Dynamic Variables Fail to Predict Fluid Responsiveness in an Animal Model With Pericardial Effusion

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• 作者：Ole Broch ; MD^* ; ^{ole.broch@uksh.de" class="auth_mail" title="E-mail the corresponding author} ; Jochen Renner ; MD^* ; Patrick Meybohm ; MD^§ ; ; Martin Albrecht ; PhD^&dagger ; ; Jan Hö ; cker ; MD^* ; Assad Haneya ; MD^&Dagger ; ; Markus Steinfath ; MD^* ; Berthold Bein ; MD^‖ ; Matthias Gruenewald ; MD^*
• 关键词：fluid responsiveness ; pericardial effusion ; dynamic variables ; heart-lung interaction ; porcine model ; preload
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：30
• 期：5
• 页码：1205-1211
• 全文大小：437 K

文摘

The reliability of dynamic and volumetric variables of fluid responsiveness in the presence of pericardial effusion is still elusive. The aim of the present study was to investigate their predictive power in a porcine model with hemodynamic relevant pericardial effusion.

Design

A single-center animal investigation.

Participants

Twelve German domestic pigs.

Interventions

Pigs were studied before and during pericardial effusion. Instrumentation included a pulmonary artery catheter and a transpulmonary thermodilution catheter in the femoral artery. Hemodynamic variables like cardiac output (CO_PAC) and stroke volume (SV_PAC) derived from pulmonary artery catheter, global end-diastolic volume (GEDV), stroke volume variation (SVV), and pulse-pressure variation (PPV) were obtained.

Measurements and Main Results

At baseline, SVV, PPV, GEDV, CO_PAC, and SV_PAC reliably predicted fluid responsiveness (area under the curve 0.81 [p = 0.02], 0.82 [p = 0.02], 0.74 [p = 0.07], 0.74 [p = 0.07], 0.82 [p = 0.02]). After establishment of pericardial effusion the predictive power of dynamic variables was impaired and only CO_PAC and SV_PAC and GEDV allowed significant prediction of fluid responsiveness (area under the curve 0.77 [p = 0.04], 0.76 [p = 0.05], 0.83 [p = 0.01]) with clinically relevant changes in threshold values.

Conclusions

In this porcine model, hemodynamic relevant pericardial effusion abolished the ability of dynamic variables to predict fluid responsiveness. COPAC, SVPAC, and GEDV enabled prediction, but their threshold values were significantly changed.