Key result
Pulse pressure and stroke volume variation predicted fluid responsiveness under closed chest conditions (r=0.856, p=0.002; r=0.897, p=0.0012), but these correlations were lost after sternotomy.
Why the study?
Do pulse pressure variation and stroke volume variation predict fluid responsiveness in patients undergoing open chest surgery?
Observational (n=15)
Do pulse pressure variation and stroke volume variation predict fluid responsiveness in patients undergoing open chest surgery?
Effect estimate: r = 0.856 and r = 0.897
p-value: p=0.002 and 0.0012
Pulse pressure and stroke volume variations are valid predictors of fluid responsiveness in closed chest conditions but lose their predictive value once the chest is open during cardiac surgery.
PPV/SVV lose predictive value post-sternotomy; leaves open their utility for guiding fluids in open-chest cardiac surgery.
SUMMARY: We investigated the ability of pulse pressure variation and stroke volume variation to predict fluid responsiveness during mechanical ventilation in patients undergoing open chest surgery by comparing their respective correlations with cardiac output changes induced by leg elevation. Serial leg elevation manoeuvres were performed before and after sternotomy in 15 patients scheduled for elective off-pump coronary bypass surgery. Under closed chest conditions, both pulse pressure variation and stroke volume variation correlated well with the induced cardiac output changes (r = 0.856, p = 0.002 and r = 0.897, p = 0.0012, respectively). These correlations were lost for both parameters following sternotomy. Our data show that pulse pressure variation and stroke volume variation are valid predictors of fluid responsiveness under closed chest conditions but that this property no longer holds when the chest is open.
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Wyffels et al. (2010) conducted an observational in Elective off-pump coronary bypass surgery (n=15). Pulse pressure variation and stroke volume variation was evaluated on Correlation with cardiac output changes induced by leg elevation (r = 0.856 and r = 0.897, p=0.002 and 0.0012). Pulse pressure and stroke volume variation predicted fluid responsiveness under closed chest conditions (r=0.856, p=0.002; r=0.897, p=0.0012), but these correlations were lost after sternotomy.
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