Pulse pressure variation-guided fluid therapy after cardiac surgery: A pilot before-and-after trial

Satoshi Suzuki, Nicholas C.Z. Woinarski, Miklos Lipcsey, Cristina Lluch Candal, Antoine G. Schneider, Neil J. Glassford, Glenn M. Eastwood, Rinaldo Bellomo

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: The 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 methods: We 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. Results: We 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. Conclusions: Pulse pressure variation-guided fluid management was feasible and safe during mandatory ventilation after cardiac surgery. However, its advantages may be clinically small.

Original languageEnglish
Pages (from-to)992-996
Number of pages5
JournalJournal of Critical Care
Volume29
Issue number6
DOIs
Publication statusPublished - Dec 1 2014
Externally publishedYes

Keywords

  • Cardiac output
  • Cardiac surgery
  • Fluid therapy
  • Intensive care
  • Pulse pressure variation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Suzuki, S., Woinarski, N. C. Z., Lipcsey, M., Candal, C. L., Schneider, A. G., Glassford, N. J., Eastwood, G. M., & Bellomo, R. (2014). Pulse pressure variation-guided fluid therapy after cardiac surgery: A pilot before-and-after trial. Journal of Critical Care, 29(6), 992-996. https://doi.org/10.1016/j.jcrc.2014.07.032