Advertisement

Journal of Anesthesia

, Volume 25, Issue 6, pp 812–817 | Cite as

Assessment of cardiac preload status by pulse pressure variation in patients after anesthesia induction: comparison with central venous pressure and initial distribution volume of glucose

  • Zhiyong He
  • Hui Qiao
  • Wei Zhou
  • Yun Wang
  • Zhendong Xu
  • Xuehua Che
  • Jun Zhang
  • Weimin Liang
Original Article

Abstract

Purpose

Recognition of intraoperative hypovolemia is important for fluid management. Previous studies demonstrated functional preload parameter pulse pressure variation (PPV) could predict volume changes in response to fluid loading and loss. In this study, we examined the correlation between PPV and other two cardiac preload indicators, central venous pressure (CVP) or initial distribution volume of glucose (IDVG), in patients after anesthesia induction.

Methods

In 30 patients undergoing scheduled craniotomy surgery, we compared measurement of PPV (%) using the Ohmeda monitor method to simultaneously measure CVP and IDVG after anesthesia induction through correlation analysis and receiver operating characteristic (ROC) curves.

Results

Pulse pressure variation has negative linear correlation with IDVG (r = −0.65, P < 0.01). IDVG values (n = 13) when PPV ≥ 11% showed a significant difference compared with those (n = 17) when PPV < 11% (P < 0.001). The ROC curve showed the best cutoff value of IDVG is 122 ml/kg, equivalent to the threshold of PPV (11%) for predicting fluid responsiveness. However, there is no significant correlation between CVP in normal ranges (4–9 mmHg) and PPV (r = −0.12, P > 0.05).

Conclusion

As an indicator of cardiac preload, PPV has a negative linear correlation with IDVG in patients after anesthesia induction. It does not correlate well with CVP in the normal range. Our results imply that an individual PPV, not CVP, is equivalent to IDVG in assessing volume status after induction.

Keywords

Hypovolemia Pulse pressure variation Initial distribution volume of glucose Central venous pressure 

Notes

Conflict of interest

None.

References

  1. 1.
    Boldt J, Lenz M, Kumle B, Papsdorf M. Volume replacement strategies on intensive care units: results from a postal survey. Intensive Care Med. 1998;24:147–51.PubMedCrossRefGoogle Scholar
  2. 2.
    Ishihara H, Suzuki A, Okawa H, Sakai I, Tsubo T, Matsuki A. The initial distribution volume of glucose rather than indocyanine green derived plasma volume is correlated with cardiac output following major surgery. Intensive Care Med. 2000;26:1441–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Suzuki A, Ishihara H, Okawa H, Tsubo T, Matsuki A. Can initial distribution volume of glucose predict hypovolemic hypotension after radical surgery for esophageal cancer? Anesth Analg. 2001;92:1146–51.PubMedCrossRefGoogle Scholar
  4. 4.
    Orban JC, Blasin-Chadoutaud A, Zolfaghari P, Ishihara H, Grimaud D, Ichai C. Hypovolaemic hypotension after abdominal aortic surgery is predicted by initial distribution volume of glucose. Eur J Anaesthesiol. 2010;27:364–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Hofer CK, Müller SM, Furrer L, Klaghofer R, Genoni M, Zollinger A. Stroke volume and pulse pressure variation for prediction of fluid responsiveness in patients undergoing off-pump coronary artery bypass grafting. Chest. 2005;128:848–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Kramer A, Zygun D, Hawes H, Easton P, Ferland A. Pulse pressure variation predicts fluid responsiveness following coronary artery bypass surgery. Chest. 2004;126:1563–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Pestel GJ, Hiltebrand LB, Fukui K, Cohen D, Hager H, Kurz AM. Assessing intravascular volume by difference in pulse pressure in pigs submitted to graded hemorrhage. Shock. 2006;26:391–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Mutoh T, Ishikawa T, Nishino K, Yasui N. Evaluation of the FloTrac uncalibrated continuous cardiac output system for perioperative hemodynamic monitoring after subarachnoid hemorrhage. J Neurosurg Anesthesiol. 2009;21:218–25.PubMedCrossRefGoogle Scholar
  9. 9.
    Durga P, Jonnavittula N, Muthuchellappan R, Ramachandran G. Measurement of systolic pressure variation during graded volume loss using simple tools on Datex Ohmeda S/5 monitor. J Neurosurg Anesth. 2009;21:161–4.CrossRefGoogle Scholar
  10. 10.
    Qiao H, Zhang J, Liang WM. Validity of pulse pressure and systolic blood pressure variation data obtained from a Datex Ohmeda S/5 monitor for predicting fluid responsiveness during surgery. J Neurosurg Anesthesiol. 2010;22:316–22.PubMedCrossRefGoogle Scholar
  11. 11.
    Ishihara H, Shimodate Y, Koh H, Isozaki K, Tsubo T, Matsuki A. The initial distribution volume of glucose and cardiac output in the critically ill. Can J Anaesth. 1993;40:28–31.PubMedCrossRefGoogle Scholar
  12. 12.
    Hirota K, Ishihara H, Tsubo T, Matsuki A. Estimation of the initial distribution volume of glucose by an incremental plasma glucose level at 3 min after i.v. glucose in humans. Br J Clin Pharmacol. 1999;47:361–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Bamboat ZM, Bordeianou L. Perioperative fluid management. Clin Colon Rectal Surg. 2009;22:28–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Cannesson M. Arterial pressure variation and goal-directed fluid therapy. J Cardiothorac Vasc Anesth. 2010;24:487–97.PubMedCrossRefGoogle Scholar
  15. 15.
    Jacob M, Chappell D, Conzen P, Finsterer U, Rehm M. Blood volume is normal after pre-operative overnight fasting. Acta Anaesthesiol Scand. 2008;52:522–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Brock H, Rapf B, Necek S, Gabriel C, Peterlik C, Pölz W, Schimetta W, Bergmann H. Vergleichende untersuchungen zur postoperativen volumentherapie bei kardiochirurgischen patienten. Anaesthesist. 1995;44:486–92.PubMedCrossRefGoogle Scholar
  17. 17.
    Shippy CR, Appel PL, Shoemaker WL. Reliability of clinical monitoring to assess blood volume in critically ill patients. Crit Care Med. 1984;12:107–12.PubMedCrossRefGoogle Scholar
  18. 18.
    Sakka SG, Bredle DL, Reinhart K, Meier-Hellmann A. Comparison between intrathoracic blood volume and cardiac filling pressures in the early phase of hemodynamic instability of patients with septic shock. J Crit Care. 1999;14:78–83.PubMedCrossRefGoogle Scholar
  19. 19.
    Kumar A, Anel R, Bunnell E, Habet K, Zanotti S, Marshall S, Neumann A, Ali A, Cheang M, Kavinsky C, Parrillo JE. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med. 2004;32:691–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Marik PE. Techniques for assessment of intravascular volume in critically ill patients. J Intensive Care Med. 2009;24:329–37.PubMedCrossRefGoogle Scholar
  21. 21.
    Cavallaro F, Sandroni C, Antonelli M. Functional hemodynamic monitoring and dynamic indices of fluid responsiveness. Minerva Anestesiol. 2008;74:123–35.PubMedGoogle Scholar
  22. 22.
    Wyffels PA, Sergeant P, Wouters PF. The value of pulse pressure and stroke volume variation as predictors of fluid responsiveness during open chest surgery. Anaesthesia. 2009;65:704–9.CrossRefGoogle Scholar
  23. 23.
    Biais M, Bernard O, Ha JC, Degryse C, Sztark F. Abilities of pulse pressure variations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery. Br J Anaesth. 2010;104:407–13.PubMedCrossRefGoogle Scholar
  24. 24.
    Bliacheriene F, Machado SB, Fonseca EB, Otsuke D, Auler JO Jr, Michard F. Pulse pressure variation as a tool to detect hypovolaemia during pneumoperitoneum. Acta Anaesthesiol Scand. 2007;51:1268–72.PubMedGoogle Scholar
  25. 25.
    Kubitz JC, Forkl S, Annecke T, Kronas N, Goetz AE, Reuter DA. Systolic pressure variation and pulse pressure variation during modifications of arterial pressure. Intensive Care Med. 2008;34:1520–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37:2642–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Fujita Y, Yamamoto T, Sano I, Yoshioka N, Hinenoya H. A comparison of changes in cardiac preload variables during graded hypovolemia and hypervolemia in mechanically ventilated dogs. Anesth Analg. 2004;99:1780–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Cannesson M, Slieker J, Desebbe O, Bauer C, Chiari P, Hénaine R, Lehot JJ. The ability of a novel algorithm for automatic estimation of the respiratory variations in arterial pulse pressure to monitor fluid responsiveness in the operating room. Anesth Analg. 2008;106:1195–200.PubMedCrossRefGoogle Scholar
  29. 29.
    Umbrello M, Formenti P, Galimberti A, Curti M, Zaniboni M, Iapichino G. On-line measurement of systolic pressure variation and pulse pressure variation on a multiparametric monitor. Intensive Care Med. 2008;34:386–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Deflandre E, Bonhomme V, Hans P. Delta down compared with delta pulse pressure as an indicator of volaemia during intracranial surgery. Br J Anaesth. 2008;100:245–50.PubMedCrossRefGoogle Scholar
  31. 31.
    Ishihara H, Takamura K, Iwakawa T, Tsubo T, Matsuki A. Does the initial distribution of glucose reflect the central ECF volume status in critically ill patients? Infusionther Transfus Med. 1996;23:196–201.CrossRefGoogle Scholar
  32. 32.
    Gabbanelli V, Pantanetti S, Donati A, Montozzi A, Carbini C, Pelaia P. Initial distribution volume of glucose as noninvasive indicator of cardiac preload: comparison with intrathoracic blood volume. Intensive Care Med. 2004;30:2067–73.PubMedCrossRefGoogle Scholar
  33. 33.
    Nakamura H, Ishihara H, Okawa H, Yatsu Y, Tsubo T, Matsuki A. Initial distribution volume of glucose is correlated with intrathoracic blood volume in hypovolaemia and following volume loading in dogs. Eur J Anaesthesiol. 2005;22:202–8.PubMedGoogle Scholar
  34. 34.
    Ishihara H, Nakamura H, Okawa H, Yatsu Y, Tsubo T, Hirota K. Comparison of initial distribution volume of glucose and intrathoracic blood volume during hemodynamically unstable states early after esophagectomy. Chest. 2005;128:1713–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Harvey M, Voss L, Sleigh J. Preload response in patients after cardiac surgery: a comparison of systolic blood pressure and systolic area variability and initial volume of distribution of glucose. Crit Care Resusc. 2003;5:171–6.PubMedGoogle Scholar
  36. 36.
    Ishihara H. Initial distribution volume of glucose early after cardiac surgery. Anesth Analg. 2006;102:1904.PubMedCrossRefGoogle Scholar
  37. 37.
    Monnet X, Teboul JL. Volume responsiveness. Curr Opin Crit Care. 2007;13:549–53.PubMedCrossRefGoogle Scholar
  38. 38.
    Haruna M, Kumon K, Yahagi N, Watanabe Y, Ishida Y, Kobayashi N, Aoyagi T. Blood volume measurement at the bedside using ICG pulse spectrophotometry. Anesthesiology. 1998;89:1322–8.PubMedCrossRefGoogle Scholar
  39. 39.
    van Tulder L, Michaeli B, Chioléro R, Berger MM, Revelly JP. An evaluation of the initial distribution volume of glucose to assess plasma volume during a fluid challenge. Anesth Analg. 2005;101:1089–93.PubMedCrossRefGoogle Scholar
  40. 40.
    Rose BO, Ishihara H, Okawa H, Panning B, Piepenbrock S, Matsuki A. Repeatability of measurements of the initial distribution volume of glucose in haemodynamically stable patients. J Clin Pharm Ther. 2004;29:317–23.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2011

Authors and Affiliations

  • Zhiyong He
    • 1
  • Hui Qiao
    • 1
  • Wei Zhou
    • 1
  • Yun Wang
    • 1
  • Zhendong Xu
    • 1
  • Xuehua Che
    • 1
  • Jun Zhang
    • 1
  • Weimin Liang
    • 1
  1. 1.Department of Anesthesiology, Huashan HospitalFudan UniversityShanghaiPeople’s Republic of China

Personalised recommendations