Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions.

摘要: Objective: Dynamic preload indicators like pulse pressure variation (PPV) and stroke volume (SVV) are increasingly being used for optimizing cardiac since they have been demonstrated to predict fluid responsiveness in a variety of perioperative settings. However, open-chest conditions, the value these indices has not systematically examined yet. We, therefore, evaluated ability PPV SVV under open- closed-chest conditions. Design. Prospective, controlled, clinical study. Setting: University hospital. Patients. Twenty-two patients scheduled elective coronary artery bypass graft surgery. Interventions: Defined loads (VL) (10 mL kg(-1) hydroxyethyl starch 6%) intra- postoperatively. Measurements Main Results. Stroke index was measured 1) before after VL intraolperatively 2) conditions within 1 hour arrival intensive care unit. Central venous global end diastolic were assessed as static indicators. In addition, (both obtained with PiCCO system) recorded. Fluid-responders defined by an increase >= 12% subsequent VL. Receiver operating characteristic analysis showed that all failed Under areas receiver curve 0.884 (p = 0.004) 0.911 0.003), respectively, whereas volumetric parameters responsiveness. A 10% identified fluid-responders sensitivity 64% specificity 100%, while >8% 100% 78%. Conclusions. Our results suggest dynamic able fail (Crit Care Med 2009; 37:510-515)