pulse pressure variation and volume responsiveness during acutely increased pulmonary artery pressure an experimental study脉压变化和体积响应在敏锐地增加肺动脉压力的实验研究.pdfVIP

Daudel et al. Critical Care 2010, 14:R122 /content/14/3/R122 RESEARCH Open Access Pulse pressure variation and volume responsiveness during acutely increased pulmonary artery pressure: an experimental study † † * Fritz Daudel , David Tüller , Stefanie Krähenbühl, Stephan M Jakob , Jukka Takala Abstract Introduction: We found that pulse pressure variation (PPV) did not predict volume responsiveness in patients with increased pulmonary artery pressure. This study tests the hypothesis that PPV does not predict fluid responsiveness during an endotoxin-induced acute increase in pulmonary artery pressure and right ventricular loading. Methods: Pigs were subjected to endotoxemia (0.4 μg/kg/hour lipopolysaccharide), followed by volume expansion, subsequent hemorrhage (20% of estimated blood volume), retransfusion, and additional stepwise volume loading until cardiac output did not increase further (n = 5). A separate control group (n = 7) was subjected to bleeding, retransfusion, and volume expansion without endotoxemia. Systemic hemodynamics were measured at baseline and after each intervention, and PPV was calculated offline. Prediction of fluid-challenge-induced stroke volume increase by PPV was analyzed using receiver operating characteristic (ROC) curves. Results: Sixty-eight volume challenges were performed in endotoxemic animals (22 before and 46 after hemorrhage), and 51 volume challenges in the controls. Endotoxin infusion resulted in an acute increase in pulmonary artery and central venous pressure and a decrease in stroke volume (all P 0.05). In endotoxemia, 68% of volume challenges before hemorrhage increased the stroke volume by 10%, but PPV did not predict fluid responsiveness (area under the ROC curve = 0.604, P = 0.461).