Background and Aims: Pulse pressure variation (PPV) is a reliable and predictive dynamic parameter presently being utilized for fluid responsiveness. In the operating room, fluid administration based on PPV monitoring...Background and Aims: Pulse pressure variation (PPV) is a reliable and predictive dynamic parameter presently being utilized for fluid responsiveness. In the operating room, fluid administration based on PPV monitoring helps the physician in deciding whether to volume resuscitate or use interventions in patients undergoing surgery. Propofol is an intravenous induction agent which lowers blood pressure. There are multiple causes such as depression in cardiac output, and peripheral vasodilatation for hypotension. We undertook this study to observe the utility of PPV as a guide to fluid therapy after propofol induction. Primary outcome of our study was to monitor PPV as a marker of fluid responsiveness for the hypotension caused by propofol induction. Secondary outcome included the correlation of PPV with other hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP);after induction with propofol at regular interval of time. Methods: A total number of 90 patients were recruited. Either of the radial artery was then cannulated under local anaesthesia with 20G VygonLeadercath arterial cannula and invasive monitoring transduced. A baseline recording of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and PPV was then recorded. Patients were then induced with predetermined doses of propofol (2 mg/kg) and recordings of HR, SBP, DBP, and PPV were taken at 5, 10 and 15 minutes. Results: Intraoperatively, PPV was significantly higher at 5 minutes and significantly lower at 15 minutes after induction. It was observed that there were no statistically significant correlations between PPV and SBP or DBP. PPV was strongly and directly associated with HR. Conclusion: We were able to establish that PPV predicts fluid responsiveness in hypotension caused by propofol induction;and can be used to administer fluid therapy in managing such hypotension. However, PPV was not directly correlated with hypotension subsequent to propofol administration.展开更多
Objective To observe the sensitivity of stroke volume variation(SVV) for assessing volume change during induction period of general anesthesia. Methods Patients who underwent orthopaedic surgery under general anesthes...Objective To observe the sensitivity of stroke volume variation(SVV) for assessing volume change during induction period of general anesthesia. Methods Patients who underwent orthopaedic surgery under general anesthesia and mechanical ventilation were divided into two groups randomly. Patients in the group Ⅰwere subjected to progressive central hypovolemia and correction of hypovolemia sequentially; patients in the Group Ⅱ were exposed to hypervolemia alone. Each step was implemented after 5 minutes when the hemodynamics was stable. SVV and cardiac index(CI) were recorded, and Pearson's product-moment correlation was used to analyze correlation between SVV and CI. Results Forty patients were included in this study, 20 cases in each group. For group Ⅰ patients, SVV was increased significantly along with blood volume reduction, and changes in CI were negatively correlated with changes in SVV(r=-0.605, P<0.01); SVV decreased significantly along with correction of blood volume; changes in CI were negatively correlated with changes in SVV(r=-0.651, P<0.01). For group Ⅱ patients, along with blood volume increase, SVV did not change significantly; changes in CI revealed no significant correlation with changes in SVV(r=0.067, P>0.05). Conclusion SVV is a useful indicator for hypovolemia, but not for hypervolemia.展开更多
Introduction: Fluid resuscitation is the cornerstone in the management of hemodynamically unstable patients. Dynamic parameters of fluid responsiveness, like pulse pressure variation, have the advantage of being more ...Introduction: Fluid resuscitation is the cornerstone in the management of hemodynamically unstable patients. Dynamic parameters of fluid responsiveness, like pulse pressure variation, have the advantage of being more reliable index for fluid management. Objective: The aim of our study was to compare between arterial pulse pressure variation (PPV) versus central venous pressure (CVP) as a predictor for fluid responsiveness during major open abdominal operations. Patients and Methods: 60 adult patients under general anesthesia with mechanical ventilation underwent open major abdominal surgical procedures were included in our prospective randomized controlled study. Intravenous fluid was infused and monitored by CVP in control group or by PPV in the other group. Hemodynamic variables (heart rate, invasive blood pressure, PPV and CVP) were measured at baseline after anesthesia induction and every 10 min, during first hour of operation, and then every 15 min, till end of surgery. Blood loss and total i.v. fluid & blood transfusion given to patients were recorded and compared between two groups intraoperatively. Results: Patients in the PPV group required more intraoperative fluid and blood transfusion than patients in CVP group to achieve more stable hemodynamic parameters. The fall in blood pressure (>20% of baseline) and increase in heart rate are more common in CVP group (p Conclusion: PPV is a better predictor and a good guide for fluid responsiveness. More stable hemodynamic variables are observed in PPV group.展开更多
BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine out...BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine output have been used to estimate intravascular volume.Recently,pulse pressure variation(PPV)and non-invasive cardiac monitoring devices have been introduced.In this case report,we introduce a patient with massive active bleeding from giant renal angiomyolipoma(AML).During emergent nephrectomy,we used non-invasive cardiac monitoring with CSN-1901(Nihon Kohden,Tokyo,Japan)and PPV to evaluate the patient's intravascular volume status to achieve optimal fluid management.CASE SUMMARY A 30-year-old male patient with giant AML with active bleeding was referred to the emergency room complaining of severe abdominal pain and spontaneous abdominal distension.AML was diagnosed by computed tomography,and emergent nephrectomy was scheduled.Massive bleeding was expected so we decided to use non-invasive cardiac monitoring and PPV to assist fluid therapy because they are relatively easy and fast compared to invasive cardiac monitoring.During the surgery,6000 mL of estimated blood loss occurred.Along with the patient's vital signs and laboratory results,we monitored cardiac output,cardiac output,stroke volume,stroke volume index with a non-invasive cardiac monitoring device,and PPV using an intra-arterial catheter to evaluate intravascular volume status of the patient to compensate for massive bleeding.CONCLUSION In addition to traditional parameters,non-invasive cardiac monitoring and PPV are useful methods to evaluate patient's intravascular volume status and provideguidance for intraoperative management of hypovolemic shock patients.展开更多
Background Stroke volume variation （SW） is a robust indicator of fluid responsiveness during volume change. We compared the sensibility of SW by Vigileo/Flotrac to central venous pressure （CVP） when volume changes...Background Stroke volume variation （SW） is a robust indicator of fluid responsiveness during volume change. We compared the sensibility of SW by Vigileo/Flotrac to central venous pressure （CVP） when volume changes in patients undergoing intraoperative acute normovolemic hemodilution （ANH） and acute hypervolemic hemodilution （AHH）. Methods Forty patients were randomly divided into an ANH group （n=20） and an AHH group （n=20）. All patients received general anesthesia and were mechanically ventilated. Data were collected from 7 different time-points in the ANH group： baseline, after withdrawal of 5%, 10%, and 15% of the estimated blood volume （EBV） and after replacement with an equal volume of 6% hydroxyethyl starch 130/0.4 （HES） in 5% EBV increments to baseline. There were four time points in the AHH group： baseline, after 5%, 10%, and 15% expansion of the EBV with 6% HES. At each time-point, CVP, SW and other hemodynamic parameters measurements were obtained. Results After removal of 10% and 15% EBV, SVV significantly increased from 10.9±3.0 to 14.1±3.4 and 10.9±3.0 to16.0±3.3 （P 〈0.01）, and returned to a final value of 10.6±3.4 after volume replacement. The CVP value was unchanged after removal and replacement of 15% of the EBV. There were no significant changes in SW after 5%, 10% whereas there was a significant reduction after 15% （8.2±1.7） expansion of the EBV compared with baseline （9.9±1.8） （P=0.033）. However, there was a significant increase in CVP after10% （10.3±2.4）, 15% （11.3±2.2） expansion of the EBV compared with baseline （8.2±2.7） （P 〈0.01）. Conclusion SW is a more sensitive parameter for volume than CVP during hypovolemia, on the contrary CVP is more sensitive than SW during hypervolemia.展开更多
The first automatic algorithm was designed to estimate the pulse pressure variation (PPVPPV) from arterial blood pressure (ABP) signals under spontaneous breathing conditions. While currently there are a few publicly ...The first automatic algorithm was designed to estimate the pulse pressure variation (PPVPPV) from arterial blood pressure (ABP) signals under spontaneous breathing conditions. While currently there are a few publicly available algorithms to automatically estimate PPVPPV accurately and reliably in mechani-cally ventilated subjects, at the moment there is no automatic algorithm for estimating PPVPPV on sponta-neously breathing subjects. The algorithm utilizes our recently developed sequential Monte Carlo method (SMCM), which is called a maximum a-posteriori adaptive marginalized particle filter (MAM-PF). The performance assessment results of the proposed algorithm on real ABP signals from spontaneously breath-ing subjects were reported.展开更多
目的观察俯卧位应用不同呼气末正压条件下对每搏量变异度、脉搏压变异度及脉搏灌注变异指数预测容量状态的准确性及诊断阈值的影响。方法选择在全麻下俯卧位行颈椎或腰椎手术患者60例,全麻后连续监测每搏量变异度(SVV)、脉搏压变异度(P...目的观察俯卧位应用不同呼气末正压条件下对每搏量变异度、脉搏压变异度及脉搏灌注变异指数预测容量状态的准确性及诊断阈值的影响。方法选择在全麻下俯卧位行颈椎或腰椎手术患者60例,全麻后连续监测每搏量变异度(SVV)、脉搏压变异度(PPV)、脉搏灌注变异指数(PVI)等血流动力学指标,在俯卧位体位下分别加以0、5、10、15 mm Hg的呼气末正压(PEEP),记录每个PEEP时点的各血流动力学指标数值,后以7 ml/kg进行补液试验后,再分别加以0、5、10、15 mm Hg的PEEP值后记录输液后各血流动力学指标数值。然后以输液前后每搏量变异指数的差值(ΔSVI)将患者分为两组,即有反应组(ΔSVI≥15%)和无反应组(ΔSVI<15%)组,分别绘制SVV、PPV和PVI判断扩容效应的受试者工作特征性(ROC)曲线,确定俯卧位时在不同PEEP条件下对SVV、PPV和PVI预测容量状况的准确性、诊断阈值及其相关性。结果与平卧位相比较,俯卧位条件下SVV、PPV、PVI均增大(P<0.05),平均动脉压降低(P<0.05),心率、每搏量、每搏量指数、心输出量、心指数差异无统计学意义(P>0.05)。俯卧位时,在PEEP=0、5、10、15 mm Hg条件下,SVV判断扩容有效的ROC曲线下面积分别为0.864、0.759、0.718、0.521,PPV判断扩容有效的ROC曲线下面积分别为0.873、0.792、0.705、0.505,PVI判断扩容有效的ROC曲线下面积分别为0.851、0.765、0.709、0.512。当PEEP=0 mm Hg时,SVV、PPV、PVI诊断阈值分别为10.5、11.5、13.5;当PEEP=5 mm Hg时,SVV、PPV、PVI诊断阈值分别为11.5、13.5、14.5;当PEEP=10 mm Hg时,SVV、PPV、PVI诊断阈值分别为13.5、14.5、16.5。俯卧位时在不同PEEP条件下SVV、PPV、PVI变化分别与PEEP值变化呈正相关(r分别为0.424、0.561、0.553,P<0.01)。结论 SVV、PPV和PVI在PEEP≤10 mm Hg时可以准确预测俯卧位时应用全麻机械通气患者的容量状况,三者预测容量状况的准确性相似,诊断阈值随PEEP值增大而增大,诊断的准确性随PEEP值增大而下降;在PEEP=15 mm Hg时,SVV、PPV和PVI不能准确预测俯卧位时应用全麻机械通气患者的容量状况。展开更多
文摘Background and Aims: Pulse pressure variation (PPV) is a reliable and predictive dynamic parameter presently being utilized for fluid responsiveness. In the operating room, fluid administration based on PPV monitoring helps the physician in deciding whether to volume resuscitate or use interventions in patients undergoing surgery. Propofol is an intravenous induction agent which lowers blood pressure. There are multiple causes such as depression in cardiac output, and peripheral vasodilatation for hypotension. We undertook this study to observe the utility of PPV as a guide to fluid therapy after propofol induction. Primary outcome of our study was to monitor PPV as a marker of fluid responsiveness for the hypotension caused by propofol induction. Secondary outcome included the correlation of PPV with other hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP);after induction with propofol at regular interval of time. Methods: A total number of 90 patients were recruited. Either of the radial artery was then cannulated under local anaesthesia with 20G VygonLeadercath arterial cannula and invasive monitoring transduced. A baseline recording of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and PPV was then recorded. Patients were then induced with predetermined doses of propofol (2 mg/kg) and recordings of HR, SBP, DBP, and PPV were taken at 5, 10 and 15 minutes. Results: Intraoperatively, PPV was significantly higher at 5 minutes and significantly lower at 15 minutes after induction. It was observed that there were no statistically significant correlations between PPV and SBP or DBP. PPV was strongly and directly associated with HR. Conclusion: We were able to establish that PPV predicts fluid responsiveness in hypotension caused by propofol induction;and can be used to administer fluid therapy in managing such hypotension. However, PPV was not directly correlated with hypotension subsequent to propofol administration.
文摘Objective To observe the sensitivity of stroke volume variation(SVV) for assessing volume change during induction period of general anesthesia. Methods Patients who underwent orthopaedic surgery under general anesthesia and mechanical ventilation were divided into two groups randomly. Patients in the group Ⅰwere subjected to progressive central hypovolemia and correction of hypovolemia sequentially; patients in the Group Ⅱ were exposed to hypervolemia alone. Each step was implemented after 5 minutes when the hemodynamics was stable. SVV and cardiac index(CI) were recorded, and Pearson's product-moment correlation was used to analyze correlation between SVV and CI. Results Forty patients were included in this study, 20 cases in each group. For group Ⅰ patients, SVV was increased significantly along with blood volume reduction, and changes in CI were negatively correlated with changes in SVV(r=-0.605, P<0.01); SVV decreased significantly along with correction of blood volume; changes in CI were negatively correlated with changes in SVV(r=-0.651, P<0.01). For group Ⅱ patients, along with blood volume increase, SVV did not change significantly; changes in CI revealed no significant correlation with changes in SVV(r=0.067, P>0.05). Conclusion SVV is a useful indicator for hypovolemia, but not for hypervolemia.
文摘Introduction: Fluid resuscitation is the cornerstone in the management of hemodynamically unstable patients. Dynamic parameters of fluid responsiveness, like pulse pressure variation, have the advantage of being more reliable index for fluid management. Objective: The aim of our study was to compare between arterial pulse pressure variation (PPV) versus central venous pressure (CVP) as a predictor for fluid responsiveness during major open abdominal operations. Patients and Methods: 60 adult patients under general anesthesia with mechanical ventilation underwent open major abdominal surgical procedures were included in our prospective randomized controlled study. Intravenous fluid was infused and monitored by CVP in control group or by PPV in the other group. Hemodynamic variables (heart rate, invasive blood pressure, PPV and CVP) were measured at baseline after anesthesia induction and every 10 min, during first hour of operation, and then every 15 min, till end of surgery. Blood loss and total i.v. fluid & blood transfusion given to patients were recorded and compared between two groups intraoperatively. Results: Patients in the PPV group required more intraoperative fluid and blood transfusion than patients in CVP group to achieve more stable hemodynamic parameters. The fall in blood pressure (>20% of baseline) and increase in heart rate are more common in CVP group (p Conclusion: PPV is a better predictor and a good guide for fluid responsiveness. More stable hemodynamic variables are observed in PPV group.
文摘BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine output have been used to estimate intravascular volume.Recently,pulse pressure variation(PPV)and non-invasive cardiac monitoring devices have been introduced.In this case report,we introduce a patient with massive active bleeding from giant renal angiomyolipoma(AML).During emergent nephrectomy,we used non-invasive cardiac monitoring with CSN-1901(Nihon Kohden,Tokyo,Japan)and PPV to evaluate the patient's intravascular volume status to achieve optimal fluid management.CASE SUMMARY A 30-year-old male patient with giant AML with active bleeding was referred to the emergency room complaining of severe abdominal pain and spontaneous abdominal distension.AML was diagnosed by computed tomography,and emergent nephrectomy was scheduled.Massive bleeding was expected so we decided to use non-invasive cardiac monitoring and PPV to assist fluid therapy because they are relatively easy and fast compared to invasive cardiac monitoring.During the surgery,6000 mL of estimated blood loss occurred.Along with the patient's vital signs and laboratory results,we monitored cardiac output,cardiac output,stroke volume,stroke volume index with a non-invasive cardiac monitoring device,and PPV using an intra-arterial catheter to evaluate intravascular volume status of the patient to compensate for massive bleeding.CONCLUSION In addition to traditional parameters,non-invasive cardiac monitoring and PPV are useful methods to evaluate patient's intravascular volume status and provideguidance for intraoperative management of hypovolemic shock patients.
文摘Background Stroke volume variation （SW） is a robust indicator of fluid responsiveness during volume change. We compared the sensibility of SW by Vigileo/Flotrac to central venous pressure （CVP） when volume changes in patients undergoing intraoperative acute normovolemic hemodilution （ANH） and acute hypervolemic hemodilution （AHH）. Methods Forty patients were randomly divided into an ANH group （n=20） and an AHH group （n=20）. All patients received general anesthesia and were mechanically ventilated. Data were collected from 7 different time-points in the ANH group： baseline, after withdrawal of 5%, 10%, and 15% of the estimated blood volume （EBV） and after replacement with an equal volume of 6% hydroxyethyl starch 130/0.4 （HES） in 5% EBV increments to baseline. There were four time points in the AHH group： baseline, after 5%, 10%, and 15% expansion of the EBV with 6% HES. At each time-point, CVP, SW and other hemodynamic parameters measurements were obtained. Results After removal of 10% and 15% EBV, SVV significantly increased from 10.9±3.0 to 14.1±3.4 and 10.9±3.0 to16.0±3.3 （P 〈0.01）, and returned to a final value of 10.6±3.4 after volume replacement. The CVP value was unchanged after removal and replacement of 15% of the EBV. There were no significant changes in SW after 5%, 10% whereas there was a significant reduction after 15% （8.2±1.7） expansion of the EBV compared with baseline （9.9±1.8） （P=0.033）. However, there was a significant increase in CVP after10% （10.3±2.4）, 15% （11.3±2.2） expansion of the EBV compared with baseline （8.2±2.7） （P 〈0.01）. Conclusion SW is a more sensitive parameter for volume than CVP during hypovolemia, on the contrary CVP is more sensitive than SW during hypervolemia.
文摘The first automatic algorithm was designed to estimate the pulse pressure variation (PPVPPV) from arterial blood pressure (ABP) signals under spontaneous breathing conditions. While currently there are a few publicly available algorithms to automatically estimate PPVPPV accurately and reliably in mechani-cally ventilated subjects, at the moment there is no automatic algorithm for estimating PPVPPV on sponta-neously breathing subjects. The algorithm utilizes our recently developed sequential Monte Carlo method (SMCM), which is called a maximum a-posteriori adaptive marginalized particle filter (MAM-PF). The performance assessment results of the proposed algorithm on real ABP signals from spontaneously breath-ing subjects were reported.
文摘目的观察俯卧位应用不同呼气末正压条件下对每搏量变异度、脉搏压变异度及脉搏灌注变异指数预测容量状态的准确性及诊断阈值的影响。方法选择在全麻下俯卧位行颈椎或腰椎手术患者60例,全麻后连续监测每搏量变异度(SVV)、脉搏压变异度(PPV)、脉搏灌注变异指数(PVI)等血流动力学指标,在俯卧位体位下分别加以0、5、10、15 mm Hg的呼气末正压(PEEP),记录每个PEEP时点的各血流动力学指标数值,后以7 ml/kg进行补液试验后,再分别加以0、5、10、15 mm Hg的PEEP值后记录输液后各血流动力学指标数值。然后以输液前后每搏量变异指数的差值(ΔSVI)将患者分为两组,即有反应组(ΔSVI≥15%)和无反应组(ΔSVI<15%)组,分别绘制SVV、PPV和PVI判断扩容效应的受试者工作特征性(ROC)曲线,确定俯卧位时在不同PEEP条件下对SVV、PPV和PVI预测容量状况的准确性、诊断阈值及其相关性。结果与平卧位相比较,俯卧位条件下SVV、PPV、PVI均增大(P<0.05),平均动脉压降低(P<0.05),心率、每搏量、每搏量指数、心输出量、心指数差异无统计学意义(P>0.05)。俯卧位时,在PEEP=0、5、10、15 mm Hg条件下,SVV判断扩容有效的ROC曲线下面积分别为0.864、0.759、0.718、0.521,PPV判断扩容有效的ROC曲线下面积分别为0.873、0.792、0.705、0.505,PVI判断扩容有效的ROC曲线下面积分别为0.851、0.765、0.709、0.512。当PEEP=0 mm Hg时,SVV、PPV、PVI诊断阈值分别为10.5、11.5、13.5;当PEEP=5 mm Hg时,SVV、PPV、PVI诊断阈值分别为11.5、13.5、14.5;当PEEP=10 mm Hg时,SVV、PPV、PVI诊断阈值分别为13.5、14.5、16.5。俯卧位时在不同PEEP条件下SVV、PPV、PVI变化分别与PEEP值变化呈正相关(r分别为0.424、0.561、0.553,P<0.01)。结论 SVV、PPV和PVI在PEEP≤10 mm Hg时可以准确预测俯卧位时应用全麻机械通气患者的容量状况,三者预测容量状况的准确性相似,诊断阈值随PEEP值增大而增大,诊断的准确性随PEEP值增大而下降;在PEEP=15 mm Hg时,SVV、PPV和PVI不能准确预测俯卧位时应用全麻机械通气患者的容量状况。
