Pulse pressure variation and stroke volume variation to predict fluid responsiveness in patients undergoing carotid endarterectomy
Open Access
- 1 January 2013
- journal article
- Published by The Korean Society of Anesthesiologists in Korean Journal of Anesthesiology
- Vol. 65 (3), 237-43
- https://doi.org/10.4097/kjae.2013.65.3.237
Abstract
During carotid endarterectomy (CEA), hemodynamic stability and adequate fluid management are crucial to prevent perioperative cerebral stroke, myocardial infarction and hyperperfusion syndrome. Both pulse pressure variation (PPV) and stroke volume variation (SVV), dynamic preload indices derived from the arterial waveform, are increasingly advocated as predictors of fluid responsiveness in mechanically ventilated patients. The aim of this study was to evaluate the accuracy of PPV and SVV for predicting fluid responsiveness in patients undergoing CEA. Twenty seven patients undergoing CEA were enrolled in this study. PPV, SVV and cardiac output (CO) were measured before and after fluid loading of 500 ml of hydroxyethyl starch solution. Fluid responsiveness was defined as an increase in CO ≥ 15%. The ability of PPV and SVV to predict fluid responsiveness was assessed using receiver operating characteristic (ROC) analysis. Both PPV and SVV measured before fluid loading are associated with changes in CO caused by fluid expansion. The ROC analysis showed that PPV and SVV predicted response to volume loading (area under the ROC curve = 0.854 and 0.841, respectively, P < 0.05). A PPV ≥ 9.5% identified responders (Rs) with a sensitivity of 71.4% and a specificity of 90.9%, and a SVV ≥ 7.5% identified Rs with a sensitivity of 92.9% and a specificity of 63.6%. Both PPV and SVV values before volume loading are associated with increased CO in response to volume expansion. Therefore, PPV and SVV are useful predictors of fluid responsiveness in patients undergoing CEA.Keywords
This publication has 19 references indexed in Scilit:
- Patients with unrecognized peripheral arterial disease (PAD) assessed by ankle-brachial index (ABI) present a defined profile of proinflammatory markers compared to healthy subjectsCytokine, 2012
- Prediction of fluid responsiveness in septic shock patientsEuropean Journal of Anaesthesiology, 2012
- Accuracy of stroke volume variation in predicting fluid responsiveness: a systematic review and meta-analysisJournal of Anesthesia, 2011
- Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trialThe Lancet, 2010
- Cardiac Output Determination From the Arterial Pressure Wave: Clinical Testing of a Novel Algorithm That Does Not Require CalibrationJournal of Cardiothoracic and Vascular Anesthesia, 2007
- Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge*Critical Care Medicine, 2007
- Hemodynamic Stability, Myocardial Ischemia, and Perioperative Outcome After Carotid Surgery with Remifentanil/Propofol or Isoflurane/Fentanyl AnesthesiaJournal of Neurosurgical Anesthesiology, 2003
- Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgeryIntensive Care Medicine, 2002
- Relation between Respiratory Changes in Arterial Pulse Pressure and Fluid Responsiveness in Septic Patients with Acute Circulatory FailureAmerican Journal of Respiratory and Critical Care Medicine, 2000
- Carotid endarterectomy: Perioperative and anesthetic considerationsJournal of Cardiothoracic and Vascular Anesthesia, 1996