J Clin Monit Comput - Combination of continuous pulse pressure variation monitoring and cardiac filling pressure to predict fluid responsiveness.

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Resumo

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.

Resumo Limpo

assess combin central venous pressur cvp andor pulmonari capillari wedg pressur pcwp inform arteri puls pressur variat can increas abil predict fluid respons patient general anesthesia studi retrospect analysi patient schedul coronari arteri bypass surgeri monitor pulmonari arteri cathet underw volum expans induct general anesthesia among patient studi respond volum expans cvp similar pcwp poor predictor fluid respons indic low valu area receiv oper characterist curv ci ci respect p area obtain ppv ci threshold valu sensit specif posit likelihood ratio negat likelihood ratio respect combin inform right andor left cardiac fill pressur ppv increas abil predict whether patient will respond nonrespond volum expans abil identifi potenti fluid respons patient better use ppv plus cardiac fill pressur compar use ppv alon therefor ppv valu monitor patient cvp pcwp valu provid addit inform predict fluid respons

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