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BJA Advance Access originally published online on September 29, 2009
British Journal of Anaesthesia 2009 103(5):678-684; doi:10.1093/bja/aep267
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© The Author [2009]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Automated pulse pressure and stroke volume variations from radial artery: evaluation during major abdominal surgery

A. Derichard1, E. Robin1, B. Tavernier1,*, M. Costecalde1, M. Fleyfel1, J. Onimus1, G. Lebuffe1, J.-P. Chambon2 and B. Vallet1

1 Federation of Anesthesiology and Critical Care Medicine and
2 Department of Vascular and General Surgery, Centre Hospitalier Universitaire de Lille, Lille, France

* Corresponding author: Pôle d'Anesthésie Réanimation, Hôpital Roger Salengro, Centre Hospitalier Universitaire de Lille, rue du Pr. Emile Laine, 59037 Lille Cedex, France. E-mail: btavernier{at}chru-lille.fr

Background: Off-line calculation of the pulse pressure variation (PPVref) has repeatedly been shown to be a reliable predictor of fluid responsiveness in mechanically ventilated patients. This study was designed to assess the ability of two algorithms for automated calculation of PPV (PPVauto) (Intellivue MP 70) and stroke volume variation (SVVauto) (FloTrac/Vigileo) to predict fluid responsiveness during abdominal surgery.

Methods: We conducted a prospective study of 56 fluid challenges given for haemodynamic instability in 11 patients undergoing major abdominal surgery. Fluid responsiveness was defined as an increase in stroke volume index (SVI) >10%. PPVref, PPVauto, SVVauto, and SVI (oesophageal Doppler) were recorded simultaneously before and after each fluid challenge.

Results: PPVauto and SVVauto both correlated with PPVref [rcorr=0.87 (P<0.0001) and 0.84 (P<0.0001), respectively; n=77]. All three indices measured before fluid challenges were higher in responder (n=32) than in non-responder (n=24) fluid challenges (P≤0.02). The mean areas under the receiver operating characteristic curves were 0.96 (PPVref), 0.96 (PPVauto), and 0.95 (SVVauto), and the optimal threshold value for each variable was 13%, 13%, and 12%, respectively. All indices correlated with the fluid challenge-induced changes in SVI (PPVref: rcorr=0.65; PPVauto: rcorr=0.58; SVVauto: rcorr=0.58, P<0.001 for all).

Conclusions: PPVauto and SVVauto predict fluid responsiveness as accurately as off-line PPVref in patients with haemodynamic instability during major abdominal surgery.

Keywords: fluids, i.v.; heart, cardiac output; monitoring, arterial pressure; ventilation, mechanical


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