A Comparison Between Pulse Pressure Variation and Right End Diastolic Volume Index as Guides to Resuscitation in a Model of Hemorrhagic Shock in Pigs

Autor(es)

de Oliveira, Marcos Antonio ^[1] ; Otsuki, Denise Aya ^[1] ; Noel-Morgan, Jessica ^[1] ; Leite, Victor Figueiredo ^[1] ; Fantoni, Denise Tabacchi ^[2] ; Costa Auler, Jr., Jose Otavio ^[3]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Lab Med Invest, LIM08 Anesthesia, BR-05403000 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med Vet & Zootecnia, Dept Surg, BR-05403000 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Fac Med, Hosp Clin, Heart Inst Incor, Dept Anesthesia & Surg Intens Ca, BR-05403000 Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE; v. 67, n. 6, p. 1225-1232, DEC 2009.
• Citações Web of Science: 5

Resumo

Background: Different hemodynamic parameters including static indicators of cardiac preload as right ventricular end-diastolic volume index (RVEDVI) and dynamic parameters as pulse pressure variation (PPV) have been used in the decision-making process regarding volume expansion in critically ill patients. The objective of this study was to compare fluid resuscitation guided by either PPV or RVEDVI after experimentally induced hemorrhagic shock. Methods: Twenty-six anesthetized and mechanically ventilated pigs were allocated into control (group I), PPV (group II), or RVEDVI (group III) group. Hemorrhagic shock was induced by blood withdrawal to target mean arterial pressure of 40 mm Hg, maintained for 60 minutes. Parameters were measured at baseline, time of shock, 60 minutes after shock, immediately after resuscitation with hydroxyethyl starch 6% (130/0.4), 1 hour and 2 hours thereafter. The endpoint of fluid resuscitation was determined as the baseline values of PPV and RVEDVI. Statistical analysis of data was based on analysis of variance for repeated measures followed by the Bonferroni test (p < 0.05). Results: Volume and time to resuscitation were higher in group III than in group II (group III = 1,305 +/- 331 mL and group II = 965 +/- 245 mL, p < 0.05; and group III = 24.8 +/- 4.7 minutes and group II = 8.8 +/- 1.3 minutes, p < 0.05, respectively). All static and dynamic parameters and biomarkers of tissue oxygenation were affected by hemorrhagic shock and nearly all parameters were restored after resuscitation in both groups. Conclusion: In the proposed model of hemorrhagic shock, resuscitation to the established endpoints was achieved within a smaller amount of time and with less volume when guided by PPV than when guided by pulmonary artery catheter-derived RVEDVI. (AU)

• Processo FAPESP: 05/59470-0 - Análise contínua de medidas de cateter de artéria pulmonar volumétrico, ecotransesofágico, variações da pressão arterial sistêmica e marcadores de hipoperfusão tissular no choque hemorrágico em porcos
• Beneficiário: José Otávio Costa Auler Junior
• Modalidade de apoio: Auxílio à Pesquisa - Regular