The effects of vasoactive drugs on pulse pressure and stroke volume variation in postoperative ventilated patients
Abstract Introduction Although pulse pressure variation (PPV) and stroke volume variation (SVV) during mechanical ventilation have been shown to predict preload responsiveness, the effect of vasoactive therapy on PPV and SVV is unknown. Methods Pulse pressure variation and SVV were measured continuo...
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| Veröffentlicht in: | Journal of critical care 2011-06, Vol.26 (3), p.328.e1-328.e8 |
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| description | Abstract Introduction Although pulse pressure variation (PPV) and stroke volume variation (SVV) during mechanical ventilation have been shown to predict preload responsiveness, the effect of vasoactive therapy on PPV and SVV is unknown. Methods Pulse pressure variation and SVV were measured continuously in 15 cardiac surgery patients for the first 4 postoperative hours. Pulse pressure variation was directly measured from the arterial pressure waveform, and both PPV and SVV were also calculated by LiDCO Plus (LiDCO Ltd, Cambridge, United Kingdom) before and after volume challenges or changes in vasoactive drug infusions done to sustain cardiovascular stability. Results Seventy-one paired events were studied (38 vasodilator, 10 vasoconstrictor, 14 inotropes, and 9 volume challenges). The difference between the measured and LiDCO-calculated PPV was 1% ± 7% (1.96 SD, 95% confidence interval, r2 = 0.8). Volume challenge decreased both PPV and SVV (15% to 10%, P < .05 and 13% to 9%, P = .09, respectively). Vasodilator therapy increased PPV and SVV (13% to 17% and 9% to 15%, respectively, P < .001), whereas increasing inotropes or vasoconstrictors did not alter PPV or SVV. The PPV/SVV ratio was unaffected by treatments. Conclusion Volume loading decreased PPV and SVV; and vasodilators increased both, consistent with their known cardiovascular effects. Thus, SVV and PPV can be used to drive fluid resuscitation algorithms in the setting of changing vasoactive drug therapy. |
| doi_str_mv | 10.1016/j.jcrc.2010.08.018 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3103641</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0883944110002583</els_id><sourcerecordid>2735062831</sourcerecordid><originalsourceid>FETCH-LOGICAL-c603t-f3a94340c4e84bf985b17370ed29cd45ea6e74cf9adeba60f5fb6484a3c131ec3</originalsourceid><addsrcrecordid>eNp9kk1v1DAQhi0EokvhD3BAljhwyuLPrCOhSqjiS6rEgXK2HGfcepuNg51E6r9nwpYCPXAaefzM65l5TchLzrac8frtfrv32W8FwwQzW8bNI7LhWu8qU3P9mGyYMbJqlOIn5Fkpe8b4Tkr9lJwIzmSthdmQfHkNFEIAPxWaAl1cSc5PcQHa5fkKcwMd574AHTOUMmegbuhomXK6Abqkfj5gcDm6KSIakU5lSiNk90tkgWGKvZugoyNm8FSekyfBoeKLu3hKvn_8cHn-ubr4-unL-fuLytdMTlWQrlFSMa_AqDY0RrfY_o5BJxrfKQ2uhp3yoXEdtK5mQYe2VkY56bnk4OUpOTvqjnN7gM7j29n1dszx4PKtTS7af2-GeG2v0mLluh3FUeDNnUBOP2Yokz3E4qHv3QBpLtbUpml0IwSSrx-Q-zTnAaezqCWF4jgSUuJI-ZxKyRDue-HMro7avV0dtaujlhmLjmLRq7-nuC_5bSEC744A4C6XCNkWj3v20MWMrtouxf_rnz0o930conf9DdxC-TOHLcIy-239U-uX4owxoY2UPwE8bsqu</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1033241603</pqid></control><display><type>article</type><title>The effects of vasoactive drugs on pulse pressure and stroke volume variation in postoperative ventilated patients</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Hadian, Mehrnaz, MD ; Severyn, Donald A., MS ; Pinsky, Michael R., MD</creator><creatorcontrib>Hadian, Mehrnaz, MD ; Severyn, Donald A., MS ; Pinsky, Michael R., MD</creatorcontrib><description>Abstract Introduction Although pulse pressure variation (PPV) and stroke volume variation (SVV) during mechanical ventilation have been shown to predict preload responsiveness, the effect of vasoactive therapy on PPV and SVV is unknown. Methods Pulse pressure variation and SVV were measured continuously in 15 cardiac surgery patients for the first 4 postoperative hours. Pulse pressure variation was directly measured from the arterial pressure waveform, and both PPV and SVV were also calculated by LiDCO Plus (LiDCO Ltd, Cambridge, United Kingdom) before and after volume challenges or changes in vasoactive drug infusions done to sustain cardiovascular stability. Results Seventy-one paired events were studied (38 vasodilator, 10 vasoconstrictor, 14 inotropes, and 9 volume challenges). The difference between the measured and LiDCO-calculated PPV was 1% ± 7% (1.96 SD, 95% confidence interval, r2 = 0.8). Volume challenge decreased both PPV and SVV (15% to 10%, P < .05 and 13% to 9%, P = .09, respectively). Vasodilator therapy increased PPV and SVV (13% to 17% and 9% to 15%, respectively, P < .001), whereas increasing inotropes or vasoconstrictors did not alter PPV or SVV. The PPV/SVV ratio was unaffected by treatments. Conclusion Volume loading decreased PPV and SVV; and vasodilators increased both, consistent with their known cardiovascular effects. Thus, SVV and PPV can be used to drive fluid resuscitation algorithms in the setting of changing vasoactive drug therapy.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2010.08.018</identifier><identifier>PMID: 21036528</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Arterial pulse contour ; Blood ; Blood Pressure - drug effects ; Cardiac arrhythmia ; Cardiovascular Surgical Procedures ; Critical Care ; Dopamine ; Ejection fraction ; Female ; Functional hemodynamic monitoring ; Heart rate ; Heart surgery ; Hemodynamic monitoring ; Hemodynamics ; Humans ; Inotrope ; Intervention ; LiDCO ; Male ; Middle Aged ; Minimally invasive ; Patients ; Postoperative Care ; Pulmonary arteries ; Pulse contour analysis ; Respiration ; Respiration, Artificial ; Stroke Volume - drug effects ; Time Factors ; Vasoconstrictor Agents - pharmacology ; Vasodilator ; Vasodilator Agents - pharmacology ; Vasomotor tone ; Vasopressor ; Ventilators</subject><ispartof>Journal of critical care, 2011-06, Vol.26 (3), p.328.e1-328.e8</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><rights>2010 Elsevier Inc. All rights reserved. 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c603t-f3a94340c4e84bf985b17370ed29cd45ea6e74cf9adeba60f5fb6484a3c131ec3</citedby><cites>FETCH-LOGICAL-c603t-f3a94340c4e84bf985b17370ed29cd45ea6e74cf9adeba60f5fb6484a3c131ec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0883944110002583$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21036528$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hadian, Mehrnaz, MD</creatorcontrib><creatorcontrib>Severyn, Donald A., MS</creatorcontrib><creatorcontrib>Pinsky, Michael R., MD</creatorcontrib><title>The effects of vasoactive drugs on pulse pressure and stroke volume variation in postoperative ventilated patients</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>Abstract Introduction Although pulse pressure variation (PPV) and stroke volume variation (SVV) during mechanical ventilation have been shown to predict preload responsiveness, the effect of vasoactive therapy on PPV and SVV is unknown. Methods Pulse pressure variation and SVV were measured continuously in 15 cardiac surgery patients for the first 4 postoperative hours. Pulse pressure variation was directly measured from the arterial pressure waveform, and both PPV and SVV were also calculated by LiDCO Plus (LiDCO Ltd, Cambridge, United Kingdom) before and after volume challenges or changes in vasoactive drug infusions done to sustain cardiovascular stability. Results Seventy-one paired events were studied (38 vasodilator, 10 vasoconstrictor, 14 inotropes, and 9 volume challenges). The difference between the measured and LiDCO-calculated PPV was 1% ± 7% (1.96 SD, 95% confidence interval, r2 = 0.8). Volume challenge decreased both PPV and SVV (15% to 10%, P < .05 and 13% to 9%, P = .09, respectively). Vasodilator therapy increased PPV and SVV (13% to 17% and 9% to 15%, respectively, P < .001), whereas increasing inotropes or vasoconstrictors did not alter PPV or SVV. The PPV/SVV ratio was unaffected by treatments. Conclusion Volume loading decreased PPV and SVV; and vasodilators increased both, consistent with their known cardiovascular effects. Thus, SVV and PPV can be used to drive fluid resuscitation algorithms in the setting of changing vasoactive drug therapy.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arterial pulse contour</subject><subject>Blood</subject><subject>Blood Pressure - drug effects</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular Surgical Procedures</subject><subject>Critical Care</subject><subject>Dopamine</subject><subject>Ejection fraction</subject><subject>Female</subject><subject>Functional hemodynamic monitoring</subject><subject>Heart rate</subject><subject>Heart surgery</subject><subject>Hemodynamic monitoring</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Inotrope</subject><subject>Intervention</subject><subject>LiDCO</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Minimally invasive</subject><subject>Patients</subject><subject>Postoperative Care</subject><subject>Pulmonary arteries</subject><subject>Pulse contour analysis</subject><subject>Respiration</subject><subject>Respiration, Artificial</subject><subject>Stroke Volume - drug effects</subject><subject>Time Factors</subject><subject>Vasoconstrictor Agents - pharmacology</subject><subject>Vasodilator</subject><subject>Vasodilator Agents - pharmacology</subject><subject>Vasomotor tone</subject><subject>Vasopressor</subject><subject>Ventilators</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kk1v1DAQhi0EokvhD3BAljhwyuLPrCOhSqjiS6rEgXK2HGfcepuNg51E6r9nwpYCPXAaefzM65l5TchLzrac8frtfrv32W8FwwQzW8bNI7LhWu8qU3P9mGyYMbJqlOIn5Fkpe8b4Tkr9lJwIzmSthdmQfHkNFEIAPxWaAl1cSc5PcQHa5fkKcwMd574AHTOUMmegbuhomXK6Abqkfj5gcDm6KSIakU5lSiNk90tkgWGKvZugoyNm8FSekyfBoeKLu3hKvn_8cHn-ubr4-unL-fuLytdMTlWQrlFSMa_AqDY0RrfY_o5BJxrfKQ2uhp3yoXEdtK5mQYe2VkY56bnk4OUpOTvqjnN7gM7j29n1dszx4PKtTS7af2-GeG2v0mLluh3FUeDNnUBOP2Yokz3E4qHv3QBpLtbUpml0IwSSrx-Q-zTnAaezqCWF4jgSUuJI-ZxKyRDue-HMro7avV0dtaujlhmLjmLRq7-nuC_5bSEC744A4C6XCNkWj3v20MWMrtouxf_rnz0o930conf9DdxC-TOHLcIy-239U-uX4owxoY2UPwE8bsqu</recordid><startdate>20110601</startdate><enddate>20110601</enddate><creator>Hadian, Mehrnaz, MD</creator><creator>Severyn, Donald A., MS</creator><creator>Pinsky, Michael R., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20110601</creationdate><title>The effects of vasoactive drugs on pulse pressure and stroke volume variation in postoperative ventilated patients</title><author>Hadian, Mehrnaz, MD ; Severyn, Donald A., MS ; Pinsky, Michael R., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c603t-f3a94340c4e84bf985b17370ed29cd45ea6e74cf9adeba60f5fb6484a3c131ec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arterial pulse contour</topic><topic>Blood</topic><topic>Blood Pressure - drug effects</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular Surgical Procedures</topic><topic>Critical Care</topic><topic>Dopamine</topic><topic>Ejection fraction</topic><topic>Female</topic><topic>Functional hemodynamic monitoring</topic><topic>Heart rate</topic><topic>Heart surgery</topic><topic>Hemodynamic monitoring</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Inotrope</topic><topic>Intervention</topic><topic>LiDCO</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Minimally invasive</topic><topic>Patients</topic><topic>Postoperative Care</topic><topic>Pulmonary arteries</topic><topic>Pulse contour analysis</topic><topic>Respiration</topic><topic>Respiration, Artificial</topic><topic>Stroke Volume - drug effects</topic><topic>Time Factors</topic><topic>Vasoconstrictor Agents - pharmacology</topic><topic>Vasodilator</topic><topic>Vasodilator Agents - pharmacology</topic><topic>Vasomotor tone</topic><topic>Vasopressor</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hadian, Mehrnaz, MD</creatorcontrib><creatorcontrib>Severyn, Donald A., MS</creatorcontrib><creatorcontrib>Pinsky, Michael R., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hadian, Mehrnaz, MD</au><au>Severyn, Donald A., MS</au><au>Pinsky, Michael R., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effects of vasoactive drugs on pulse pressure and stroke volume variation in postoperative ventilated patients</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2011-06-01</date><risdate>2011</risdate><volume>26</volume><issue>3</issue><spage>328.e1</spage><epage>328.e8</epage><pages>328.e1-328.e8</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>Abstract Introduction Although pulse pressure variation (PPV) and stroke volume variation (SVV) during mechanical ventilation have been shown to predict preload responsiveness, the effect of vasoactive therapy on PPV and SVV is unknown. Methods Pulse pressure variation and SVV were measured continuously in 15 cardiac surgery patients for the first 4 postoperative hours. Pulse pressure variation was directly measured from the arterial pressure waveform, and both PPV and SVV were also calculated by LiDCO Plus (LiDCO Ltd, Cambridge, United Kingdom) before and after volume challenges or changes in vasoactive drug infusions done to sustain cardiovascular stability. Results Seventy-one paired events were studied (38 vasodilator, 10 vasoconstrictor, 14 inotropes, and 9 volume challenges). The difference between the measured and LiDCO-calculated PPV was 1% ± 7% (1.96 SD, 95% confidence interval, r2 = 0.8). Volume challenge decreased both PPV and SVV (15% to 10%, P < .05 and 13% to 9%, P = .09, respectively). Vasodilator therapy increased PPV and SVV (13% to 17% and 9% to 15%, respectively, P < .001), whereas increasing inotropes or vasoconstrictors did not alter PPV or SVV. The PPV/SVV ratio was unaffected by treatments. Conclusion Volume loading decreased PPV and SVV; and vasodilators increased both, consistent with their known cardiovascular effects. Thus, SVV and PPV can be used to drive fluid resuscitation algorithms in the setting of changing vasoactive drug therapy.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>21036528</pmid><doi>10.1016/j.jcrc.2010.08.018</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Arterial pulse contour Blood Blood Pressure - drug effects Cardiac arrhythmia Cardiovascular Surgical Procedures Critical Care Dopamine Ejection fraction Female Functional hemodynamic monitoring Heart rate Heart surgery Hemodynamic monitoring Hemodynamics Humans Inotrope Intervention LiDCO Male Middle Aged Minimally invasive Patients Postoperative Care Pulmonary arteries Pulse contour analysis Respiration Respiration, Artificial Stroke Volume - drug effects Time Factors Vasoconstrictor Agents - pharmacology Vasodilator Vasodilator Agents - pharmacology Vasomotor tone Vasopressor Ventilators |
| title | The effects of vasoactive drugs on pulse pressure and stroke volume variation in postoperative ventilated patients |
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