Validity of Pulse Pressure Variation (PPV) Compared with Stroke Volume Variation (SVV) in Predicting Fluid Responsiveness / Sivi Yanitinin Tahmin Edilmesinde Atim Hacmi Degisimi (SVV) ile Karsilastirildiginda Nabiz Basinci Degisiminin (PPV) Gecerliligi.
Objective: Static monitors for assessing the fluid status during major surgeries and in critically ill patients have been gradually replaced by more accurate dynamic monitors in modern-day anaesthesia practice. Pulse pressure variation (PPV) and systolic pressure variation (SPV) are the two commonly used dynamic indices for assessing fluid responsiveness.
Methods: In this prospective observational study, 50 patients undergoing major surgeries were monitored for PPV and SPV: after the induction of anaesthesia and after the administration of 500 mL of isotonic crystalloid bolus. Following the fluid bolus, patients with a cardiac output increase of more than 15% were classified as responders and those with an increase of less than 15% were classified as non-responders.
Results: There were no significant differences in the heart rate (HR), mean arterial pressure (MAP), PPV, SVV, central venous pressure (CVP) and cardiac index (CI) between responders and non-responders. Before fluid bolus, the stroke volume was significantly lower in responders (p=0.030). After fluid bolus, MAP was significantly higher in responders but there were no significant changes in HR, CVP, CI, PPV and SVV. In both responders and non-responders, PPV strongly correlated with SVV before and after fluid bolus.
Conclusion: Both PPV and SVV are useful to predict cardiac response to fluid loading. In both responders and non-responders, PPV has a greater association with fluid responsiveness than SVV.
Keywords: Fluid management, pulse pressure variation, systolic pressure variation, fluid responsiveness
Amac: Gunumuzde anestezi pratiginde, buyuk ameliyatlarda ve agir hastalarda sivi durumunun degerlendirilmesi icin kullanilan statik izlem yontemlerinin yerini, daha dogru sonuclar veren dinamik izlemler almistir. Nabiz basinci degisimi (PPV) ve sistolik basinc degisimi (SPV) sivi yanitini degerlendirmek amaciyla yaygin bir sekilde kullanilan dinamik indekslerdir.
Yontemler: Bu prospektif gozlemsel calismada, major cerrahi gecirecek 50 hastada anestezi induksiyonundan ve 500 mL izotonik verildikten sonra PPV ve SPV monitorize edildi. Bolus sivi uygulamasini takiben, %15'ten fazla kardiyak debisi artisi olan hastalar yanit verenler olarak, %15'ten daha az artisi olanlar ise yanit vermeyenler olarak siniflandirildilar.
Bulgular: Yanit verenler ve vermeyenler arasinda kalp atim hizi (HR), ortalama arter basinci (MAP), PPV, SVV, santral venoz basinc (CVP) ve kardiyak indeks (CI) acisindan anlamli bir fark bulunmadi. Bolus sivi uygulamasi oncesinde, atim hacmi yanit verenlerde anlamli derecede daha dusuktu (p=0,030). Bolus sivi uygulamasi sonrasinda, MAP yanit verenlerde anlamli olcude daha yuksek bulundu, ancak HR, CVP, CI, PPV ve SVV acisindan anlamli fark gozlenmedi. Bolus sivi uygulamasi oncesinde ve sonrasinda, hem yanit veren hem de yanit vermeyen hastalarda, PPV degeri ile SVV degeri arasinda guclu bir iliski saptandi.
Sonuc: PPV ve SVV sivi yuklenmesine verilen kardiyak yaniti tahmin etmede yararlidir. Hem yanit veren hem de vermeyen hastalarda PPV, SVV ile kiyaslandiginda, sivi yaniti ile daha fazla iliskilidir.
Anahtar Sozcukler: Sivi yonetimi, nabiz basinci degisimi, sistolik basinc degisimi, sivi yaniti
Managing intraoperative fluid therapy in major surgeries can be challenging. Preoperative fasting and general anaesthesia reduce intravascular volume, blood pressure as well as tissue perfusion in patients undergoing surgeries. Hypovolaemia increases the risk of vital organ dysfunction, but excessive intravenous fluid administration can also have deleterious effects. Thus, judicious intravenous fluid supplementation to achieve optimum cardiac performance is one of the most important haemodynamic goals in patients undergoing major surgeries. Objective quantification of the intravascular fluid status can be very difficult and erroneous.
Central venous pressure (CVP) monitoring and pulmonary capillary wedge pressure (PCWP) have been traditionally used to estimate the circulating blood volume, but studies have shown that these monitors cannot reliably estimate preload (1) or predict responsiveness to fluid therapy (2-4).
On the other hand, analysis of arterial pressure contour is a very effective way to assess the haemodynamic status during major surgeries (5). Several studies have reported that dynamic variables obtained from arterial pressure waveform analysis, such as pulse pressure variation (PPV) and stroke volume variation (SVV), are appropriate indicators to assess fluid responsiveness in patients under mechanical ventilation. SVV is a reliable predictor of fluid responsiveness (6). However, the assessment of SVV requires special monitors such as Vigileo monitors with FloTrac transducers (Edwards Life-science, USA), which may not be widely available. The Vigileo-FloTrac system, which is based on analysis of arterial pulse contour, does not need external calibration, dye dilution, or thermodilution. This system provides a nearly beat-to-beat estimate of stroke volume (SV) and SVV. The device is accurate in assessing the cardiac output and SVV, which has been tested in several settings.
Pulse Pressure Variation (PPV) is a derivative of the arterial pulse waveform integrated in monitors of most anaesthesia workstations. The aim of the study was to validate the accuracy and effectiveness of PPV (measured using standard anaesthesia monitors integrated with workstations) compared with those of SVV (measured using a FloTrac transducer and Vigileo monitor) in predicting fluid responsiveness in patients undergoing major surgeries.
Institutional Ethics Committee approval was obtained prior to conducting this prospective observational study. The participants were provided a detailed explanation about the purpose of the study and were assured about the confidentiality of the information and that their participation was entirely optional. Written informed consent was obtained from 50 patients undergoing major non-cardiac surgery in a tertiary care hospital. Patients who hadAmerican Society of Anesthesiologists (ASA) physical status 1-3, were aged between 18-60 years, had undergone surgery and required invasive arterial pressure and CVP monitoring at the discretion of the attending anaesthesiologist were included in the study. Patients with any history of arrhythmias, significant valvular diseases, pulmonary hypertension, left ventricular ejection fraction less than 40%, or right ventricular dysfunction respiratory disorders that would result in elevated peak airway pressures wereexcluded from the study. After patient's arrival to the operating room, standard ASA monitors were placed. Anaesthesia was induced using propofol, and vecuronium was used to facilitate tracheal intubation. Patients were ventilated withan inspired oxygen fraction of 0.50 with a tidal volume of 8 mL k[g.sup.-1] ideal body weight and with no positive end expiratory pressure (PEEP). The respiratory rate was adjusted to maintain an end-tidal carbon dioxide concentration of 35-40 mmHg. After the induction of anaesthesia, a 20-gauge arterial cannula was placed in the radial artery. Arterial pressures were measured using a FloTrac transducer and Vigileo monitor, and PPV was calculated using a standard anaesthesia workstation. Newer anaesthesia workstationshave the features of measuring PPV in response to fluid replacement therapy. This feature can be used with standard arterial pressure contour analysis. Clinicians can freeze a pressure waveform and identify the maximum and minimum pressure pulses, which coincide with the respiration cycles, and can estimate PPV. The machine automatically calculates PPV and displays it. Both PPV and arterial blood pressure values were considered as the average of three consecutive values at a 1-minute interval. A triple-lumen (7 Fr) central venous catheter was inserted in the right internal jugular vein or right sub-clavian vein and used for CVP monitoring and the administration of vasopressors, if required. During measurements and fluid trial, any manipulation such as tilting the operating table, urinary catheter insertion or any surgical intervention was strictly avoided. After establishing the apparatus, the first set of readings of both variables was recorded and the patient was infused with two boluses of 250 mL isotonic electrolyte solution (Sterofundin ISO; B Braun Medical, Switzerland) over a period of 10 minutes. After each bolus, SVV and PPV were recorded. Cardiac output (CO) was calculated from stroke volume (SV) and heart rate (HR) (CO=SVXHR). The values were recorded at baseline and after each bolus of fluid infusion, and this was used to classify patients as responders and non-responders. Following the crystalloid bolus, patients with a cardiac output increase of more than 15% were classified as responders and those with an increase of less than 15% were classified as non-responders. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), HR, Mean Arterial Pressure (MAP), CO, PPV and SVV were simultaneously recorded at each time point.
The primary objective was to measure PPV and SVV before and after fluid infusion to the patient undergoing major surgery and to classify patients as responders and non-re-sponders based on the percentage change in CO and the secondary objectives were to compare and validate the accuracy and predictability of fluid responsiveness measured using PPV and SVV.
All statistical analyses were performed using IBM Statistical Package for the Social Sciences (IBM SPSS Statistics, Armonk, NY, USA) version 20. The clinical profile of patients was analysed using chi-square test for qualitative variables and Student's t-test for quantitative variables. The correlation between quantitative outcomes was assessed using Pearson's correlation. A p value less than 0.05 was considered statistically significant.
A total of 50 patients were included in this study. Of them 64% were males and 36% were females and most of them belonged to ASA physical status II (78%). The mean age of the patients was 44.36 (SD[+ or -]10.8) years. Patient characteristics and preoperative findings are presented in Table 1. We observed no technical failure in either device. After anaesthesia induction and endotracheal intubation, baseline haemodynamic parameters were as follows: 115[+ or -]10 mmHg (SBP), 69[+ or -]8 mmHg (DBP), 84[+ or -]7 mmHg (MAP), 16[+ or -]2 (SVV), 73[+ or -]6 beats per min (HR) and 2.6[+ or -]0.3 [m.sup.-2] mi[n.sup.-1] (cardiac index, CI). There were 25 (50%) responders, defined by an increase in the cardiac output (CO) of >15% after volume expansion of 500 mL. There were no significant differences in HR, MAP, PPV, SVV, CVP and CI between responders and non-responders (p=0.05, 0.13, 0.21, 0.42, 0.81 and 0.08, respectively) at baseline. The increase in CO was at least 15% (range: 15.10%-35.42%) in 25 patients (responders) and less than 15% (range: 10.37%-12.79%) in 25 patients (non-responders). Haemodynamic variables in responders and non-responders before and after fluid challenge are outlined in Table 2. Before fluid infusion, SV was significantly lesser in responders than in non-responders (p=0.030). After fluid infusion, MAP was significantly higher in responders than in non-responders (p=0.07), while there were no significant changes in HR, CVP, CI, PPV and SVV (p=0.08, 0.74, 0.49, 0.89 and 0.56, respectively) between responders and non-responders. Correlations between different parameters in responders and non-responders are outlined in Tables 3-10. In responders, PPV before and after fluid loading was strongly correlated with SVV before fluid loading (Pearson's correlation coefficient=0.875, 0.685 and 0.769, respectively, p<0.001). A similar significant positive correlation was observed in non-responders. SVV and PPV were found to have a direct correlation with the degree of fluid responsiveness, expressed as CI. PPV and SVV showed better correlation with CI in responders than in non-responders, but the results were not significant. This may be due to a small sample size. Our results demonstrate the efficacy of SVV and PPV in predicting cardiac response to intravenous fluid loading in the given clinical setting. In both responders and non-responders, PPV has a greater association with fluid responsiveness than SVV.
Determination of the intravascular volume status based on clinical parameters can be difficult as well as misleading in critically ill patients and in patients undergoing major surgery. Traditionally, estimation of cardiac filling pressure to guide fluid therapy have been done with central venous and pulmonary artery catheters. However, several studies performed in recent times have challenged this traditional concept and have demonstrated that cardiac filling pressures are inaccurate in predicting fluid responsiveness. In addition, several dynamic tests of intravenous fluid responsiveness have been reported. These tests essentially monitor the change in SV after any manoeuvre that either increases or decreases the left ventricular preload. These tests commonly monitor the change in SV during mechanical ventilation to assess the intravascular volume status and predict fluid responsiveness. Several studies have demonstrated that PPV and SVV, which are derived from pulse contour analysis, and plethy smographic variation, which is derived from the change in the amplitude of the pulse oximetry waveform, are highly predictive of fluid responsiveness (7).
Stroke volume variation occurs because of a cyclical change in intrathoracic pressure caused by positive pressure mechanical ventilation. SVV has been recognised as a concept for guiding intravenous fluid therapy more than 20 years ago (8). This variable is the result of decreased venous return to the heart during positive pressure inspiration. SVV results in a concomitant change in arterial pressure and its objective estimation is possible by systolic pulse variation (SPV) and PPV. Both these variables have been used to assess fluid responsiveness in a number of clinical studies and have been shown to be sensitive in predicting the ventricular response to fluid loading (9-11). However, Michard et al. (12) found PPV to be superior to SPV because it reflects changes in transmural pressures more accurately and is less affected by extramural pressures changes such as pleural pressure. Another study found that SPV cannot be explained by only left ventricular volume changes and other factors such as intrathoracic and airway pressure changes affect SPV (13). Both these variables may be affected by changes in the vasomotor tone (14).
The current PiCCOplus monitoring system displays PPV values automatically in real time. In one study, SVV was found to be useful to assess the fluid responsiveness in postoperative patients with preserved as well as diminished left ventricular function (15), whereas in another study, no strong correlation was observed between SVV and changes in SV during a preoperative fluid bolus trial (16). Contradictory findings from a number of published studies may be the result of significant differences in designing these studies, e.g. adopting different ventilatory strategies and fluid therapy protocols and differences in the cardiovascular reserve of the studied patient population. Some authors have even questioned the importance of SVV in accurately assessing fluid responsiveness (14).
There are very few studies that have directly compared SVV with other estimates of SV variation. One such study found a close relationship between SVV and SPV (17), and both these variables can predict fluid responsiveness. Again, in another study, both were found to SVV and PPV correlate well with each other, but the prediction of fluid responsiveness was not studied (18).
Stroke volume variation assessed by a FlowTrac transducer and Vigileo monitor and PPV assessed by anaesthesia workstation-integrated monitors showed comparable performance in predicting fluid responsiveness in patients undergoing major surgeries. PPV monitoring is cost-effective because the transducer used to estimate SVV is more expensive. Therefore, if the appropriate monitor is available, PPV could be preferred for preload estimation in patients undergoing major surgeries.
Ethics Committee Approval: Ethics committee approval was received for this study from the ethics committee of Institutional Ethics Committee Army Hospital (R&R), Delhi Cantt, India (Date: 23.10.2013).
Informed Consent: Written informed consent was obtained from patients who participated in this study.
Peer-review: Externally peer-reviewed.
Author Contributions: Concept - A.R.; Design - A.R.; Supervision - P.T.; Resources - A.R.; Data Collection and/or Processing - S.S.; Analysis and/or Interpretation - S.S., P.T.; Literature Search - S.S.; Writing Manuscript - R.L.; Critical Review - D.P.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study has received no financial support.
Etik Komite Onayi: Bu calisma icin etik komite onayi Hindistan Askeri Hastanesi Etik Kurulu'ndan (Tarih: 23.10.2013) alinmistir.
Hasta Onami: Yazili hasta onami bu calismaya katilan hastalardan alinmistir.
Hakem Degerlendirmesi: Dis bagimsiz.
Yazar Katkilari: Fikir - A.R.; Tasarim - A.R.; Denetleme - P.T.; Kaynaklar - A.R.; Veri Toplanmasi ve/veya Islemesi - S.S.; Analiz ve/veya Yorum - S.S., P.T.; Literatur Taramasi - S.S.; Yaziyi Yazan - R.L.; Elestirel Inceleme - D.P.
Cikar Catismasi: Yazarlar cikar catismasi bildirmemislerdir.
Finansal Destek: Yazarlar bu calisma icin finansal destek almadiklarini beyan etmislerdir.
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(14.) Pinsky MR. Probing the limits of arterial pulse contour analysis to predict preload responsiveness. Anesth Analg 2003; 96: 1245-7. [CrossRef]
(15.) Reuter DA, Felbinger TW, Schmidt C,Kilger E, Goedje O, Lamm P. Stroke volume variation for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med 2002; 28: 392-8. [CrossRef]
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Abhishek Rathore (1), Shalendra Singh (1), Ritesh Lamsal (2), Priya Taank (3), Debashish Paul (1)
(1) Department of Anaesthesiology, Army R&R Hospital Delhi Cantt, Delhi, India
(2) Department of Neuroanaesthesiology, All India Institute of Medical Science, New Delhi, India
(3) Department of Ophthalmology, Army R&R Hospital Delhi Cantt, Delhi, India
Cite this article as: Rathore A, Singh S, Lamsal R, Taank P, Paul D. Validity of Pulse Pressure Variation (PPV) Compared with Stroke Volume Variation (SVV) in Predicting Fluid Responsiveness. Turk J Anaesthesiol Reanim 2017; 45: 210-7.
Address for Correspondence/Yazisma Adresi: Shalendra Singh E-mail: email@example.com
Received/GelisTarihi : 21.12.2016
Accepted / Kabul Tarihi : 06.04.2017
Table 1. Demographic data (n=50) Patient Responders Non-responders characteristic (n=25) (n=25) Age (years) (range) 42.53 (22-60) 45.34 (27-60) Sex (male/female) 17/8 15/10 (% Male/female) 68/32 60/40 Weight (mean and in years) 62.0 (43-86) 60.61 (47-75) ASA class I 0 6 II 21 18 III 4 1 ASA: American Society of Anaesthesiologists Table 2. Haemodynamic variables before and after fluid loading n Mean SD Statistic Statistic SE Statistic PFB SBP 50 115.0600 1.55430 10.99055 PFB DBP 50 69.1800 1.13342 8.01450 PFB MAP 50 84.4800 1.06339 7.51934 PFB HR 50 73.6800 0.89417 6.32275 PFB SVV 50 16.0400 0.39275 2.77717 PFB PPV 50 24.2800 0.57003 4.03070 PFB CVP 50 9.8000 0.16903 1.19523 PFB SV 50 66.7200 0.83644 5.91449 PFB CI 50 2.6560 0.05607 0.39649 PFB CO 50 4916.4400 85.83716 606.96038 Post 250 mL SBP 50 117.8200 1.30890 9.25531 Post 250 mL DBP 50 73.2600 1.07354 7.59111 Post 250 mL MAP 50 88.2000 0.97729 6.91051 Post 250 mL HR 50 72.0800 0.65704 4.64600 Post 250 mL SVV 50 9.9600 0.38857 2.74761 Post 250 mL PPV 50 16.2000 0.45175 3.19438 Post 250 mL CVP 50 11.4200 0.10725 0.75835 Post 250 mL SV 50 75.1400 0.89215 6.30843 Post 250 mL CI 50 3.4740 0.07204 0.50943 Post 500 mL SBP 50 119.0600 1.26859 8.97027 Post 500 mL DBP 50 74.3800 1.03091 7.28961 Post 500 mL MAP 50 89.2800 0.94201 6.66100 Post 500 mL HR 50 72.8800 0.65630 4.64072 Post 500 mL SVV 50 9.4600 0.37927 2.68184 Post 500 mL PPV 50 15.0200 0.45400 3.21025 Post 500 mL CVP 50 11.6400 0.12041 0.85141 Post 500 mL SV 50 76.0800 0.92044 6.50852 Post 500 mL CI 50 3.5640 0.06944 0.49105 CO 50 5549.4400 90.10411 637.13229 % change in CO 50 13.4284 1.44432 10.21288 PFB: Prefluid Bolus; SBP: Systolic Blood Pressure; DBP: Diastolic Blood Pressure; MAP: mean blood pressure; HR: heart rate; SV: stroke volume; SVV: stroke volume variation; CVP: central venous pressure; PPV: pulse pressure variation; SD: standard deviation; SE: standard error; CI: cardiac index; CO: cardiac output Table 3. Correlation between different parameters in non-responders Post Post Post Post PFB 250 mL 250 mL 500 mL 500 mL PPV SVV PPV SVV PPV PFB SVV r 0.875 (*) 0.553 (*) 0.764 (*) 0.579 (*) 0.655 (*) p <0.001 0.004 <0.001 0.002 <0.001 PFB PPV r 0.367 0.808 (*) 0.408 (*) 0.602 (*) p 0.071 <0.001 0.043 0.001 Post r 0.685 (*) 0.874 (*) 0.772 (*) 250 mL SVV p <0.001 <0.001 <0.001 Post r 0.599 (*) 0.798 (*) 250 mL PPV p 0.002 0 Post r 0.769 (*) 500 mL SVV p <0.001 (*) Significant change. PFB: Prefluid Bolus; SVV: stroke volume variation; PPV: pulse pressure variation; Table 4. Correlation between different parameters in non-responders PFB PPV PFB SBP PFB DBP PFB MAP PFB HR PFB SVV r 0.875 (*) 0.005 -0.144 -0.105 0.376 p <0.001 0.981 0.492 0.618 0.064 PFB PPV r 0.082 -0.182 -0.093 0.480 (*) p 0.698 0.385 0.658 0.015 PFB SBP r 0.36 0.743 (*) -0.194 p 0.077 <0.001 0.353 PFB DBP r 0.891 (*) -0.139 p <0.001 0.507 PFB MAP r -0.193 p 0.355 PFB HR r p PFB CVP r p PFB SV r p PFB CI r p PFB CVP PFB SV PFB CI PFB CO PFB SVV -0.540 (*) -0.312 -0.443 (*) 0.076 0.005 0.129 0.027 0.717 PFB PPV -0.590 (*) -0.446 (*) -0.515 (*) 0.059 0.002 0.025 0.008 0.78 PFB SBP 0.079 -0.307 0.348 -0.338 0.709 0.136 0.088 0.098 PFB DBP 0.261 0.128 0.387 -0.041 0.207 0.543 0.056 0.848 PFB MAP 0.238 -0.042 0.460 (*) -0.183 0.251 0.842 0.021 0.382 PFB HR -0.216 0.02 -0.185 0.758 (*) 0.3 0.924 0.377 <0.001 PFB CVP 0.572 (*) 0.565 (*) 0.217 0.003 0.003 0.298 PFB SV 0.562 (*) 0.666 (*) 0.003 <0.001 PFB CI 0.232 0.265 (*) Significant change. PFB: Prefluid Bolus; SBP: Systolic Blood Pressure; DBP: Diastolic Blood Pressure; MAP: mean blood pressure; HR: heart rate; SV: stroke volume; SVV: stroke volume variation; CI: cardiac index; CO: cardiac output; CVP: central venous pressure Table 5. Correlation between different parameters in non-responders Post Post Post Post 250 mL 250 mL 250 mL 250 mL PPV SBP DBP MAP Post 250 mL SVV r 0.685 (*) -0.14 0.118 0.024 p <0.001 0.504 0.574 0.911 Post 250 mL PPV r -0.008 0.187 0.141 p 0.969 0.369 0.503 Post 250 mL SBP r 0.520 (*) 0.816 (*) - p 0.008 <0.001 Post 250 mL DBP r 0.917 (*) p <0.001 Post 250 mL MAP r - p Post 250 mL HR r p Post 250 mL CVP r p Post 250 mL SV r p Post Post Post Post 250 mL 250 mL 250 mL 250 mL HR CVP SV CI Post 250 mL SVV 0.374 -0.249 0.131 -0.023 0.066 0.231 0.534 0.912 Post 250 mL PPV 0.411 (*) -0.36 0.136 <0.001 0.041 0.077 0.517 0.998 Post 250 mL SBP 0.059 0.304 -0.024 0.326 0.781 0.139 0.909 0.112 Post 250 mL DBP 0.014 0.067 -0.137 0.035 0.947 0.749 0.515 0.868 Post 250 mL MAP 0.009 0.178 -0.108 0.173 0.966 0.396 0.608 0.407 Post 250 mL HR -0.401 (*) 0.066 -0.032 0.047 0.755 0.88 Post 250 mL CVP 0.428 (*) 0.664 (*) 0.033 <0.001 Post 250 mL SV 0.701 (*) <0.001 (*) Significant change. PPV: pulse pressure variation; SVV: stroke volume variation; SBP: Systolic Blood Pressure; MAP: mean blood pressure; HR: heart rate; CVP: central venous pressure; SV: stroke volume; CI: cardiac index; DBP: Diastolic Blood Pressure Table 6. Correlation between different parameters in non-responders Post Post Post Post 500 mL 500 mL 500 mL 500 mL PPV SBP DBP MAP Post 500 mL SVV r 0.769 (*) -0.186 -0.422 (*) -0.371 p <0.001 0.372 0.036 0.068 Post 500 mL PPV r -0.136 -0.159 -0.161 p 0.518 0.448 0.442 Post 500 mL SBP r 0.440 (*) 0.782 (*) p 0.028 <0.001 Post 500 mL DBP r 0.903 (*) p <0.001 Post 500 mL MAP r p Post 500 mL HR r p Post 500 mL CVP r p Post 500 mL SV r p Post Post Post Post 500 mL 500 mL 500 mL 500 mL HR CVP SV CI Post 500 mL SVV 0.437 (*) -0.410 (*) 0.206 -0.019 0.029 0.042 0.322 0.93 Post 500 mL PPV 0.349 -0.578 (*) 0.34 0.007 0.088 0.002 0.097 0.972 Post 500 mL SBP 0.079 0.237 -0.159 0.234 0.707 0.253 0.447 0.26 Post 500 mL DBP 0.107 -0.132 -0.415 (*) -0.094 0.612 0.53 0.039 0.656 Post 500 mL MAP 0.13 0.012 -0.353 0.054 0.537 0.953 0.084 0.796 Post 500 mL HR -0.295 0.032 -0.008 0.153 0.879 0.969 Post 500 mL CVP 0.354 0.602 (*) 0.083 0.001 Post 500 mL SV 0.733 (*) <0.001 (*) Significant change. PPV: pulse pressure variation; SVV: stroke volume variation; SBP: Systolic Blood Pressure; MAP: mean blood pressure; HR: heart rate; CVP: central venous pressure; SV: stroke volume; CI: cardiac index; DBP: Diastolic Blood Pressure; CI: cardiac index; CO: cardiac output Table 7. Correlation between different parameters in responders PFB PPV Post 250 mL SVV Post 250 mL PPV PFB SVV r 0.31 0.554 (*) 0.107 p 0.132 0.004 0.611 PFB PPV r 0.177 0.522 (*) p 0.396 0.007 Post 250 mL SVV r 0.429 (*) p 0.032 Post 250 mL PPV r p Post 500 mL SVV r p Post 500 mL SVV PFB 500 mL PPV PFB SVV 0.527 (*) 0.513 (*) 0.007 0.009 PFB PPV 0.03 0.294 0.887 0.153 Post 250 mL SVV 0.828 (*) 0.782 (*) <0.001 <0.001 Post 250 mL PPV 0.261 0.670 (*) 0.208 <0.001 Post 500 mL SVV 0.811 (*) <0.001 (*) Significant change. PFB: Prefluid Bolus; PPV: pulse pressure variation; SVV: stroke volume variation Table 8. Correlation between different parameters in responders PFB PPV PFB SBP PFB DBP PFB MAP PFB HR PFB CVP PFB SVV r 0.31 -0.27 -0.014 -0.147 0.158 -0.522 (*) p 0.132 0.192 0.945 0.484 0.451 0.008 PFB PPV r 0.231 -0.044 0.089 0.349 -0.352 p 0.268 0.836 0.673 0.087 0.084 PFB SBP r 0.309 0.729 (*) 0.001 0.277 p 0.132 <0.001 0.995 0.18 PFB DBP r 0.876 (*) -0.073 -0.101 p <0.001 0.728 0.632 PFB MAP r -0.038 0.067 p 0.858 0.75 PFB HR r -0.024 p 0.911 PFB CVP r p PFB SV r p PFB CI r p PFB SV PFB CI PFB CO PFB SVV -0.259 -0.588 (*) -0.116 0.211 0.002 0.581 PFB PPV 0.01 -0.449 (*) 0.246 0.961 0.024 0.236 PFB SBP -0.063 0.159 -0.035 0.766 0.449 0.867 PFB DBP -0.104 -0.119 -0.128 0.621 0.571 0.541 PFB MAP -0.107 -0.006 -0.101 0.612 0.976 0.631 PFB HR -0.156 -0.348 0.552 (*) 0.455 0.088 0.004 PFB CVP 0.582 (*) 0.804 (*) 0.474 (*) 0.002 <0.001 0.017 PFB SV 0.536 (*) 0.736 (*) 0.006 <0.001 PFB CI 0.202 0.333 (*) Significant change. PPV: pulse pressure variation; SVV: stroke volume variation; SBP: Systolic Blood Pressure; MAP: mean blood pressure; HR: heart rate; CVP: central venous pressure; SV: stroke volume; CI: cardiac index; DBP: Diastolic Blood Pressure; CI: cardiac index; CO: cardiac output Table 9. Correlation between different parameters in responders PFB PFB PFB PFB 250 mL 250 mL 250 mL 250 mL PPV SBP DBP MAP Post 250 mL SVV r 0.429 (*) -0.514 (*) -0.431 (*) -0.588 (*) p 0.032 0.009 0.032 0.002 Post 250 mL PPV r -0.109 -0.173 -0.188 p 0.603 0.407 0.368 Post 250 mL SBP r 0.198 0.673 (*) p 0.344 <0.001 Post 250 mL DBP r 0.857 (*) p <0.001 Post 250 mL MAP r p Post 250 mL HR r p Post 250 mL CVP r p Post 250 mL SV r p PFB PFB Post Post 250 mL 250 mL 250 mL 250 mL HR CVP SV CI Post 250 mL SVV 0.268 -0.368 -0.207 0.148 0.196 0.07 0.32 0.481 Post 250 mL PPV 0.458 (*) 0.017 0.36 0.179 0.021 0.934 0.077 0.392 Post 250 mL SBP -0.135 0.352 -0.048 -0.281 0.519 0.084 0.821 0.173 Post 250 mL DBP 0.162 -0.004 0.151 -0.01 0.438 0.984 0.47 0.962 Post 250 mL MAP 0.047 0.178 0.103 -0.15 0.822 0.393 0.625 0.474 Post 250 mL HR 0.031 0.015 -0.035 0.883 0.945 0.869 Post 250 mL CVP 0.418 (*) 0.173 0.038 0.409 Post 250 mL SV 0.615 (*) 0.001 (*) Significant change. PPV: pulse pressure variation; SVV: stroke volume variation; SBP: Systolic Blood Pressure; MAP: mean blood pressure; HR: heart rate; CVP: central venous pressure; SV: stroke volume; CI: cardiac index; DBP: Diastolic Blood Pressure; CI: cardiac index Table 10. Correlation between different parameters in responders Post PFB Post PFB 500 mL 500 mL 500 mL 500 mL PPV SBP DBP MAP Post 500 mL SVV r 0.811 (*) -0.539 (*) -0.356 -0.528 (**) p <0.001 0.005 0.08 0.007 Post 500 mL PPV r -0.459 (*) -0.231 -0.392 p 0.021 0.267 0.052 Post 500 mL SBP r 0.245 0.671 (*) p 0.237 <0.001 Post 500 mL DBP r 0.882 (*) p <0.001 Post 500 mL MAP r p Post 500 mL HR r p Post 500 mL CVP r p Post 500 mL SV r p Post Post Post Post 500 mL 500 mL 500 mL 500 mL HR CVP SV CI Post 500 mL SVV 0.007 -0.495 (*) -0.139 0.008 0.972 0.012 0.507 0.97 Post 500 mL PPV 0.32 0.507 (*) 0.063 0.119 0.119 0.01 0.765 0.57 Post 500 mL SBP 0.049 0.333 0.042 0.058 0.816 0.104 0.843 0.783 Post 500 mL DBP 0.393 -0.007 0.053 -0.068 0.052 0.972 0.802 0.747 Post 500 mL MAP 0.319 0.146 0.081 -0.01 0.12 0.486 0.7 0.962 Post 500 mL HR 0.089 0.323 0.166 0.671 0.115 0.427 Post 500 mL CVP 0.401 (*) 0.323 0.047 0.115 Post 500 mL SV 0.779 (*) <0.001 (*)Significant change. PPV: pulse pressure variation; SVV: stroke volume variation; SBP: Systolic Blood Pressure; MAP: mean blood pressure; HR: heart rate; CVP: central venous pressure; SV: stroke volume; CI: cardiac index; DBP: Diastolic Blood Pressure; CI: cardiac index
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|Title Annotation:||Original Article / Ozgun Arastirma|
|Author:||Rathore, Abhishek; Singh, Shalendra; Lamsal, Ritesh; Taank, Priya; Paul, Debashish|
|Publication:||Turkish Journal of Anaesthesiology and Reanimation|
|Date:||Aug 1, 2017|
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