J Clin Monit Comput - Variations in the pre-ejection period induced by ventricular extra systoles may be feasible to predict fluid responsiveness.


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Monitoring that can predict fluid responsiveness is an unsettled matter for spontaneously breathing patients. Based on the convincing results with dynamic monitoring based on preload variations induced by mechanical ventilation, we hypothesised that the extra systolic post-ectopic beat could constitute a similar intermittent preload shift inducing a brief variation in blood pressure and that the magnitude of this variation could predict the hemodynamic response to volume expansion in sedated pigs. Ten pigs were sedated and hemodynamically monitored and four intravascular volume shifts were made: blood depletion (25% of estimated blood volume; 660 ml), retransfusion (of 500 ml depleted blood), and two sequential volume expansions (500 ml colloid each). Between volume shifts, supraventricular and ventricular extra systoles were induced by a pacemaker. Hemodynamic variables such as pulse pressure (PP) and pre-ejection period (PEP) were determined for each heart beat and the hemodynamic changes in the post-ectopic beats compared to sinus beats was extracted (e.g. PP and PEP) and used to predict fluid responsiveness of subsequent volume expansions which was determined by receiver operating characteristic (ROC) curves. Ventricular extra systoles were generally useful for fluid responsiveness prediction (ROC areas >0.65). PEP variables best predicted fluid responsiveness: PEP derived from arterial pressure curve and ECG had ROC area of 0.84 and sensitivity of 0.77 and specificity of 0.71; PEP derived from plethysmographic curve and ECG had ROC area of 0.79 and sensitivity of 0.71 and specificity of 0.70. However, PP was not a useful variable in this study (ROC area <0.65). Hemodynamic analysis of post ectopic beats may be a feasible method for fluid responsiveness prediction.

Resumo Limpo

monitor can predict fluid respons unsettl matter spontan breath patient base convinc result dynam monitor base preload variat induc mechan ventil hypothesis extra systol postectop beat constitut similar intermitt preload shift induc brief variat blood pressur magnitud variat predict hemodynam respons volum expans sedat pig ten pig sedat hemodynam monitor four intravascular volum shift made blood deplet estim blood volum ml retransfus ml deplet blood two sequenti volum expans ml colloid volum shift supraventricular ventricular extra systol induc pacemak hemodynam variabl puls pressur pp preeject period pep determin heart beat hemodynam chang postectop beat compar sinus beat extract eg pp pep use predict fluid respons subsequ volum expans determin receiv oper characterist roc curv ventricular extra systol general use fluid respons predict roc area pep variabl best predict fluid respons pep deriv arteri pressur curv ecg roc area sensit specif pep deriv plethysmograph curv ecg roc area sensit specif howev pp use variabl studi roc area hemodynam analysi post ectop beat may feasibl method fluid respons predict

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