• Satoshi Suzuki, Nicholas C Z Woinarski, Miklos Lipcsey, Cristina Lluch Candal, Antoine G Schneider, Neil J Glassford, Glenn M Eastwood, and Rinaldo Bellomo.
• Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia.
• J Crit Care. 2014 Dec 1;29(6):992-6.

PurposeThe aim of this study is to study the feasibility, safety, and physiological effects of pulse pressure variation (PPV)-guided fluid therapy in patients after cardiac surgery.Materials And MethodsWe conducted a pilot prospective before-and-after study during mandatory ventilation after cardiac surgery in a tertiary intensive care unit. We introduced a protocol to deliver a fluid bolus for a PPV≥13% for at least >10 minutes during the intervention period.ResultsWe studied 45 control patients and 53 intervention patients. During the intervention period, clinicians administered a fluid bolus on 79% of the defined PPV trigger episodes. Median total fluid intake was similar between 2 groups during mandatory ventilation (1297 mL [interquartile range 549-1968] vs 1481 mL [807-2563]; P=.17) and the first 24 hours (3046 mL [interquartile range 2317-3982] vs 3017 mL [2192-4028]; P=.73). After adjusting for several baseline factors, PPV-guided fluid management significantly increased fluid intake during mandatory ventilation (P=.004) but not during the first 24 hours (P=.47). Pulse pressure variation-guided fluid therapy, however, did not significantly affect hemodynamic, renal, and metabolic variables. No serious adverse events were noted.ConclusionsPulse pressure variation-guided fluid management was feasible and safe during mandatory ventilation after cardiac surgery. However, its advantages may be clinically small.Copyright © 2014 Elsevier Inc. All rights reserved.

25 keywords...

hide…