Cardiac cycle efficiency and dicrotic pressure variations: new parameters for fluid therapy

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Abstract

BACKGROUND

During a fluid challenge, the changes in cardiac performance and peripheral circulatory tone are closely related to the position of the ventricle on the Frank–Starling curve. Some patients have a good haemodynamic response to a fluid challenge, others hardly any response. The early haemodynamic effects of a fluid challenge could predict the final response before the entire fluid volume has been administered.

OBJECTIVE

To assess whether a multivariate logistic regression model, including pulse pressure variation (PPV), cardiac cycle efficiency (CCE), arterial elastance and the difference between the dicrotic pressure and both systolic and mean arterial pressure (SAP − Pdic and MAP − Pdic) can predict cardiac responsiveness early during a fluid challenge in comparison with the standard procedure described elsewhere.

DESIGN

Observational study.

SETTING

Elective surgical patients undergoing laparotomy, enrolled in two Italian University Hospitals.

PATIENTS

Fifty adult surgical patients, ventilated with a lung protective strategy, were enrolled and data from 46 were analysed.

INTERVENTIONS

A fluid challenge consisting of 500 ml of crystalloid infused over 10 min.

MAIN OUTCOME MEASURES AND ANALYSIS

The changes in CCE, arterial elastance, SAP − Pdic and MAP − Pdic were compared using analysis of variance. A multivariate logistic regression analysis utilising baseline values and the first minute measuring a variation statistically significant for the considered variables.

RESULTS

At baseline, PPV correctly identified 70% of patients (89% of non-responders; 42% of responders). The model, including baseline PPV, ΔCCE and ΔSAP − Pdic, correctly identified the efficiency of fluid challenge in 87% of patients (84.2% of responders; 92.5 of non-responders) after 5 min from fluid challenge infusion.

CONCLUSION

In this pilot study conducted in a population of surgical patients mechanically ventilated with a VT less than 8 ml kg−1, a dynamic model of fluid challenge assessment, including PPV, ΔCCE and ΔSAP − Pdic, enhances the prediction of fluid challenge response after 5 min of a 10-min administration.

TRIAL REGISTRATION

ACTRN12616001479493.

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