Influence of tidal volume on pulse pressure variation and stroke volume variation during experimental intra-abdominal hypertension

BMC Anesthesiology

Research Article

Pablo Cruces¹  B. Erranz²  F. Díaz³  T. Salomon⁴  A. Donoso⁵ 

[1] Centro de Investigación de Medicina Veterinaria, Escuela de Medicina Veterinaria, Facultad de Ecología y Recursos Naturales, Universidad Andres Bello, Santiago, Chile;Pediatric ICU, Hospital El Carmen de Maipú, Camino a Rinconada 1201, Maipú, Santiago, Chile;Centro de Medicina Regenerativa, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile;Critical Care Division, Department of Pediatrics, University of Alabama at Birmingham, Alabama, USA;Unidad de Cuidados Intensivos Pediatricos, Clínica Alemana de Santiago, Santiago, Chile;Unidad de Cuidados Intensivos Pediatricos, Clínica Alemana de Santiago, Santiago, Chile;Unidad de Paciente Crítico Pediátrico, Hospital Clínico Metropolitano La Florida, Santiago, Chile;

关键词: Cardiac Index;    Fluid Responsiveness;    Abdominal Compartment Syndrome;    Fluid Administration;    Pulse Pressure Variation;   

DOI  :  10.1186/s12871-015-0105-x

 received in 2015-02-26, accepted in 2015-09-07,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundPulse pressure variation (PPV) and stroke volume variation (SVV) are frequently used to assess fluid responsiveness in critically ill patients on mechanical ventilation (MV). There are many factors, in addition to preload that influence the magnitude of these cyclic variations. We sought to investigate the effect of tidal volume (VT) on PPV and SVV, and prediction of fluid responsiveness in a model of intra-abdominal hypertension (IAH).MethodsTwelve anesthetized and mechanically ventilated piglets on continuous pulse contour cardiac output monitoring. Hypovolemia was ruled out with 2 consecutive fluid boluses after instrumentation. IAH was induced by intraperitoneal instillation of colloid solution with a goal of reducing respiratory system compliance by 50 %. Subjects were classified as fluid responders if stroke volume increased >15 % after each fluid challenge. SVV and PPV were recorded with tidal volumes (VT) of 6, 12 and 18 ml/kg before IAH after IAH induction and after a fluid challenge during IAH.ResultsVT influenced PPV and SVV at baseline and during IAH, being significantly larger with higher VT. These differences were attenuated after fluid administration in both conditions. After IAH induction, there was a significant increase in SVV with the three-tested VT, but the magnitude of that change was larger with high VT: with 6 ml/kg from 3 % (3, 4) to 5 % (4, 6.25) (p = 0.05), with 12 ml/kg from 5 % (4, 6) to 11 % (8.75, 17) (p = 0.02) and 18 ml/kg from 5 % (4,7.5) to 15 % (8.75, 19.5) (p = 0.02). Similarly, PPV increased with all the tested VT after IAH induction, being this increase larger with high VT: with 6 ml/kg from 3 % (2, 4.25) to 6 % (4.75, 7) (p = 0.05), with 12 ml/kg from 5 % (4, 6) to 13.5 % (10.25, 15.5) (p = 0.02) and 18 ml/kg from 7 % (5.5, 8.5) to 24 % (13.5, 30.25) (p = 0.02). One third of subjects responded to fluid administration after IAH, but neither SVV nor PPV were able to identify the fluid responders with the tested VT.ConclusionIAH induction in non-hypovolemic subjects significantly increased SVV and PPV with the three tested VT, but the magnitude of that change was higher with larger VT. This observation reveals the dependence of functional hemodynamic markers on intrathoracic as well intra-abdominal pressures, in addition to volemic status. Also, PPV and SVV were unable to predict fluid responsiveness after IAH induction. Future studies should take into consideration these findings when exploring relationships between dynamic preload indicators and fluid responsiveness during IAH.

【 授权许可】

CC BY   
© Díaz et al. 2015