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Journal of Clinical Monitoring and Computing

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01-03-2022 | Heart Surgery | Original Research

Right ventricular and pulmonary artery pulse pressure variation and systolic pressure variation for the prediction of fluid responsiveness: an interventional study in coronary artery bypass surgery patients

Authors: Moritz Flick, Ulrike Sand, Alina Bergholz, Karim Kouz, Beate Reiter, Doris Flotzinger, Bernd Saugel, Jens Christian Kubitz

Published in: Journal of Clinical Monitoring and Computing | Issue 6/2022

Abstract

Purpose

Predicting fluid responsiveness is essential when treating surgical or critically ill patients. When using a pulmonary artery catheter, pulse pressure variation and systolic pressure variation can be calculated from right ventricular and pulmonary artery pressure waveforms.

Methods

We conducted a prospective interventional study investigating the ability of right ventricular pulse pressure variation (PPV_RV) and systolic pressure variation (SPV_RV) as well as pulmonary artery pulse pressure variation (PPV_PA) and systolic pressure variation (SPV_PA) to predict fluid responsiveness in coronary artery bypass (CABG) surgery patients. Additionally, radial artery pulse pressure variation (PPV_ART) and systolic pressure variation (SPV_ART) were calculated. The area under the receiver operating characteristics (AUROC) curve with 95%-confidence interval (95%-CI) was used to assess the capability to predict fluid responsiveness (defined as an increase in cardiac index of > 15%) after a 500 mL crystalloid fluid challenge.

Results

Thirty-three patients were included in the final analysis. Thirteen patients (39%) were fluid-responders with a mean increase in cardiac index of 25.3%. The AUROC was 0.60 (95%-CI 0.38 to 0.81) for PPV_RV, 0.63 (95%-CI 0.43 to 0.83) for SPV_RV, 0.58 (95%-CI 0.38 to 0.78) for PPV_PA, and 0.71 (95%-CI 0.52 to 0.89) for SPV_PA. The AUROC for PPV_ART was 0.71 (95%-CI 0.53 to 0.89) and for SPV_ART 0.78 (95%-CI 0.62 to 0.94). The correlation between pulse pressure variation and systolic pressure variation measurements derived from the different waveforms was weak.

Conclusions

Right ventricular and pulmonary artery pulse pressure variation and systolic pressure variation seem to be weak predictors of fluid responsiveness in CABG surgery patients.

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Title: Right ventricular and pulmonary artery pulse pressure variation and systolic pressure variation for the prediction of fluid responsiveness: an interventional study in coronary artery bypass surgery patients
Authors: Moritz Flick
Ulrike Sand
Alina Bergholz
Karim Kouz
Beate Reiter
Doris Flotzinger
Bernd Saugel
Jens Christian Kubitz
Publication date: 01-03-2022
Publisher: Springer Netherlands
Keywords: Heart Surgery
Heart Surgery
CABG
CABG
Published in: Journal of Clinical Monitoring and Computing / Issue 6/2022
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-022-00830-4

At a glance: The STEP trials

Springer Medicine

Right ventricular and pulmonary artery pulse pressure variation and systolic pressure variation for the prediction of fluid responsiveness: an interventional study in coronary artery bypass surgery patients

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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