Assessment of Parameters Measured with Volumetric Pulmonary Artery Catheter as Predictors of Fluid Responsiveness in Patients with Coronary Artery Occlusive Disease.
- Author:
Ji Yeon LEE
1
;
Young Lan KWAK
;
Jong Hwa LEE
;
Jae Kwang SHIM
;
Kyung Jong YOO
;
Seung Bum HONG
Author Information
1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Korea. ylkwak@yuhs.ac
- Publication Type:Original Article
- Keywords:
Coronary artery bypass surgery;
Pulmonary artery;
Cardiac output
- MeSH:
Anesthesia;
Cardiac Output;
Catheters;
Central Venous Pressure;
Coronary Artery Bypass;
Coronary Vessels;
Fluid Therapy;
Hemodynamics;
Hetastarch;
Humans;
Linear Models;
Pulmonary Artery;
Pulmonary Wedge Pressure;
ROC Curve;
Stress, Psychological;
Stroke Volume
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2008;41(1):41-48
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Accurate assessment of the preload and the fluid responsiveness is of great importance for optimizing cardiac output, especially in those patients with coronary artery occlusive disease (CAOD). In this study, we evaluated the relationship between the parameters of preload with the changes in the stroke volume index (SVI) after fluid loading in patients who were undergoing coronary artery bypass grafting (CABG). The purpose of this study was to find the predictors of fluid responsiveness in order to assess the feasibility of using certain parameters of preload as a guide to fluid therapy. MATERIAL AND METHOD: We studied 96 patients who were undergoing CABG. After induction of anesthesia, the hemodynamic parameters were measured before (T1) and 10 min after volume replacement (T2) by an infusion of 6% hydroxyethyl starch 130/0.4 (10 mL/kg) over 20 min. RESULT: The right ventricular end-diastolic volume index (RVEDVI), as well as the central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP), failed to demonstrate significant correlation with the changes in the SVI (%). Only the right ventricular ejection fraction (RVEF) measured at T1 showed significant correlation with the changes of the SVI by linear regression (r=0.272, p=0.017). However, when the area under the curve of receiver operating characteristics (ROC) was evaluated, none of the parameters were over 0.7. The volume-induced increase in the SVI was 10% or greater in 31 patients (responders) and under 10% in 65 patients (non-responders). None of the parameters of preload measured at T1 showed a significant difference between the responders and non-responders, except for the RVEF. CONCLUSION: The conventional parameters measured with a volumetric pulmonary artery catheter failed to predict the response of SVI following fluid administration in patients suffering with CAOD.
