CVP vs. dynamic hemodynamic parameters as preload indicators in hemodynamically unstable patients after major surgery
1University of Zagreb, School of Medicine Šalata 3, 10 000 Zagreb Department of Anesthesiology, reanimatology and intensive care University hospital centre Zagreb, Kišpatićeva 12, 10000 Zagreb
DOI: 10.22514/SV131.032017.8 Vol.13,Issue S1,May 2017 pp.56-60
Published: 08 May 2017
Introduction. Adequate circulating blood volume is essential for the good outcome in postoperative patients. Therefore, the primary resuscitation question is how to assess the circulating volume. The aim of this study was to compare the central ve-nous pressure (CVP) and dynamic LIDCO parameters as markers indicating preload in surgical patients.
Materials and Methods. This prospective study included 24 patients hospitalized af-ter major surgery at the surgical intensive care unit of the University hospital Zagreb, Croatia. The patients were mechanically ventilated, without spontaneous breath-ing attempts and in sinus rhythm. Patients were divided into 2 groups, hemodynami-cally stable and hemodynamically unsta-ble. The CVP was measured as a static pa-rameter while the stroke volume variation (SVV) and pulse pressure variation (PPV) were measured as the dynamic parameters. Results. Study groups were comparable in terms of gender, age and body mass in-dex. The difference in the CVP between the hemodynamically stable (13,2±3,74 mmHg) and hemodynamically unstable group of patients (10,1±5,6 mmHg) was statistically insignificant (p=0,144). Differ-ences in SVV (10,2±6,48% in stable com-pared to 18,8±7,04% in unstable group) and PPV (11,5±6,65% in stable compared to 18±6,32% in unstable group) were both statistically significant with p values of 0,005 and 0,022 respectively. Conclusion. The study confirmed the inability of CVP to provide valid assessment of the preload as a reason for hemodynam-ic instability in comparison to dynamic LiDCOTMplus system parameters in me-chanically ventilated major surgical pa-tients.
Blood Volume, Central Venous Pressure, Stroke Volume, Pulse Pressure
TAJANA ZAH BOGOVIĆ,ANTONIO BULUM,PERO HRABAČ,MLADEN PERIĆ,DINKO TONKOVIĆ,DANIELA BANDIĆ PAVLOVIĆ,ROBERT BARONICA. CVP vs. dynamic hemodynamic parameters as preload indicators in hemodynamically unstable patients after major surgery. Signa Vitae. 2017. 13(S1);56-60.
1. Wadhwa J, Sood R. Multiple organ dysfunction syndrome. Natl Med J India 1997; 10:277-82.
2. Lees N, Hamliton M, Rhodes A: Clinical review: Goal-directed therapy in high risk surgical patients. Crit Care 2009,13:231.
3. Funk D, Sebat F, Kumar A: A systematic approach to the early recognition and rapid administration of best practice therapy in sepsis and septic shock. Curr Opin Crit Care 2009,15:301-7.
4. Swan HJ, Ganz W, Forrester J et al. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 1970;283:447-51.
5. Dellinger RP, Carlet JM, Masur H et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858–73.
6. Button D, Weibel L, Reuthebuch O, Genoni M, Zollinger A, Hofer CK. Clinical evaluation of the FloTrac/VigileoTM system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery. Br. J. Anaesth 2007; 99:329-36.
7. Dhillon P, Singh KS, Krishnan K, Mallick AA. National Survey of Current Trends in Cardiac Output Monitoring in the UK Intensive Care Units. Anaesthesiology 2008; 109:1451.
8. Pearse RM, Ikram K, Barry J. Equipment review: An appraisal of the LiDCO™ plus method of measuring cardiac output. Crit Care Med, 2008;8:190.
9. Lim W, Dentali F, Eikelboom JW, Crowther MA. Meta-analysis: low-molecular-weight heparin and bleeding in patients with severe renal insufficiency. Ann Intern Med 2006;144:673-84.
10. Rhodes A, Sunderland R. Arterial Pulse Power Analysis: The LiDCOTMplus System. In: Michael R. Pinsky MR, Payen D, editors. Functional hemodynamic monitoring, Springer Berlin Heidelberg; 2005:183-192.
11. Dabbagh A, Esmailian F, Aranki SF. Postoperative critical care for cardiac surgical patients. Heidelberg: Springer; 2014.
12. Marik, PE. Hemodynamic parameters to guide fluid therapy. Transfusion Alternatives in Transfusion Medicine, 2011;11:102–12.
13. Kastrup M, Markewitz A, Spies C, Carl M, Erb J, Grosse J, et al.: Current practice of hemodinamic monitoring and vassopresor and inotropic therapy in post-operative cardiac surgery patients in Germany: results from a postal survey. Acta Anaesthesiol Scand 2007;51:347-58.
14. Kumar A, Anel R, Bunnell E, Habe K, Zanotti S, Marshall S, et al. 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.
15. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. CHEST J 2008;134:172-8.
16. Bakker J, Coffernils M, Leon M, Gris P, Vincent J. Blood lactate levels are superior to oxygen-derived variables In predicting outcome in human septic shock. CHEST 1991; 99:956-62.
17. Forrester JS, Diamond G, McHugh TJ, Swan HJ. Filling pressures in the right and left sides of the heart in acute myocardial infarction: a reappraisal of central-venous-pressure monitoring. N Engl J Med 1971;285:190-3.
18. Benes J, Chytra I, Altmann P, Hluchy M, Kasal E, Svitak R, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care 2010;14:R118.
19. McGee WT. A simple physiologic algorithm for managing hemodynamics using stroke volume and stroke volume variation: physi-ologic optimization program. J Intensive Care Med 2009;24:352-60.
20. Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in me-chanically ventilated patients: a systematic review of literature. Crit Care Med 2009,37:2642-7.
21. Shippy C, Appel P, William C. Reliability of clinical monitoring to assess blood volume in critically ill patients. Crit Care Med 1984;2:107-12.
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