Right ventricular and pulmonary artery pulse pressure variation and systolic pressure variation for the prediction of fluid responsiveness: an interventional study in coronary artery bypass surgery patients.

PURPOSE

Predicting fluid responsiveness is essential when treating surgical or critically ill patients. When using a pulmonary artery catheter, pulse pressure variation and systolic pressure variation can be calculated from right ventricular and pulmonary artery pressure waveforms.

METHODS

We conducted a prospective interventional study investigating the ability of right ventricular pulse pressure variation (PPV) and systolic pressure variation (SPV) as well as pulmonary artery pulse pressure variation (PPV) and systolic pressure variation (SPV) to predict fluid responsiveness in coronary artery bypass (CABG) surgery patients. Additionally, radial artery pulse pressure variation (PPV) and systolic pressure variation (SPV) were calculated. The area under the receiver operating characteristics (AUROC) curve with 95%-confidence interval (95%-CI) was used to assess the capability to predict fluid responsiveness (defined as an increase in cardiac index of > 15%) after a 500 mL crystalloid fluid challenge.

RESULTS

Thirty-three patients were included in the final analysis. Thirteen patients (39%) were fluid-responders with a mean increase in cardiac index of 25.3%. The AUROC was 0.60 (95%-CI 0.38 to 0.81) for PPV, 0.63 (95%-CI 0.43 to 0.83) for SPV, 0.58 (95%-CI 0.38 to 0.78) for PPV, and 0.71 (95%-CI 0.52 to 0.89) for SPV. The AUROC for PPV was 0.71 (95%-CI 0.53 to 0.89) and for SPV 0.78 (95%-CI 0.62 to 0.94). The correlation between pulse pressure variation and systolic pressure variation measurements derived from the different waveforms was weak.

CONCLUSIONS

Right ventricular and pulmonary artery pulse pressure variation and systolic pressure variation seem to be weak predictors of fluid responsiveness in CABG surgery patients.