Pulse pressure variation-guided fluid therapy after cardiac surgery: A pilot before-and-after trial

被引:14
作者
Suzuki, Satoshi [1 ]
Woinarski, Nicholas C. Z. [2 ]
Lipcsey, Miklos [3 ]
Candal, Cristina Lluch [4 ]
Schneider, Antoine G. [5 ]
Glassford, Neil J. [1 ]
Eastwood, Glenn M. [1 ]
Bellomo, Rinaldo [1 ,6 ]
机构
[1] Austin Hosp, Dept Intens Care, Heidelberg, Vic 3084, Australia
[2] Monash Univ, Fac Med Nursing & Hlth Sci, Melbourne, Vic 3004, Australia
[3] Uppsala Univ, Dept Surg Sci Anaesthesiol & Intens Care, Uppsala, Sweden
[4] Hosp Univ Mutua Terrassa, Dept Intens Care, Barcelona, Spain
[5] Univ Lausanne, Lausanne, Switzerland
[6] Monash Univ, Australian & New Zealand Intens Care Res Ctr, Sch Publ Hlth & Preventat Med, Melbourne, Vic 3004, Australia
关键词
Pulse pressure variation; Fluid therapy; Cardiac surgery; Intensive care; Cardiac output; OF-THE-LITERATURE; RESPONSIVENESS; FAILURE; MANAGEMENT;
D O I
10.1016/j.jcrc.2014.07.032
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: The aim of this study is to study the feasibility, safety, and physiological effects of pulse pressure variation (PPV)-guided fluid therapy in patients after cardiac surgery. Materials and methods: We conducted a pilot prospective before-and-after study during mandatory ventilation after cardiac surgery in a tertiary intensive care unit. We introduced a protocol to deliver a fluid bolus for a PPV >= 13% for at least >10 minutes during the intervention period. Results: We studied 45 control patients and 53 intervention patients. During the intervention period, clinicians administered a fluid bolus on 79% of the defined PPV trigger episodes. Median total fluid intake was similar between 2 groups during mandatory ventilation (1297 mL[interquartile range 549-1968] vs 1481 mL [807-2563]; P =. 17) and the first 24 hours (3046 mL [interquartile range 2317-3982] vs 3017 mL [2192-4028]; P = .73). After adjusting for several baseline factors, PPV-guided fluid management significantly increased fluid intake during mandatory ventilation (P = .004) but not during the first 24 hours (P = .47). Pulse pressure variation-guided fluid therapy, however, did not significantly affect hemodynamic, renal, and metabolic variables. No serious adverse events were noted. Conclusions: Pulse pressure variation-guided fluid management was feasible and safe during mandatory ventilation after cardiac surgery. However, its advantages may be clinically small. (C) 2014 Elsevier Inc. All rights reserved.
引用
收藏
页码:992 / 996
页数:5
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