Relative value of pressures and volumes in assessing fluid responsiveness after valvular and coronary artery surgery

R.B.G.E. Breukers, R.J. Trof, R. de Wilde, P.A.W. van den Berg, J.W.R. Twisk, J.H. Jansen, A.B.J. Groeneveld

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Abstract

Background and aims: Cardiac function may differ after valvular (VS) and coronary artery (CAS) surgery and this may affect assessment of fluid responsiveness. The aim of the study was to compare VS and CAS in the value of cardiac fitting pressures and volumes herein. Methods: There were eight consecutive patients after VS and eight after CAS, with femoral and pulmonary artery catheters in place. In each patient, five sequential fluid loading steps of 250 ml of colloid each were done. We measured central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP) and, by transpulmonary thermodilution, cardiac index (CI) and global end-diastolic (GEDVI) and intrathoracic blood volume (ITBVI) indices. Fluid responsiveness was defined by a Cl increase >5% or >10% per step. Results: Global ejection fraction was tower and PAOP was higher after VS than CAS. In responding steps after VS (n = 9-14) PACP and volumes increased, white CVP and volumes increased in responding steps (n = 12-19) after CAS. Baseline PAOP was tower in responding steps after VS only. Hence, baseline PACP as well as changes in PACP and volumes were of predictive value after VS and changes in CVP and volumes after CAS, in receiver operating characteristic curves. After VS, PAOP and volume changes equally correlated to Cl changes. After CAS, only changes in CVP and volumes correlated to those in Cl. Conclusions: While volumes are equally useful in monitoring fluid responsiveness, the predictive and monitoring value of PAOP is greater after VS than after CAS. In contrast, the CVP is of similar value as volume measurements in monitoring fluid responsiveness after CAS. The different value of pressures rather than of volumes between surgery types is likely caused by systolic left ventricular dysfunction in VS. The study suggests an effect of systolic cardiac function on optimal parameters of fluid responsiveness and superiority of the pulmonary artery catheter over transpulmonary dilution, for haemodynamic monitoring of VS patients. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Original languageUndefined/Unknown
Pages (from-to)62-68
JournalEuropean Journal of Cardio-thoracic Surgery
Volume35
Issue number1
DOIs
Publication statusPublished - 2009

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