Intensive Care Medicine

, Volume 29, Issue 3, pp 476–480

Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients

Authors

  • Daniel A. Reuter
    • Department of AnesthesiologyUniversity of Munich
  • Julian Bayerlein
    • Department of AnesthesiologyUniversity of Munich
  • Matthias S. G. Goepfert
    • Department of AnesthesiologyUniversity of Munich
  • Florian C. Weis
    • Department of AnesthesiologyUniversity of Munich
  • Erich Kilger
    • Department of AnesthesiologyUniversity of Munich
  • Peter Lamm
    • Department of Cardiac SurgeryUniversity of Munich
    • Department of AnesthesiologyUniversity of Munich
Brief Report

DOI: 10.1007/s00134-003-1649-7

Cite this article as:
Reuter, D.A., Bayerlein, J., Goepfert, M.S.G. et al. Intensive Care Med (2003) 29: 476. doi:10.1007/s00134-003-1649-7
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Abstract

Objective

Real-time measurement of stroke volume variation by arterial pulse contour analysis (SVV) is useful in predicting volume responsiveness and monitoring volume therapy in mechanically ventilated patients. This study investigated the influence of the depth of tidal volume (Vt) on SVV both during the state of fluid responsiveness and after fluid loading in mechanically ventilated patients.

Design and setting

Prospective study in a university hospital, adult cardiac surgery intensive care unit.

Patients and participants

20 hemodynamically stable patients immediately after cardiac surgery.

Interventions

Stepwise fluid loading using colloids until stroke volume index (SVI) did not increase by more than 10%. Before and after fluid loading Vt was varied (5, 10, and 15 ml/kg body weight) in random order.

Measurements and results

Pulse contour SVV was measured before and after volume loading at the respective Vt values. Thirteen patients responded to fluid loading with an increase in SVI greater than 10%, which confirmed volume responsiveness at baseline measurements. These were included in further analysis. During volume responsiveness SVV at Vt of 5 ml/kg (7±0.7%) and SVV at Vt of 15 ml/kg (21±2.5%) differed significantly from that at Vt of 10 ml/kg (15±2.1%). SVV was correlated significantly with the magnitude of Vt. After volume resuscitation SVV at the respective Vt was significantly reduced; further, SVV at Vt of 5 ml/kg-1 (5.3±0.6%) and 15 ml/kg (16.2±2.0%) differed significantly from that at Vt of 10 ml/kg (10.2±1.0%). SVV and depth of Vt were significantly related.

Conclusions

In addition to intravascular volume status SVV is affected by the depth of tidal volume under mechanical ventilation. This influence must be regarded when using SVV for functional preload monitoring.

Keywords

Diagnostic techniquesCardiovascularPreloadFluid responsivenessCardiac outputPulse contour analysisMechanical ventilation

Copyright information

© Springer-Verlag 2003