Influences of different vasopressors on stroke volume variation and pulse pressure variation

Abstract

Pulse pressure variation (PPV) and stroke volume variation (SVV) during mechanical ventilation have been shown to be effective parameters to predict preload responsiveness. Although induced hypertension decreases PPV and SVV, the influences of different vasopressors on PPV and SVV are unknown. 94 patients undergoing elective otologic surgery were randomly divided into three groups: Group P (patients were given phenylephrine), Group D (patients were given dopamine), Group E (patients were given ephedrine). When surgery was ongoing and the circulation state was stable, patients were given the vasopressor to increase the systolic arterial pressure (SAP) to the pre-calculated levels: low level, 10 % < ΔSAP ≤ 20 %; medium level, 20 % < ΔSAP ≤ 30 %; high level, 30 % < ΔSAP ≤ 40 %. When invasive arterial pressure reached the target value, PPV, SVV and other parameters were recorded. Dopamine decreased the PPV and SVV more significantly than ephedrine, but less significantly than phenylephrine. The influences of phenylephrine, dopamine and ephedrine on SVV and PPV are different due to their different pharmacological mechanisms.

Ability of a New Smartphone Pulse Pressure Variation and Cardiac Output Application, to Predict Fluid Responsiveness in Patients Undergoing Cardiac Surgery

“…In that initial study, the arterial waveform displayed by the simulator was consistent over time, with no impact of other physiological variables (sympathetic tone, heart rate variability). 26 The present study confirms a significant area under the ROC curve before incision for both PPV CAP and PPV PC . The strength of this study was that we intentionally chose to compare PPV from the Capstesia with PPV from a widely used pulse contour analysis device (Pulsioflex).…”

“…Additionally, 14 patients (25%) were receiving norepinephrine during their measurements, which would decrease the threshold value of PPV to predict fluid responsiveness. 26,31 Indeed, the area under the ROC curve was larger in patients without norepinephrine and before surgery (Supplemental Digital Content 2, Table 2, http://links.lww.com/AA/C499).…”

The Use of Stroke Volume Variation to Guide Donor Management Is Associated With Increased Organs Transplanted per Donor

“…12,28 There have been multiple studies that compare the several available hemodynamic monitoring devices and the effects of fluid boluses and vasopressors on hemodynamic parameters. 9,[11][12]29,30 The LiDCO device uses a transthoracic lithium dilution technique to estimate PPV and CO. 9 Although this measurement is slightly better at predicting fluid responsiveness, it requires external calibration and is less widely available. A systematic review by Marik et al compared various techniques used to determine fluid responsiveness using area under the curve that demonstrated the superiority of arterial waveform technology compared to transpulmonary dilution and central venous catheter 25 (Supplementary Table 1).…”

Multimorbidity and Critical Care Neurosurgery: Minimizing Major Perioperative Cardiopulmonary Complications

“…By contrast, vasodilators can decrease SVV and PPV by increasing unstressed circulating blood volume, thus creating a relative hypovolemic state [121]. The implication is that significant variations in inotropy or vasomotor tone can influence both PPV and SVV independently of true volume status, potentially leading to misinterpretation of these indicators for fluid management [122][123][124][125][126][127][128][129][130][131]. For instance, fluid therapy guided by ideal cutoff values for SVV and PPV may lead to volume overload in patients with increased contractility or decreased afterload, and occult hypovolemia in those with either decreased contractility or vasopressor-induced increases in afterload and venomotor tone.…”