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The effects of vasoactive drugs on pulse pressure and stroke volume variation in postoperative ventilated patients

Hadian, M and Severyn, DA and Pinsky, MR (2011) The effects of vasoactive drugs on pulse pressure and stroke volume variation in postoperative ventilated patients. Journal of Critical Care, 26 (3). 328.e1 - 328.e8. ISSN 0883-9441

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Abstract

Introduction: Although pulse pressure variation (PPV) and stroke volume variation (SVV) during mechanical ventilation have been shown to predict preload responsiveness, the effect of vasoactive therapy on PPV and SVV is unknown. Methods: Pulse pressure variation and SVV were measured continuously in 15 cardiac surgery patients for the first 4 postoperative hours. Pulse pressure variation was directly measured from the arterial pressure waveform, and both PPV and SVV were also calculated by LiDCO Plus (LiDCO Ltd, Cambridge, United Kingdom) before and after volume challenges or changes in vasoactive drug infusions done to sustain cardiovascular stability. Results: Seventy-one paired events were studied (38 vasodilator, 10 vasoconstrictor, 14 inotropes, and 9 volume challenges). The difference between the measured and LiDCO-calculated PPV was 1% ± 7% (1.96 SD, 95% confidence interval, r2 = 0.8). Volume challenge decreased both PPV and SVV (15% to 10%, P < .05 and 13% to 9%, P = .09, respectively). Vasodilator therapy increased PPV and SVV (13% to 17% and 9% to 15%, respectively, P < .001), whereas increasing inotropes or vasoconstrictors did not alter PPV or SVV. The PPV/SVV ratio was unaffected by treatments. Conclusion: Volume loading decreased PPV and SVV; and vasodilators increased both, consistent with their known cardiovascular effects. Thus, SVV and PPV can be used to drive fluid resuscitation algorithms in the setting of changing vasoactive drug therapy. © 2011 Elsevier Inc.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Hadian, M
Severyn, DA
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Date: 1 January 2011
Date Type: Publication
Journal or Publication Title: Journal of Critical Care
Volume: 26
Number: 3
Page Range: 328.e1 - 328.e8
DOI or Unique Handle: 10.1016/j.jcrc.2010.08.018
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0883-9441
PubMed Central ID: PMC3103641
PubMed ID: 21036528
Date Deposited: 07 Mar 2012 20:56
Last Modified: 30 Jan 2020 16:55
URI: http://d-scholarship.pitt.edu/id/eprint/11358

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