Original article
Pulse Pressure Variation Predicts Fluid Responsiveness in Elderly Patients After Coronary Artery Bypass Graft Surgery

https://doi.org/10.1053/j.jvca.2011.09.014Get rights and content

Objective

To assess the ability of pulse pressure variation to predict fluid responsiveness in mechanically ventilated elderly patients after coronary artery bypass graft surgery.

Design

A prospective, interventional study.

Setting

An academic, tertiary referral hospital.

Participants

Sixty patients >70 years old and mechanically ventilated after coronary artery bypass graft surgery.

Interventions

Intravascular volume expansion using 6% hydroxyethyl starch solution, 7 mL/kg over 20 minutes.

Measurements and Main Results

Heart rate, arterial blood pressure, pulse pressure variation, central venous pressure, pulmonary artery occlusion pressure, and stroke volume index were measured immediately before and after volume expansion. Fluid responsiveness was defined as an increase in stroke volume index ≥15% after volume expansion. Forty-one patients were fluid responders and 19 patients were nonresponders. In contrast to central venous pressure or pulmonary artery occlusion pressure, pulse pressure variation was higher in the responders than in the nonresponders (22 ± 6% v 9.3 ± 3%, p = 0.001) and correlated with the percent changes in the stroke volume index after volume expansion (r = 0.47, p = 0.001). The area under the receiver operating characteristic curve for pulse pressure variation was 0.85 (95% confidence interval 0.75–0.94). The threshold value of 11.5% allowed the discrimination between responders and nonresponders with a sensitivity of 80% and a specificity of 74%.

Conclusions

Pulse pressure variation is a reliable predictor of fluid responsiveness in mechanically ventilated elderly patients after coronary artery bypass graft surgery.

Section snippets

Methods

This prospective interventional study was approved by the institutional review board and all patients gave an informed written consent. From January 2010 to February 2011, 68 consecutive patients >70 years old and admitted to the intensive care unit (ICU) after elective CABG surgery under cardiopulmonary bypass were eligible for the study. Eight patients were excluded subsequently because of a left ventricular ejection fraction ≤40%, intracardiac shunting, valvular heart disease, a pulmonary

Results

Sixty patients were included in this study. Forty-one patients were classified as fluid responders and 19 patients were classified as nonresponders (SVI increase after volume expansion 34 ± 8% v 4.6 ± 2%, p = 0.001). Patients' demographic, medical, and surgical data in the responder and nonresponder groups are presented in Table 1. The 2 groups were comparable for all the recorded data. Hemodynamic measurements at baseline (T0) and after volume expansion (T1) are presented in Table 2. Mean

Discussion

This study showed that the PPV during controlled mechanical ventilation predicts fluid responsiveness in patients >70 years old after CABG. The positive correlation between baseline values of PPV and the percent changes in SVI after volume expansion and between the area under the ROC curve and the threshold PPV value of 11.5% were similar to the data reported in younger patients undergoing cardiac surgery.5, 6, 7, 8, 9, 10 The ability of PPV to discriminate between fluid responders and

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