PULSE PRESSURE VARIATION IS COMPARABLE WITH CENTRAL VENOUS PRESSURE TO GUIDE FLUID RESUSCITATION IN EXPERIMENTAL HEMORRHAGIC SHOCK WITH ENDOTOXEMIA

Autor(es)

Noel-Morgan, Jessica ^{[1, 2]} ; Otsuki, Denise Aya ^[2] ; Costa Auler, Jr., Jose Otavio ^{[1, 2]} ; Fukushima, Julia Tizue ^[1] ; Fantoni, Denise Tabacchi ^{[1, 2, 3]}

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Sch Med, Dept Anesthesiol, BR-01246903 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Lab Med Invest LIM Anesthesiol 08, BR-01246903 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Sch Vet Med & Anim Sci, Dept Surg, BR-01246903 Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Shock; v. 40, n. 4, p. 303-311, OCT 2013.
• Citações Web of Science: 5

Resumo

Introduction: Pulse pressure variation (PPV) has been proposed as a promising resuscitation goal, but its ability to predict fluid responsiveness has been questioned in various conditions. The purpose of this study was to assess the performance of PPV in predicting fluid responsiveness in experimental hemorrhagic shock with endotoxemia, while comparing it with goals determined by a conventional set of guidelines. Methods: Twenty-seven pigs were submitted to acute hemorrhagic shock with intravenous infusion of endotoxin and randomized to three groups: (i) control; (ii) conventional treatment with crystalloids to achieve and maintain central venous pressure (CVP) 12 to 15 mmHg, mean arterial pressure of 65 mmHg or greater, and SvO(2) (mixed venous oxygen saturation) of 65% or greater; (iii) treatment to achieve and maintain PPV of 13% or less. Parametric data were analyzed by two-way analysis of variance and Tukey test and differences in crystalloid volumes by t test. Predictive values of variables regarding fluid responsiveness were evaluated by receiver operating characteristic curves and multiple logistic regression. Results: Both treatments produced satisfactory hemodynamic recovery, without statistical differences in fluid administration (P = 0.066), but conventional treatment induced higher CVP (P = 0.001). Areas under receiver operating characteristic curves were larger for CVP (0.77; 95% confidence interval, 0.68-0.86) and PPV (0.74; 95% confidence interval, 0.65-0.83), and these variables were further selected by multiple logistic regression as independent predictors of responsiveness. Optimal PPV cutoff was 15%, with false-positive results involving mean pulmonary arterial pressure of 27 mmHg or greater. Conclusions: Acute resuscitation guided by PPV was comparable with the strategy guided by CVP, mean arterial pressure, and SvO(2). Central venous pressure and PPV were individually limited but independently predictive of fluid responsiveness. (AU)

• Processo FAPESP: 08/50063-0 - Comparacao de reposicao volemica guiada por variacao de pressao de pulso por parametros tradicionais em modelos suinos de choque hemorragico e choque hemorragico com endotoxemia.
• Beneficiário: Denise Tabacchi Fantoni
• Modalidade de apoio: Auxílio à Pesquisa - Regular
• Processo FAPESP: 08/50062-4 - Comparação de reposição volêmica guiada por variação de pressão de pulso e por parâmetros tradicionais em modelos suínos de choque hemorrágico e choque hemorrágico com endotoxemia
• Beneficiário: Jessica Noel-Morgan
• Modalidade de apoio: Bolsas no Brasil - Doutorado Direto