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

Imagem de Miniatura
Arquivos
art_NOEL-MORGAN_PULSE_PRESSURE_VARIATION_IS_COMPARABLE_WITH_CENTRAL_VENOUS_2013.PDF (3.16 MB)
Citações na Scopus
8
Tipo de produção
article
Data de publicação
2013
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
LIPPINCOTT WILLIAMS & WILKINS
Autores
Citação
SHOCK, v.40, n.4, p.303-311, 2013
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
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.
Palavras-chave
Goals, hemorrhage, sepsis, fluid therapy, Sus scrofa
URI
https://observatorio.fm.usp.br/handle/OPI/5059
Referências
  1. Bewick V, 2005, CRIT CARE, V9, P112, DOI 10.1186/cc3045
  2. Cannesson M, 2011, ANESTHESIOLOGY, V115, P231, DOI 10.1097/ALN.0b013e318225b80a
  3. Cannesson M, 2010, J CARDIOTHOR VASC AN, V24, P487, DOI 10.1053/j.jvca.2009.10.008
  4. Daudel F, 2010, CRIT CARE, V14, DOI 10.1186/cc9080
  5. De Backer D, 2005, INTENS CARE MED, V31, P517, DOI 10.1007/s00134-005-2586-4
  6. Dellinger RP, 2008, INTENS CARE MED, V34, P17, DOI 10.1007/s00134-007-0934-2
  7. de Oliveira MA, 2009, J TRAUMA, V67, P1225, DOI 10.1097/TA.0b013e3181b845e4
  8. Dingley J, 1999, CRIT CARE MED, V27, P2435, DOI 10.1097/00003246-199911000-00019
  9. Galie N, 2009, EUR HEART J, V30, P2493, DOI 10.1093/eurheartj/ehp297
  10. Greyson CR, 2011, REV ESP CARDIOL, V63, P81
  11. Grocott MPW, 2005, ANESTH ANALG, V100, P1093, DOI 10.1213/01.ANE.0000148691.33690.AC
  12. Kortbeek JB, 2008, J TRAUMA, V64, P1638, DOI 10.1097/TA.0b013e3181744b03
  13. Lakhal K, 2011, CRIT CARE, V15, DOI 10.1186/cc10083
  14. Lee CH, 2011, SHOCK, V36, P628, DOI 10.1097/SHK.0b013e3182353395
  15. Lefrant JY, 2009, INTENS CARE MED, V35, P966, DOI 10.1007/s00134-009-1479-3
  16. Levy MM, 2010, INTENS CARE MED, V36, P222, DOI 10.1007/s00134-009-1738-3
  17. Lipcsey M, 2008, SHOCK, V29, P173, DOI 10.1097/SHK.0b013e318067dfbc
  18. Lopes MR, 2007, CRIT CARE, V11, DOI 10.1186/cc6117
  19. Magder S, 2010, CURR OPIN CRIT CARE, V16, P289, DOI 10.1097/MCC.0b013e32833b6bab
  20. Mahjoub Y, 2009, CRIT CARE MED, V37, P2570, DOI 10.1097/CCM.0b013e3181a380a3
  21. Mallat Jihad, 2011, Crit Care, V15, P432, DOI 10.1186/cc10222
  22. Marik PE, 2009, CRIT CARE MED, V37, P2642, DOI 10.1097/CCM.0b013e3181a590da
  23. Michard F, 2000, AM J RESP CRIT CARE, V162, P134
  24. Michard F, 1999, AM J RESP CRIT CARE, V159, P935
  25. NOLDGE GFE, 1992, ANESTH ANALG, V75, P660
  26. Osman D, 2009, INTENS CARE MED, V35, P69, DOI 10.1007/s00134-008-1307-1
  27. Parker SJ, 2000, SHOCK, V13, P291
  28. Neto EPD, 2011, BRIT J ANAESTH, V106, P856, DOI 10.1093/bja/aer090
  29. Pestel GJ, 2006, SHOCK, V26, P391, DOI 10.1097/01.shk.0000228792.10550.ed
  30. Pinsky MR, 2004, INTENS CARE MED, V30, P1008, DOI 10.1007/s00134-004-2208-6
  31. Ray P, 2010, ANESTHESIOLOGY, V112, P1023, DOI 10.1097/ALN.0b013e3181d47604
  32. Renner J, 2009, CRIT CARE MED, V37, P650, DOI 10.1097/CCM.0b013e3181959864
  33. Rivers E, 2001, NEW ENGL J MED, V345, P1368, DOI 10.1056/NEJMoa010307
  34. Rossaint R, 2010, CRIT CARE, V14, P52
  35. Rossaint R, 2006, SHOCK, V26, P322, DOI 10.1097/01.shk.0000225403.15722.e9
  36. Schmidhammer R, 2006, SHOCK, V25, P389, DOI 10.1097/01.shk.0000209529.43367.00
  37. Tavernier B, 2008, ANESTHESIOLOGY, V109, P935
  38. Tavernier B, 2008, ANESTHESIOLOGY, V109, P934
  39. Varela JE, 2003, SHOCK, V20, P476, DOI 10.1097/01.SHK.0000094036.09886.9b
  40. Vieillard-Baron A, 2004, INTENS CARE MED, V30, P1734, DOI 10.1007/s00134-004-2361-y
  41. Vieillard-Baron A, 2003, AM J RESP CRIT CARE, V168, P671, DOI 10.1164/rccm.200301-135OC
  42. Vieillard-Baron A, 2002, AM J RESP CRIT CARE, V166, P1310, DOI 10.1164/rccm.200202-146CC
  43. Vieillard-Baron A, 2009, CRIT CARE MED, V37, P2662, DOI 10.1097/CCM.0b013e3181abfa2b
  44. Vieillard-Baron A, 1999, J APPL PHYSIOL, V87, P1644
  45. Wiedemann HP, 2006, NEW ENGL J MED, V354, P2564
  46. von Ballmoos MW, 2010, CRIT CARE, V14, DOI 10.1186/cc9060

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/08