Key result
Pulse pressure variability was superior to CVP and PAOP in discriminating fluid responders in adult post-cardiac surgery patients (AUC 0.83 vs 0.40 and 0.21; p<0.0001).
Why the study?
Predicting fluid responsiveness can identify patients who benefit from fluid loading post-cardiac surgery, but the best hemodynamic parameters to guide hydration needed comparison.
Does pulse pressure variability (PPV) predict fluid responsiveness better than central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) in mechanically ventilated adult patients immediately after cardiac surgery?
Cohort (n=101)
Does pulse pressure variability (PPV) predict fluid responsiveness better than central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) in mechanically ventilated adult patients immediately after cardiac surgery?
Effect estimate: AUC 0.83
p-value: p=<0.0001
In mechanically ventilated patients immediately following cardiac surgery, dynamic indices like pulse pressure variability (PPV) are significantly superior to static indices (CVP, PAOP) for predicting fluid responsiveness.
PPV may better discriminate fluid responders than CVP or PAOP post-cardiac surgery; hypothesis-generating and requires prospective validation.
Background: Prediction of fluid responsiveness can identify patients who will benefit from fluid loading in the immediate postoperative period of cardiac surgery. Several hemodynamic parameters may help identify those who will benefit from hydration. This study aimed to identify and compare the parameters that predict fluid responsiveness in post-cardiac surgery patients. Methodology: This prospective cohort study included 101 post-cardiac surgery patients. Hemodynamic parameters were recorded at baseline and after an 8 mL/kg IV fluid challenge. Fluid responders are those with an increase in stroke volume of ≥15%. Multivariate analysis was used to identify independent predictors of fluid responder status. Sensitivity and specificity analyses were done to determine the predictive accuracy of each parameter. Results: The rate of fluid responsiveness was 54.5%. Independent predictors were: central venous pressure (CVP) ≤6 mmHg (p=0.001), pulmonary artery occlusion pressure (PAOP) ≤12 mmHg (p=0.016), PAOP increase by ≥7 mmHg (p=0.002), pulse pressure variability (PPV) >12% (p<0.001), PPV decrease by >5% (p=0.049) and weight (p=0.04). PPV was the most sensitive (92%) and specific (74%); while PAOP was the least sensitive (70%) and CVP the least specific (51%). PPV had the highest ability to discriminate fluid responders (AUC 0.83) compared to PAOP (AUC 0.21) and CVP (AUC 0.40) (p<0.0001). Conclusion: PPV (a dynamic index) is superior to CVP and PAOP (static indices) in discriminating fluid responders in adult patients who underwent cardiac surgery. PPV is the favored tool to guide initiation of fluid therapy in this clinical setting.
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Albano et al. (2021) conducted a cohort in post-cardiac surgery (n=101). Pulse pressure variability (PPV) vs. Central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) was evaluated on Fluid responsiveness (increase in stroke volume of ≥15% after an 8 mL/kg IV fluid challenge) (AUC 0.83, p=<0.0001). Pulse pressure variability was superior to CVP and PAOP in discriminating fluid responders in adult post-cardiac surgery patients (AUC 0.83 vs 0.40 and 0.21; p<0.0001).
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