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Open Access 01-12-2007 | Research

Prediction of volume response under open-chest conditions during coronary artery bypass surgery

Authors: Michael Sander, Claudia D Spies, Katharina Berger, Herko Grubitzsch, Achim Foer, Michael Krämer, Matthias Carl, Christian von Heymann

Published in: Critical Care | Issue 6/2007

Abstract

Introduction

Adequate fluid loading is the first step of hemodynamic optimization in cardiac patients undergoing surgery. Neither a clinical approach alone nor conventional parameters like central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) are thought to be sufficient for recognizing fluid deficiency or overload. The aim of this study was to evaluate the suitability of CVP, PCWP, global end-diastolic volume index (GEDVI), pulse pressure variation (PPV), and stroke volume variation (SVV) for predicting changes in the cardiac index (CI) and stroke volume index (SVI) after sternotomy.

Methods

In 40 patients, CVP, PCWP, GEDVI, PPV, SVV, and the CI were measured at two points of time. One measurement was performed after inducing anesthesia and one after sternotomy.

Results

A significant increase in heart rate, CI, and GEDVI was observed during the study period. CVP, SVV, and PPV decreased significantly. There were no significant correlations between CVP and PCWP and changes in CI. In contrast, GEDVI, SVV, and PPV significantly correlated with CI changes. Only relative changes of GEDVI, SVV, and PPV predicted changes in SVI.

Conclusion

During cardiac surgery and especially after sternotomy, CVP and PCWP are not suitable for monitoring fluid status. Direct volume measurement like GEDVI and dynamic volume responsive measurements like SVV and PPV may be more suitable for monitoring the volume status of patients, particularly under open-chest conditions.

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Title: Prediction of volume response under open-chest conditions during coronary artery bypass surgery
Authors: Michael Sander
Claudia D Spies
Katharina Berger
Herko Grubitzsch
Achim Foer
Michael Krämer
Matthias Carl
Christian von Heymann
Publication date: 01-12-2007
Publisher: BioMed Central
Published in: Critical Care / Issue 6/2007
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc6181

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prediction of volume response under open-chest conditions during coronary artery bypass surgery

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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