Systolic Blood Pressure Variation is a Sensitive Indicator of Hypovolemia in Ventilated Dogs Subjected to Graded Hemorrhage

Perel, Azriel; Pizov, Reuven; Cotev, Shamay

doi:10.1097/00000542-198710000-00009

Cited by 372 publications

(196 citation statements)

References 0 publications

Supporting

Mentioning

174

Contrasting

Unclassified

Order By: Relevance

“…ventilated canine model of ALI, shows that over a wide range of filling pressures and levels of PEEP, SPV was very closely related to LV preload during the ventilation cycle. In keeping with previous studies, SPV was also closely associated with LV output [1][2][3][12][13][14][15][16]. Despite the differences in our animal model and the patients studied by Kramer et al [3], there was close agreement in the relative threshold in SPV that was predictive of volume responsiveness.…”

Section: Discussionsupporting

confidence: 89%

“…In ventilated patients, Rooke et al [14] showed that volume loading reduced while volume removal increased d Down and a value ≤ 2 mmHg would predict minimal intravascular volume depletion. This corresponds well to our data -a d Down that volume loading reduces SPV (and SVV) in relation to changes in LV preload which we and others [1,12] attribute mainly to a reduced expiratory decrease in d Down (SV). As changes in LV output are a major determinant of changes in arterial pressure, it is not surprising that previous studies have shown similar results when comparing SVV and SPV/PPV in predicting the response to a volume challenge [45,46].…”

Section: Physiological Considerationssupporting

confidence: 92%

“…Relying on pulmonary capillary wedge pressure to reflect ventricular volume, Perel et al [ 12 ] and Szold et al [15] showed that pulmonary capillary wedge pressure was related to SPV with both volume loading and phlebotomy in mechanically ventilated dogs. However, filling pressure cannot be used to reflect preload during mechanical ventilation (as is clear in Figure 4) or predict volume responsiveness [31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

“…Their results suggested the accentuated paradox seen in hypovolemic states was reduced by a volume challenge with the reduction in the d Down component appearing to be of particular importance. Perel et al [12] subsequently showed that the d Down component reflects volume status and is closely related to changes in CO. However, the d Up remained unchanged in their canine model of graded hemorrhage.…”

Section: Physiological Considerationsmentioning

confidence: 99%

“…Cyclical changes in left ventricular (LV) preload during mechanical ventilation and the resultant changes in stroke volume are related to complex cardiopulmonary interactions including changes in external constraint and LV afterload, as well as systemic and pulmonary venous return through series and direct ventricular interaction [4][5][6][7][8][9][10][11]. The magnitude of SPV has been shown to predict responsiveness to a volume challenge [1][2][3][12][13][14][15][16]. One might anticipate that as LV and right ventricular (RV) preload increase during volume loading, changes in intrathoracic pressure would affect ventricular filling (and output) less and thus, SPV would be less.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Left Ventricular Preload Determines Systolic Pressure Variation during Mechanical Ventilation in Acute Lung Injury

Mitchell¹,

Doig²,

Whitelaw³

2011

J Clinic Experiment Cardiol

View full text Add to dashboard Cite

Although volume is commonly administered to patients with hemodynamic compromise during mechanical ventilation to improve cardiac output, excessive amounts may precipitate or aggravate pulmonary edema, especially in patients with predisposing pulmonary or cardiac conditions. The ability to predict the hemodynamic response to a volume challenge should facilitate patient management and might help to avoid harm in those who are unlikely to benefit from volume loading.Systolic arterial pressure variation (SPV) during mechanical ventilation is more pronounced in hypovolemic than in euvolemic patients [1][2][3]. Cyclical changes in left ventricular (LV) preload during mechanical ventilation and the resultant changes in stroke volume are related to complex cardiopulmonary interactions including changes in external constraint and LV afterload, as well as systemic and pulmonary venous return through series and direct ventricular interaction [4][5][6][7][8][9][10][11]. The magnitude of SPV has been shown to predict responsiveness to a volume challenge [1][2][3][12][13][14][15][16]. One might anticipate that as LV and right ventricular (RV) preload increase during volume loading, changes in intrathoracic pressure would affect ventricular filling (and output) less and thus, SPV would be less. Alternatively stated, at higher filling pressures, the ventricles are on a flatter part of the Starling curve (fiber length cannot be increased further by increasing the filling pressure further). Therefore, a given airway pressure is less likely to reduce fiber length at higher filling pressures than at lower pressures where the Starling curve is steeper.We therefore assessed the relations between LV preload, output and SPV in an oleic acid (OA) induced acute lung injury (ALI) model in which LV filling pressures and positive end-expiratory pressures (PEEP) were systematically varied. We also assessed the potential value of estimated transmural LV end-diastolic pressure [left atrial enddiastolic pressure (P LAED ) -RV end-diastolic pressure (P RVED )], which reflects LV preload, in predicting volume responsiveness in our model. MethodsThis study was approved by the institutional animal care committee whose criteria are consistent with those of the American Physiological Society. Animal preparationIn 8 mongrel dogs of either sex (20-30 kg, mean 24 kg), anesthesia was induced with thiopental sodium (25 mg/kg i.v.) and midazolam (5 mg/ml bolus) and was maintained with fentanyl citrate (0.04 mg/ml i.v., initially, followed by an infusion of 4 mg/h), which was adjusted AbstractBackground: Systolic pressure variation (SPV) predicts responsiveness to volume loading during mechanical ventilation and may be related to changes in LV preload and the resultant changes in stroke volume (SV). We, therefore, tested the relations between LV preload, output and SPV in an acute lung injury (ALI) model during mechanical ventilation.

show abstract