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Combination of continuous pulse pressure variation monitoring and cardiac filling pressure to predict fluid responsiveness

Journal of Clinical Monitoring and Computing volume 26, pages 401–405 (2012)Cite this article

Abstract

To assess if combining central venous pressure (CVP) and/or pulmonary capillary wedge pressure (PCWP) information with arterial pulse pressure variation can increase the ability to predict fluid responsiveness in patients under general anesthesia. This study is a retrospective analysis of patients scheduled for coronary artery bypass surgery and monitored with a pulmonary artery catheter who underwent a volume expansion after induction of general anesthesia. Among the 46 patients studied, 31 were responders to volume expansion. CVP similar to PCWP, was a poor predictor of fluid responsiveness, as indicated by low values of areas under the receiver operating characteristic curves [0.585 (95 % CI 0.389–0.780) and 0.563 (95 % CI 0.373–0.753) respectively, p = 0.76]. The area obtained for PPV was 0.897 (95 % CI 0.801–0.992) with a threshold value of 12 %. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio was 83.9 %, 86.7 %, 6.29 and 0.19 respectively. Combining information on right and/or left cardiac filling pressures with PPV did not increase the ability to predict whether a patient will be a responder or a non-responder to volume expansion. The ability to identify a potentially fluid responsive patient was no better using PPV plus cardiac filling pressures when compared to using PPV alone. Therefore, if PPV values are being monitored in a patient, CVP and PCWP values do not provide additional information to predict fluid responsiveness.

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Acknowledgments

The authors wish to thank Nadine Bossard, MD, PhD (Biostatistics Unit of Lyon University Hospital, Lyon, France) for help in statistical analysis. The authors don’t have any financial relationship with the organization that sponsored the research.

Conflict of interest

The authors declare that they have no conflict of interest.

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Affiliations

  1. Hospices Civils de Lyon, Groupement Hospitalier Est, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital, Claude Bernard Lyon 1 University, Lyon, France

    Geoffray Keller, Olivier Desebbe & Jean-Jacques Lehot

  2. Service d’Anesthésie Réanimation, Hôpital Cardiologique Louis Pradel, 59 bd Pinel, 69677, Bron, France

    Geoffray Keller

  3. Department of Anesthesia, University of California, San Francisco, CA, 94143 - 1654, USA

    Karin Sinavsky

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  1. Geoffray Keller
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  2. Karin Sinavsky
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  3. Olivier Desebbe
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  4. Jean-Jacques Lehot
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Correspondence to Geoffray Keller.

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Keller, G., Sinavsky, K., Desebbe, O. et al. Combination of continuous pulse pressure variation monitoring and cardiac filling pressure to predict fluid responsiveness. J Clin Monit Comput 26, 401–405 (2012). https://doi.org/10.1007/s10877-012-9365-x

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  • DOI: https://doi.org/10.1007/s10877-012-9365-x

Keywords

  • Central venous pressure
  • Pulmonary capillary wedge pressure
  • Volume challenge
  • Volume responsiveness