0
Clinical Investigations: SURGERY |

Pulse Pressure Variation Predicts Fluid Responsiveness Following Coronary Artery Bypass Surgery*

Andreas Kramer, MD; David Zygun, MD; Harvey Hawes, MSC; Paul Easton, MD, FCCP; Andre Ferland, MD
Author and Funding Information

*From the Brandon Regional Health Center (Dr. Kramer), Brandon, MB, Canada; the Department of Critical Care Medicine (Drs. Zygun, Easton, and Ferland), Foothills Medical Center, Calgary, AB, Canada; and the Faculty of Medicine (Mr. Hawes), University of Calgary, Calgary, AB, Canada.

Correspondence to: Andreas H. Kramer, MD, Intensive Care Unit, Brandon Regional Health Center, 150 McTavish Ave East, Brandon, MB, R7A 2B3 Canada; e-mail: atkramer@mts.net



Chest. 2004;126(5):1563-1568. doi:10.1378/chest.126.5.1563
Text Size: A A A
Published online

Study objective: To determine whether the degree of pulse pressure variation (PPV) and systolic pressure variation (SPV) predict an increase in cardiac output (CO) in response to volume challenge in postoperative patients who have undergone coronary artery bypass grafting (CABG), and to determine whether PPV is superior to SPV in this setting.

Design and setting: This was a prospective clinical study conducted in the cardiovascular ICU of a university hospital.

Patients: Twenty-one patients were studied immediately after arrival in the ICU following CABG.

Intervention: A fluid bolus was administered to all patients.

Measurements: Hemodynamic measurements, including central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP), CO (thermodilution), percentage of SPV (%SPV), and percentage of PPV (%PPV), were performed shortly after patient arrival in the ICU. Patients were given a rapid 500-mL fluid challenge, after which hemodynamic measurements were repeated. Patients whose CO increased by ≥ 12% were considered to be fluid responders. The ability of different parameters to distinguish between responders and nonresponders was compared.

Results: In response to the volume challenge, 6 patients were responders and 15 were nonresponders. Baseline CVP and PAOP were no different between these two groups. In contrast, the %SPV and the %PPV were significantly higher in responders than in nonresponders. Receiver operating characteristic curve analysis suggested that the %PPV was the best predictor of fluid responsiveness. The ideal %PPV threshold for distinguishing responders from nonresponders was found to be 11. A PPV value of ≥ 11% predicted an increase in CO with 100% sensitivity and 93% specificity.

Conclusion: PPV and SPV can be used to predict whether or not volume expansion will increase CO in postoperative CABG patients. PPV was superior to SPV at predicting fluid responsiveness. Both of these measures were far superior to CVP and PAOP.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543