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BMC Anesthesiology

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Open Access 01-12-2015 | Research article

Pulse pressure variation shows a direct linear correlation with tidal volume in anesthetized healthy patients

Authors: Yi Liu, Jing-sheng Lou, Wei-dong Mi, Wei-xiu Yuan, Qiang Fu, Min Wang, Jing Qu

Published in: BMC Anesthesiology | Issue 1/2015

Abstract

Background

The settings of mechanical ventilation, like tidal volume (VT), occasionally need to be adjusted in the process of anesthesia for some special reasons. The aim of this study was therefore to assess the relationship between pulse pressure variations (PPVs) in different settings of VT in anesthetized healthy patients under mechanical ventilation.

Methods

Sixty nine ASA I-II patients scheduled for gastrointestinal surgery under general anesthesia were included in this prospective study. All the patients were ventilated at a VT of 6, 8 or 10 ml/kg (predicted body weight) with no positive end expiratory pressure (PEEP) in a random order after intubation. PPV, mean arterial blood pressure, and other hemodynamic and respiratory parameters were recorded in each VT setting respectively after Partial Pressure of End-Tidal Expiration Carbon Dioxide (PetCO₂) maintained between 30 mmHg and 40 mmHg by changing Respiratory Rate (RR) before incision.

Results

The values of PPV at different settings of VT showed a tight correlation between each other (6 vs. 8 ml/kg: r = 0.97, P < 0.0001; 6 vs.10 ml/kg: r = 0.95, P < 0.0001; 8 vs. 10 ml/kg: r = 0.98, P < 0.0001, respectively).

Conclusion

There is a direct linear correlation between PPVs at different tidal volumes in anesthetized ASA I-II patients. PPV in any of the 3 VT settings (6, 8 or 10 ml/kg) can deduce that in any other 2 settings. Further studies are needed to explore the effect of intraoperative confounders for this knowledge to be clinically applied.

Trial registration

NCT01950949, www.clinicaltrials.gov, July 26, 2013.

Wang P, Zhou M, Rana MW, Ba ZF, Chaudry IH. Differential alterations in microvascular perfusion in various organs during early and late sepsis. Am J Physiol. 1992;263(1 Pt 1):G38–43.PubMed

Astiz ME, Rackow EC. Septic shock. Lancet. 1998;351(9114):1501–5.CrossRefPubMed

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, Early Goal-Directed Therapy Collaborative G. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.CrossRefPubMed

Hollenberg SM, Ahrens TS, Annane D, Astiz ME, Chalfin DB, Dasta JF, Heard SO, Martin C, Napolitano LM, Susla GM, et al. Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med. 2004;32(9):1928–48.CrossRefPubMed

Bliacheriene F, Machado SB, Fonseca EB, Otsuke D, Auler Jr JO, Michard F. Pulse pressure variation as a tool to detect hypovolaemia during pneumoperitoneum. Acta Anaesthesiol Scand. 2007;51(9):1268–72.PubMed

Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642–7.CrossRefPubMed

De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med. 2005;31(4):517–23.CrossRefPubMed

Vallee F, Richard JC, Mari A, Gallas T, Arsac E, Verlaan PS, Chousterman B, Samii K, Genestal M, Fourcade O. Pulse pressure variations adjusted by alveolar driving pressure to assess fluid responsiveness. Intensive Care Med. 2009;35(6):1004–10.CrossRefPubMed

Muller L, Louart G, Bousquet PJ, Candela D, Zoric L, de La Coussaye JE, Jaber S, Lefrant JY. The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness. Intensive Care Med. 2010;36(3):496–503.CrossRefPubMed

10.

Choi G, Wolthuis EK, Bresser P, Levi M, van der Poll T, Dzoljic M, Vroom MB, Schultz MJ. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents alveolar coagulation in patients without lung injury. Anesthesiology. 2006;105(4):689–95.CrossRefPubMed

11.

Putensen C, Theuerkauf N, Zinserling J, Wrigge H, Pelosi P. Meta-analysis: ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury. Ann Intern Med. 2009;151(8):566–76.CrossRefPubMed

12.

Guldner A, Kiss T, Serpa Neto A, Hemmes SN, Canet J, Spieth PM, Rocco PR, Schultz MJ, Pelosi P, Gama de Abreu M. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology. 2015;123(3):692–713.CrossRefPubMed

13.

Mesquida J, Kim HK, Pinsky MR. Effect of tidal volume, intrathoracic pressure, and cardiac contractility on variations in pulse pressure, stroke volume, and intrathoracic blood volume. Intensive Care Med. 2011;37(10):1672–9.CrossRefPubMed

14.

Freitas FG, Bafi AT, Nascente AP, Assuncao M, Mazza B, Azevedo LC, Machado FR. Predictive value of pulse pressure variation for fluid responsiveness in septic patients using lung-protective ventilation strategies. Br J Anaesth. 2013;110(3):402–8.CrossRefPubMed

15.

Miller RD. Miller's anesthesia. 7th ed. Philadelphia: Churchill Livingstone/Elsevier; 2010.

16.

Jardin F, Genevray B, Brun-Ney D, Bourdarias JP. Influence of lung and chest wall compliances on transmission of airway pressure to the pleural space in critically ill patients. Chest. 1985;88(5):653–8.CrossRefPubMed

17.

Mallat J, Lemyze M, Thevenin D. Ability of respiratory pulse pressure variation to predict fluid responsiveness in ARDS: still an unanswered question? Crit Care. 2011;15(3):432. author reply 432.CrossRefPubMedPubMedCentral

18.

Gouvea G, Diaz R, Auler L, Toledo R, Martinho JM. Evaluation of the pulse pressure variation index as a predictor of fluid responsiveness during orthotopic liver transplantation. Br J Anaesth. 2009;103(2):238–43.CrossRefPubMed

19.

Hoiseth LO, Hoff IE, Myre K, Landsverk SA, Kirkeboen KA. Dynamic variables of fluid responsiveness during pneumoperitoneum and laparoscopic surgery. Acta Anaesthesiol Scand. 2012;56(6):777–86.CrossRefPubMed

20.

van Lavieren M, Veelenturf J, Hofhuizen C, van der Kolk M, van der Hoeven J, Pickkers P, Lemson J, Lansdorp B. Dynamic preload indicators decrease when the abdomen is opened. BMC Anesthesiol. 2014;14:90.CrossRefPubMedPubMedCentral

21.

Oliveira RH, Azevedo LC, Park M, Schettino GP. Influence of ventilatory settings on static and functional haemodynamic parameters during experimental hypovolaemia. Eur J Anaesthesiol. 2009;26(1):66–72.CrossRefPubMed

22.

Bendixen HH, Hedley-Whyte J, Laver MB. Impaired Oxygenation in Surgical Patients during General Anesthesia with Controlled Ventilation. A Concept of Atelectasis. N Engl J Med. 1963;269:991–6.CrossRefPubMed

23.

Marini JJ. Evolving concepts in the ventilatory management of acute respiratory distress syndrome. Clin Chest Med. 1996;17(3):555–75.CrossRefPubMed

24.

Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338(6):347–54.CrossRefPubMed

25.

Petrucci N, Iacovelli W. Ventilation with lower tidal volumes versus traditional tidal volumes in adults for acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev. 2003;3, CD003844.PubMed

26.

Weingarten TN, Whalen FX, Warner DO, Gajic O, Schears GJ, Snyder MR, Schroeder DR, Sprung J. Comparison of two ventilatory strategies in elderly patients undergoing major abdominal surgery. Br J Anaesth. 2010;104(1):16–22.CrossRefPubMed

27.

Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, Marret E, Beaussier M, Gutton C, Lefrant JY, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013;369(5):428–37.CrossRefPubMed

28.

Serpa Neto A, Nagtzaam L, Schultz MJ. Ventilation with lower tidal volumes for critically ill patients without the acute respiratory distress syndrome: a systematic translational review and meta-analysis. Curr Opin Crit Care. 2014;20(1):25–32.CrossRefPubMed

Title: Pulse pressure variation shows a direct linear correlation with tidal volume in anesthetized healthy patients
Authors: Yi Liu
Jing-sheng Lou
Wei-dong Mi
Wei-xiu Yuan
Qiang Fu
Min Wang
Jing Qu
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/s12871-016-0233-y

At a glance: The STEP trials

Springer Medicine

Pulse pressure variation shows a direct linear correlation with tidal volume in anesthetized healthy patients

Abstract

Background

Methods

Results

Conclusion

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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