PULSE PRESSURE VARIATION IS COMPARABLE WITH CENTRAL VENOUS PRESSURE TO GUIDE FLUID RESUSCITATION IN EXPERIMENTAL HEMORRHAGIC SHOCK WITH ENDOTOXEMIA

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author NOEL-MORGAN, Jessica FMUSP-HC
OTSUKI, Denise Aya FMUSP-HC
AULER JR., Jose Otavio Costa FMUSP-HC
FUKUSHIMA, Julia Tizue FMUSP-HC
FANTONI, Denise Tabacchi FMUSP-HC
dc.date.issued 2013
dc.identifier.citation SHOCK, v.40, n.4, p.303-311, 2013
dc.identifier.issn 1073-2322
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/5059
dc.description.abstract Introduction: Pulse pressure variation (PPV) has been proposed as a promising resuscitation goal, but its ability to predict fluid responsiveness has been questioned in various conditions. The purpose of this study was to assess the performance of PPV in predicting fluid responsiveness in experimental hemorrhagic shock with endotoxemia, while comparing it with goals determined by a conventional set of guidelines. Methods: Twenty-seven pigs were submitted to acute hemorrhagic shock with intravenous infusion of endotoxin and randomized to three groups: (i) control; (ii) conventional treatment with crystalloids to achieve and maintain central venous pressure (CVP) 12 to 15 mmHg, mean arterial pressure of 65 mmHg or greater, and SvO(2) (mixed venous oxygen saturation) of 65% or greater; (iii) treatment to achieve and maintain PPV of 13% or less. Parametric data were analyzed by two-way analysis of variance and Tukey test and differences in crystalloid volumes by t test. Predictive values of variables regarding fluid responsiveness were evaluated by receiver operating characteristic curves and multiple logistic regression. Results: Both treatments produced satisfactory hemodynamic recovery, without statistical differences in fluid administration (P = 0.066), but conventional treatment induced higher CVP (P = 0.001). Areas under receiver operating characteristic curves were larger for CVP (0.77; 95% confidence interval, 0.68-0.86) and PPV (0.74; 95% confidence interval, 0.65-0.83), and these variables were further selected by multiple logistic regression as independent predictors of responsiveness. Optimal PPV cutoff was 15%, with false-positive results involving mean pulmonary arterial pressure of 27 mmHg or greater. Conclusions: Acute resuscitation guided by PPV was comparable with the strategy guided by CVP, mean arterial pressure, and SvO(2). Central venous pressure and PPV were individually limited but independently predictive of fluid responsiveness.
dc.description.sponsorship · Sao Paulo Research Foundation (FAPESP) [08/50063-0, 08/50062-4]
· Laboratory of Medical Investigation of Anesthesiology [FMUSP-HC/LIM-08]
dc.language.iso eng
dc.publisher LIPPINCOTT WILLIAMS & WILKINS
dc.relation.ispartof Shock
dc.rights restrictedAccess
dc.subject Goals; hemorrhage; sepsis; fluid therapy; Sus scrofa
dc.subject.other respiratory-distress-syndrome; pulmonary-artery pressure; acute lung injury; severe sepsis; preload responsiveness; surviving sepsis; anesthetized pig; septic patients; cyclic changes; porcine model
dc.title PULSE PRESSURE VARIATION IS COMPARABLE WITH CENTRAL VENOUS PRESSURE TO GUIDE FLUID RESUSCITATION IN EXPERIMENTAL HEMORRHAGIC SHOCK WITH ENDOTOXEMIA
dc.type article
dc.rights.holder Copyright LIPPINCOTT WILLIAMS & WILKINS
dc.description.group LIM/08
dc.identifier.doi 10.1097/SHK.0b013e3182a0ca00
dc.identifier.pmid 23807247
dc.type.category original article
dc.type.version publishedVersion
hcfmusp.author NOEL-MORGAN, Jessica:FM:
hcfmusp.author OTSUKI, Denise Aya:HC:LIM/08
hcfmusp.author AULER JR., Jose Otavio Costa:FM:MCG
hcfmusp.author FUKUSHIMA, Julia Tizue:HC:ICESP
hcfmusp.author FANTONI, Denise Tabacchi:HC:LIM/08
hcfmusp.origem.id WOS:000330246300008
hcfmusp.origem.id 2-s2.0-84885663972
hcfmusp.publisher.city PHILADELPHIA
hcfmusp.publisher.country USA
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dc.description.index MEDLINE
dc.identifier.eissn 1540-0514
hcfmusp.citation.scopus 6
hcfmusp.citation.wos 5


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