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Title: Pulse pressure variation-guided fluid therapy after cardiac surgery: a pilot before-and-after trial.
Austin Authors: Suzuki, Satoshi;Woinarski, Nicholas C Z;Lipcsey, Miklos;Candal, Cristina Lluch;Schneider, Antoine G;Glassford, Neil J;Eastwood, Glenn M ;Bellomo, Rinaldo 
Affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
Department of Intensive Care, Hospital Universitari Mutua Terrassa, Barcelona, Spain.
Intensive Care Medicine, Universite de LaUSAnne, LaUSAnne, Switzerland.
Issue Date: 7-Aug-2014
Publication information: Journal of Critical Care 2014; 29(6): 992-6
Abstract: The aim of this study is to study the feasibility, safety, and physiological effects of pulse pressure variation (PPV)-guided fluid therapy in patients after cardiac surgery.We conducted a pilot prospective before-and-after study during mandatory ventilation after cardiac surgery in a tertiary intensive care unit. We introduced a protocol to deliver a fluid bolus for a PPV≥13% for at least >10 minutes during the intervention period.We studied 45 control patients and 53 intervention patients. During the intervention period, clinicians administered a fluid bolus on 79% of the defined PPV trigger episodes. Median total fluid intake was similar between 2 groups during mandatory ventilation (1297 mL [interquartile range 549-1968] vs 1481 mL [807-2563]; P=.17) and the first 24 hours (3046 mL [interquartile range 2317-3982] vs 3017 mL [2192-4028]; P=.73). After adjusting for several baseline factors, PPV-guided fluid management significantly increased fluid intake during mandatory ventilation (P=.004) but not during the first 24 hours (P=.47). Pulse pressure variation-guided fluid therapy, however, did not significantly affect hemodynamic, renal, and metabolic variables. No serious adverse events were noted.Pulse pressure variation-guided fluid management was feasible and safe during mandatory ventilation after cardiac surgery. However, its advantages may be clinically small.
Gov't Doc #: 25220528
DOI: 10.1016/j.jcrc.2014.07.032
Journal: Journal of Critical Care
Type: Journal Article
Subjects: Cardiac output
Cardiac surgery
Fluid therapy
Intensive care
Pulse pressure variation
Analysis of Variance
Blood Pressure.physiology
Cardiac Surgical Procedures
Case-Control Studies
Controlled Before-After Studies
Feasibility Studies
Fluid Therapy.adverse effects.methods
Middle Aged
Pilot Projects
Prospective Studies
Respiration, Artificial
Appears in Collections:Journal articles

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