;    Pulse pressure variation;    Stroke volume variation;    Systolic pressure variation;   

DOI  :  10.1186/s12871-016-0224-z

 received in 2015-11-21, accepted in 2016-07-14,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundWhether during spontaneous breathing arterial pressure variations (APV) can detect a volume deficit is not established. We hypothesized that amplification of intra-thoracic pressure oscillations by breathing through resistors would enhance APV to allow identification of a reduced cardiac output (CO). This study tested that hypothesis in healthy volunteers exposed to central hypovolemia by head-up tilt.MethodsThirteen healthy volunteers were exposed to central hypovolemia by 45° head-up tilt while breathing through a facemask with 7.5 cmH2O inspiratory and/or expiratory resistors. A brachial arterial catheter was used to measure blood pressure and thus systolic pressure variation (SPV), pulse pressure variation and stroke volume variation . Pulse contour analysis determined stroke volume (SV) and CO and we evaluated whether APV could detect a 10 % decrease in CO.ResultsDuring head-up tilt SV decreased form 91 (±46) to 55 (±24) mL (mean ± SD) and CO from 5.8 (±2.9) to 4.0 (±1.8) L/min (p < 0.05), while heart rate increased (65 (±11) to 75 (±13) bpm; P < 0.05). Systolic pressure decreased from 127 (±14) to 121 (±13) mmHg during head-up tilt, while SPV tended to increase (from 21 (±15)% to 30 (±13)%). Yet during head-up tilt, a SPV ≥ 37 % predicted a decrease in CO ≥ 10 % with a sensitivity and specificity of 78 % and 100 %, respectively.ConclusionIn spontaneously breathing healthy volunteers combined inspiratory and expiratory resistors enhance SPV during head-up tilted induced central hypovolemia and allow identifying a 10 % reduction in CO. Applying inspiratory and expiratory resistors might detect a fluid deficit in spontaneously breathing patients.Trial registrationClinicalTrials.gov number NCT02549482 Registered September 10th 2015.

【 授权许可】

CC BY   
© The Author(s). 2016