Advanced search
1 file | 803.17 KB Add to list

Noninvasive pulse pressure variation and stroke volume variation to predict fluid responsiveness at multiple thresholds : a prospective observational study

Author
Organization
Abstract
Pulse pressure variation (PPV) and stroke volume variation (SVV) are dynamic preload variables that can be measured noninvasively to assess fluid responsiveness (FR) in anesthetized patients with mechanical ventilation. Few studies have examined the effectiveness of predicting FR according to the definition of FR, and assessment of inconclusive values of PPV and SVV around the cut-off value (the "grey zone") might improve individual FR prediction. We explored the ability of noninvasive volume clamp derived measurements of PPV and SVV to predict FR using the grey zone approach, and we assessed the influence of multiple thresholds on the predictive ability of the numerical definition of FR. Ninety patients undergoing general surgery were included in this prospective observational study and received a 500 mL fluid bolus as deemed clinically required by the attending anesthesiologist. A minimal relative increase in stroke volume index (a dagger SVI) was used to define FR with different thresholds from 10-25%. The PPV, SVV, and SVI were measured using the NexfinA (R) device that employs noninvasive volume clamp plethysmography. The area under the receiver operator characteristic curve gradually increased for PPV / SVV with higher threshold values (from 0.818 / 0.760 at 10% a dagger SVI to 0.928 / 0.944 at 25% a dagger SVI). The grey zone limits of both PPV and SVV changed from 9-16% (PPV) and 5-13% (SVV) at the 10% a dagger SVI threshold to 18-21% (PPV) and 14-16% (SVV) at the 25% a dagger SVI threshold. Noninvasive PPV and SVV measurements allow an acceptable FR prediction, although the reliability of both variables is dependent on the intended increase in SVI, which improves substantially with concomitant smaller grey zones at higher a dagger SVI thresholds.
Keywords
CONTINUOUS CARDIAC-OUTPUT, ARTERIAL-PRESSURE, ESOPHAGEAL DOPPLER, DYNAMIC INDEXES, GRAY-ZONE, SURGERY, NEXFIN, THERMODILUTION, VARIABLES, DEVICE

Downloads

  • 8591492.pdf
    • full text
    • |
    • open access
    • |
    • PDF
    • |
    • 803.17 KB

Citation

Please use this url to cite or link to this publication:

MLA
Vos, Jaap Jan, Marieke Poterman, Pieternel Papineau Salm, et al. “Noninvasive Pulse Pressure Variation and Stroke Volume Variation to Predict Fluid Responsiveness at Multiple Thresholds : a Prospective Observational Study.” CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE 62.11 (2015): 1153–1160. Print.
APA
Vos, J. J., Poterman, M., Salm, P. P., Van Amsterdam, K., Struys, M., Scheeren, T. W., & Kalmar, A. (2015). Noninvasive pulse pressure variation and stroke volume variation to predict fluid responsiveness at multiple thresholds : a prospective observational study. CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE, 62(11), 1153–1160.
Chicago author-date
Vos, Jaap Jan, Marieke Poterman, Pieternel Papineau Salm, Kai Van Amsterdam, Michel Struys, Thomas WL Scheeren, and Alain Kalmar. 2015. “Noninvasive Pulse Pressure Variation and Stroke Volume Variation to Predict Fluid Responsiveness at Multiple Thresholds : a Prospective Observational Study.” Canadian Journal of Anesthesia-journal Canadien D Anesthesie 62 (11): 1153–1160.
Chicago author-date (all authors)
Vos, Jaap Jan, Marieke Poterman, Pieternel Papineau Salm, Kai Van Amsterdam, Michel Struys, Thomas WL Scheeren, and Alain Kalmar. 2015. “Noninvasive Pulse Pressure Variation and Stroke Volume Variation to Predict Fluid Responsiveness at Multiple Thresholds : a Prospective Observational Study.” Canadian Journal of Anesthesia-journal Canadien D Anesthesie 62 (11): 1153–1160.
Vancouver
1.
Vos JJ, Poterman M, Salm PP, Van Amsterdam K, Struys M, Scheeren TW, et al. Noninvasive pulse pressure variation and stroke volume variation to predict fluid responsiveness at multiple thresholds : a prospective observational study. CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE. 2015;62(11):1153–60.
IEEE
[1]
J. J. Vos et al., “Noninvasive pulse pressure variation and stroke volume variation to predict fluid responsiveness at multiple thresholds : a prospective observational study,” CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE, vol. 62, no. 11, pp. 1153–1160, 2015.
@article{8591759,
  abstract     = {Pulse pressure variation (PPV) and stroke volume variation (SVV) are dynamic preload variables that can be measured noninvasively to assess fluid responsiveness (FR) in anesthetized patients with mechanical ventilation. Few studies have examined the effectiveness of predicting FR according to the definition of FR, and assessment of inconclusive values of PPV and SVV around the cut-off value (the "grey zone") might improve individual FR prediction. We explored the ability of noninvasive volume clamp derived measurements of PPV and SVV to predict FR using the grey zone approach, and we assessed the influence of multiple thresholds on the predictive ability of the numerical definition of FR. 
Ninety patients undergoing general surgery were included in this prospective observational study and received a 500 mL fluid bolus as deemed clinically required by the attending anesthesiologist. A minimal relative increase in stroke volume index (a dagger SVI) was used to define FR with different thresholds from 10-25%. The PPV, SVV, and SVI were measured using the NexfinA (R) device that employs noninvasive volume clamp plethysmography. 
The area under the receiver operator characteristic curve gradually increased for PPV / SVV with higher threshold values (from 0.818 / 0.760 at 10% a dagger SVI to 0.928 / 0.944 at 25% a dagger SVI). The grey zone limits of both PPV and SVV changed from 9-16% (PPV) and 5-13% (SVV) at the 10% a dagger SVI threshold to 18-21% (PPV) and 14-16% (SVV) at the 25% a dagger SVI threshold. 
Noninvasive PPV and SVV measurements allow an acceptable FR prediction, although the reliability of both variables is dependent on the intended increase in SVI, which improves substantially with concomitant smaller grey zones at higher a dagger SVI thresholds.},
  author       = {Vos, Jaap Jan and Poterman, Marieke and Salm, Pieternel Papineau and Van Amsterdam, Kai and Struys, Michel and Scheeren, Thomas WL and Kalmar, Alain},
  issn         = {0832-610X},
  journal      = {CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE},
  keywords     = {CONTINUOUS CARDIAC-OUTPUT,ARTERIAL-PRESSURE,ESOPHAGEAL DOPPLER,DYNAMIC INDEXES,GRAY-ZONE,SURGERY,NEXFIN,THERMODILUTION,VARIABLES,DEVICE},
  language     = {eng},
  number       = {11},
  pages        = {1153--1160},
  title        = {Noninvasive pulse pressure variation and stroke volume variation to predict fluid responsiveness at multiple thresholds : a prospective observational study},
  url          = {http://dx.doi.org/10.1007/s12630-015-0464-2},
  volume       = {62},
  year         = {2015},
}

Altmetric
View in Altmetric
Web of Science
Times cited: