Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  13. Bamboat ZM, Bordeianou L. Perioperative fluid management. Clin Colon Rectal Surg. 2009;22:28–33.

    Article  PubMed  Google Scholar 

  14. Cannesson M. Arterial pressure variation and goal-directed fluid therapy. J Cardiothorac Vasc Anesth. 2010;24:487–97.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  20. Marik PE. Techniques for assessment of intravascular volume in critically ill patients. J Intensive Care Med. 2009;24:329–37.

    Article  PubMed  Google Scholar 

  21. Cavallaro F, Sandroni C, Antonelli M. Functional hemodynamic monitoring and dynamic indices of fluid responsiveness. Minerva Anestesiol. 2008;74:123–35.

    PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  36. Ishihara H. Initial distribution volume of glucose early after cardiac surgery. Anesth Analg. 2006;102:1904.

    Article  PubMed  Google Scholar 

  37. Monnet X, Teboul JL. Volume responsiveness. Curr Opin Crit Care. 2007;13:549–53.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Huashan Hospital, Fudan University, No. 12 Urumqi Central Rd., 200040, Shanghai, People’s Republic of China

    Zhiyong He, Hui Qiao, Wei Zhou, Yun Wang, Zhendong Xu, Xuehua Che, Jun Zhang & Weimin Liang

Authors
  1. Zhiyong He
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hui Qiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhendong Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xuehua Che
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jun Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Weimin Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jun Zhang.

About this article

Cite this article

He, Z., Qiao, H., Zhou, W. et al. 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. J Anesth 25, 812–817 (2011). https://doi.org/10.1007/s00540-011-1225-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-011-1225-1

Keywords

Search

Navigation