Dynamic preload indicators decrease when the abdomen is opened

BMC Anesthesiology

Research Article

Charlotte Hofhuizen¹  Johannes van der Hoeven²  Peter Pickkers²  Joris Lemson²  Marion van der Kolk³  Jeroen Veelenturf⁴  Martijn van Lavieren⁴  Benno Lansdorp⁵ 

[1] Department of Anaesthesiology, Radboud university medical center, PO Box 9101, 6500, Nijmegen, HB, The Netherlands;Department of Intensive Care, Radboud university medical center, PO Box 9101, 6500, Nijmegen, HB, The Netherlands;Department of Surgery, Radboud university medical center, PO Box 9101, 6500, Nijmegen, HB, The Netherlands;University of Twente, MIRA - Institute for Biomedical Technology and Technical Medicine, PO box 217, 7500, Enschede, AE, The Netherlands;University of Twente, MIRA - Institute for Biomedical Technology and Technical Medicine, PO box 217, 7500, Enschede, AE, The Netherlands;Department of Intensive Care, Radboud university medical center, PO Box 9101, 6500, Nijmegen, HB, The Netherlands;

关键词: Tidal Volume;    Sufentanil;    Fluid Responsiveness;    Pulse Pressure Variation;    Abdominal Pressure;   

DOI  :  10.1186/1471-2253-14-90

 received in 2014-04-28, accepted in 2014-10-03,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundOptimizing cardiac stroke volume during major surgery is of interest to many as a therapeutic target to decrease the incidence of postoperative complications. Because dynamic preload indicators are strongly correlated with stroke volume, it is suggested that these indices can be used for goal directed fluid therapy. However, threshold values of these indicators depend on many factors that are influenced by surgery, including opening of the abdomen. The aim of this study was therefore to assess the effect of opening the abdomen on arterial pressure variations in patients undergoing abdominal surgery.MethodsBlood pressure and bladder pressure were continuously recorded just before and after opening of the abdomen in patients undergoing elective laparotomy. Based on waveform analysis of the non-invasively derived blood pressure, the stroke volume index, pulse pressure variation (PPV) and stroke volume variation (SVV) were calculated off-line.ResultsThirteen patients were included. After opening the abdomen, PPV and SVV decreased from 11.5 ± 5.8% to 6.4 ± 2.9% (p < 0.005, a relative decrease of 40 ± 19%) and 12.7 ± 6.1% to 4.8 ± 1.6% (p < 0.05, a relative decrease of 53 ± 26%), respectively. Although mean arterial pressure and stroke volume index tended to increase (41 ± 6 versus 45 ± 4 ml/min/m2, p = 0.14 and 41 ± 6 versus 45 ± 4 ml/min/m2, p = 0.05), and heart rate tended to decrease (73 ± 15 versus 68 ± 11 1/min, p = 0.05), no significant change was found. No significant change was found in respiratory parameter (tidal volume, respiratory rate or inspiratory pressure; p = 0.36, 0.34 and 0.17, respectively) or bladder pressure (6.0 ± 3.7 versus 5.6 ± 2.7 mmHg, p = 0.6) either.ConclusionsOpening of the abdomen decreases PPV and SVV. During goal directed therapy, current thresholds for fluid responsiveness should be changed accordingly.

【 授权许可】

Unknown   
© van Lavieren et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.