Non-invasive measurements of pulse pressure variation and stroke volume variation in anesthetized patients using the Nexfin blood pressure monitor

Stens, Jurre; Oeben, Jeroen; Dusseldorp, Ab A. Van; Boer, Christa

doi:10.1007/s10877-015-9759-7

Cited by 21 publications

(16 citation statements)

References 29 publications

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“…For example, in the study of Stens J et al, Ea dyn was evaluated non-invasively with a finger plethysmography device (Nexfin R ) for predicting preloadresponsiveness after positioning the patient in Trendelenburg position. They found that the degree of fluid responsiveness was not associated with baseline Ea dyn values (Stens et al, 2016). Since Trendelenburg maneuvers will increase arterial pressure independent of flow, such negative results are predictable.…”

Section: Ea Dyn For Guiding Fluid Therapy In Hypotensive and Preload-mentioning

confidence: 98%

Dynamic Arterial Elastance as a Ventriculo-Arterial Coupling Index: An Experimental Animal Study

García¹,

Jian

Hatib

et al. 2020

Front. Physiol.

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Dynamic arterial elastance (Ea dyn), the ratio between arterial pulse pressure and stroke volume changes during respiration, has been postulated as an index of the coupling between the left ventricle (LV) and the arterial system. We aimed to confirm this hypothesis using the gold-standard for defining LV contractility, afterload, and evaluating ventricular-arterial (VA) coupling and LV efficiency during different loading and contractile experimental conditions. Twelve Yorkshire healthy female pigs submitted to three consecutive stages with two opposite interventions each: changes in afterload (phenylephrine/nitroprusside), preload (bleeding/fluid bolus), and contractility (esmolol/dobutamine). LV pressure-volume data was obtained with a conductance catheter, and arterial pressures were measured via a fluid-filled catheter in the proximal aorta and the radial artery. End-systolic elastance (Ees), a load-independent index of myocardial contractility, was calculated during an inferior vena cava occlusion. Effective arterial elastance (Ea, an index of LV afterload) was calculated as LV end-systolic pressure/stroke volume. VA coupling was defined as the ratio Ea/Ees. LV efficiency (LV eff) was defined as the ratio between stroke work and the LV pressure-volume area. Ea dyn was calculated as the ratio between the aortic pulse pressure variation (PPV) and conductance-derived stroke volume variation (SVV). A linear mixed model was used for evaluating the relationship between Ees, Ea, VA coupling, LV eff with Ea dyn. Ea dyn was inversely related to VA coupling and directly to LV eff. The higher the Ea dyn , the higher the LV eff and the lower the VA coupling. Thus, Ea dyn , an easily measured parameter at the bedside, may be of clinical relevance for hemodynamic assessment of the unstable patient.

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Section: Ea Dyn For Guiding Fluid Therapy In Hypotensive and Preload-mentioning

confidence: 98%

Dynamic Arterial Elastance as a Ventriculo-Arterial Coupling Index: An Experimental Animal Study

García¹,

Jian

Hatib

et al. 2020

Front. Physiol.

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“…Results of studies including ICU septic patients with acute circulatory failure and receiving vasopressors are very promising [13, 16, 17]. On the another hand, studies including operating room patients without vasopressor support and suffering from non-septic hypovolemia showed conflicting results [11, 12, 15, 18]. We can hypothesize that volume expansion induces different effects on arterial compliance in patients receiving vasopressors or not.…”

Section: Introductionmentioning

confidence: 99%

Changes in dynamic arterial elastance induced by volume expansion and vasopressor in the operating room: a prospective bicentre study

Courson

Boyer

Grobost

et al. 2019

Ann. Intensive Care

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BackgroundDynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variations and stroke volume variations, has been proposed to assess functional arterial load. We evaluated the evolution of Eadyn during volume expansion and the effects of neosynephrine infusion in hypotensive and preload-responsive patients.MethodsIn this prospective bicentre study, we included 56 mechanically ventilated patients in the operating room. Each patient had volume expansion and neosynephrine infusion. Stroke volume and stroke volume variations were obtained using esophageal Doppler, and pulse pressure variations were measured through the arterial line. Pressure response to volume expansion was defined as an increase in mean arterial pressure (MAP) ≥ 10%.ResultsTwenty-one patients were pressure responders to volume expansion. Volume expansion induced a decrease in Eadyn (from 0.69 [0.58–0.85] to 0.59 [0.42–0.77]) related to a decrease in pulse pressure variations more pronounced than the decrease in stroke volume variations. Baseline and changes in Eadyn after volume expansion were related to age, history of arterial hypertension, net arterial compliance and effective arterial elastance. Eadyn value before volume expansion > 0.65 predicted a MAP increase ≥ 10% with a sensitivity of 76% (95% CI 53–92%) and a specificity of 60% (95% CI 42–76%). Neosynephrine infusion induced a decrease in Eadyn (from 0.67 [0.48–0.80] to 0.54 [0.37–0.68]) related to a decrease in pulse pressure variations more pronounced than the decrease in stroke volume variations. Baseline and changes in Eadyn after neosynephrine infusion were only related to heart rate.ConclusionEadyn is a potential sensitive marker of arterial tone changes following vasopressor infusion.

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“…However, in some previous studies, Trendelenburg position was performed to assess fluid responsiveness instead of volume expansion, and it has been demonstrated that this manoeuvre was effective to induce a relevant volume challenge. 29,30 Even with these methodological limitations, the current study revealed that deep breathing could improve the reliability of dynamic indices in spontaneously breathing patients. By means of deep breathing, SVV can be used as a simple bedside test to guide fluid management, even in patients with spontaneous breathing, eg before anaesthetic induction.…”

Section: Discussionmentioning

confidence: 75%

“…Instead, we induced volume shift by tilting the patients to the Trendelenburg position, which can be associated with false negative. However, in some previous studies, Trendelenburg position was performed to assess fluid responsiveness instead of volume expansion, and it has been demonstrated that this manoeuvre was effective to induce a relevant volume challenge …”

Section: Discussionmentioning

confidence: 99%

Impact of deep breathing on predictability of stroke volume variation in spontaneous breathing patients

Mukai

Suehiro

Kimura

et al. 2020

Acta Anaesthesiol Scand

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Background This study investigated the ability of stroke volume variation (SVV) during deep breathing to discriminate fluid responders among spontaneously breathing patients. Methods Thirty patients undergoing general anaesthesia were enrolled and assessed before anaesthetic induction. Haemodynamic variables, including stroke volume (SV) and SVV, were measured using the ClearSight system during normal breathing. After these measurements, each patient was required to maintain deep breathing (6 breaths min−1) and haemodynamic variables were recorded. Then, the table was adjusted to the Trendelenburg position (15°) for 2 minutes, and haemodynamic variables were measured. Receiver operating characteristic curves were created for SVV during normal and deep breathing, and the difference in SVV between normal and deep breathing (ΔSVV) to discriminate fluid responders (SV increase >10% after changing position). The correlation between SV increase and ΔSVV was examined using Pearson's correlation coefficient. The grey zone approach was used to assess the inconclusive range of the haemodynamic variables. Results Receiver operating characteristic curve analysis indicated that ΔSVV showed good reliability in predicting fluid responsiveness (AUC: 0.850; 95% CI: 0.672‐0.953; threshold: 4%, sensitivity: 75.0%, specificity: 88.9%], while SVV during normal breathing did not (AUC: 0.579; 95% CI: 0.386‐0.756)]. Although SVV during deep breathing exhibited acceptable predictability (AUC: 0.778; 95% CI: 0.589‐0.908), the sensitivity was not good (58.3%). With the grey zone approach, the inconclusive range of ΔSVV was small with the range of 1.4%‐4.2% (23% of patients). Conclusion Deep breathing could improve the reliability of dynamic indices in spontaneously breathing patients. Trial registration UMIN‐CTR, identifer: UMIN000027970. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000032040

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Non-invasive measurements of pulse pressure variation and stroke volume variation in anesthetized patients using the Nexfin blood pressure monitor

Cited by 21 publications

References 29 publications

Dynamic Arterial Elastance as a Ventriculo-Arterial Coupling Index: An Experimental Animal Study

Dynamic Arterial Elastance as a Ventriculo-Arterial Coupling Index: An Experimental Animal Study

Changes in dynamic arterial elastance induced by volume expansion and vasopressor in the operating room: a prospective bicentre study

Impact of deep breathing on predictability of stroke volume variation in spontaneous breathing patients

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