Fluid therapy in acute myocardial infarction: evaluation of predictors of volume responsiveness

J Snygg; O Bech-Hanssen; L Lönn; B Andersson; A Aneman

doi:10.1111/j.1399-6576.2008.01824.x

Fluid therapy in acute myocardial infarction: evaluation of predictors of volume responsiveness

J Snygg, O Bech-Hanssen, L Lönn, B Andersson, A Aneman

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

9 Citationer (Scopus)

Abstract

Udgivelsesdato: 2009-Jan

Originalsprog	Engelsk
Tidsskrift	Acta Anaesthesiologica Scandinavica
Vol/bind	53
Udgave nummer	1
Sider (fra-til)	26-33
Antal sider	7
ISSN	0001-5172
DOI	https://doi.org/10.1111/j.1399-6576.2008.01824.x
Status	Udgivet - 2008

Bibliografisk note

Keywords: Acute Disease; Animals; Female; Fluid Therapy; Male; Myocardial Infarction; Swine; Treatment Outcome

Adgang til dokumentet

10.1111/j.1399-6576.2008.01824.x

Citationsformater

@article{8ece57b056ae11df928f000ea68e967b,

title = "Fluid therapy in acute myocardial infarction: evaluation of predictors of volume responsiveness",

abstract = "BACKGROUND: Static vascular filling pressures suffer from poor predictive power in identifying the volume-responsive heart. The use of dynamic arterial pressure variables, including pulse pressure variation (PPV) has instead been suggested to guide volume therapy. The aim of the present study was to evaluate the performance of several clinically applicable haemodynamic parameters to predict volume responsiveness in a pig closed chest model of acute left ventricular myocardial infarction. METHODS: Fifteen anaesthetized, mechanically ventilated pigs were studied following acute left myocardial infarction by temporary coronary occlusion. Animals were instrumented to monitor central venous (CVP) and pulmonary artery occlusion (PAOP) pressures and arterial systolic variations (SPV) and PPV. Cardiac output (CO) was measured using the pulmonary artery catheter and by using the PiCCO monitor also giving stroke volume variation (SVV). Variations in the velocity time integral by pulsed-wave Doppler echocardiography were determined in the left (DeltaVTI(LV)) and right (DeltaVTI(RV)) ventricular outflow tracts. Consecutive boluses of 4 ml/kg hydroxyethyl starch were administered and volume responsiveness was defined as a 10% increase in CO. RESULTS: Receiver-operator characteristics (ROC) demonstrated the largest area under the curve for DeltaVTI(RV) [0.81 (0.70-0.93)] followed by PPV [0.76 (0.64-0.88)] [mean (and 95% CI)]. SPV, DeltaVTI(LV) and SVV did not change significantly during volume loading. CVP and PAOP increased but did not demonstrate significant ROC. CONCLUSION: PPV may be used to predict the response to volume administration in the setting of acute left ventricular myocardial infarction.",

author = "J Snygg and O Bech-Hanssen and L L{\"o}nn and B Andersson and A Aneman",

note = "Keywords: Acute Disease; Animals; Female; Fluid Therapy; Male; Myocardial Infarction; Swine; Treatment Outcome",

year = "2008",

doi = "10.1111/j.1399-6576.2008.01824.x",

language = "English",

volume = "53",

pages = "26--33",

journal = "Acta Anaesthesiologica Scandinavica",

issn = "0001-5172",

publisher = "Wiley-Blackwell",

number = "1",

}

TY - JOUR

T1 - Fluid therapy in acute myocardial infarction: evaluation of predictors of volume responsiveness

AU - Snygg, J

AU - Bech-Hanssen, O

AU - Lönn, L

AU - Andersson, B

AU - Aneman, A

N1 - Keywords: Acute Disease; Animals; Female; Fluid Therapy; Male; Myocardial Infarction; Swine; Treatment Outcome

PY - 2008

Y1 - 2008

N2 - BACKGROUND: Static vascular filling pressures suffer from poor predictive power in identifying the volume-responsive heart. The use of dynamic arterial pressure variables, including pulse pressure variation (PPV) has instead been suggested to guide volume therapy. The aim of the present study was to evaluate the performance of several clinically applicable haemodynamic parameters to predict volume responsiveness in a pig closed chest model of acute left ventricular myocardial infarction. METHODS: Fifteen anaesthetized, mechanically ventilated pigs were studied following acute left myocardial infarction by temporary coronary occlusion. Animals were instrumented to monitor central venous (CVP) and pulmonary artery occlusion (PAOP) pressures and arterial systolic variations (SPV) and PPV. Cardiac output (CO) was measured using the pulmonary artery catheter and by using the PiCCO monitor also giving stroke volume variation (SVV). Variations in the velocity time integral by pulsed-wave Doppler echocardiography were determined in the left (DeltaVTI(LV)) and right (DeltaVTI(RV)) ventricular outflow tracts. Consecutive boluses of 4 ml/kg hydroxyethyl starch were administered and volume responsiveness was defined as a 10% increase in CO. RESULTS: Receiver-operator characteristics (ROC) demonstrated the largest area under the curve for DeltaVTI(RV) [0.81 (0.70-0.93)] followed by PPV [0.76 (0.64-0.88)] [mean (and 95% CI)]. SPV, DeltaVTI(LV) and SVV did not change significantly during volume loading. CVP and PAOP increased but did not demonstrate significant ROC. CONCLUSION: PPV may be used to predict the response to volume administration in the setting of acute left ventricular myocardial infarction.

AB - BACKGROUND: Static vascular filling pressures suffer from poor predictive power in identifying the volume-responsive heart. The use of dynamic arterial pressure variables, including pulse pressure variation (PPV) has instead been suggested to guide volume therapy. The aim of the present study was to evaluate the performance of several clinically applicable haemodynamic parameters to predict volume responsiveness in a pig closed chest model of acute left ventricular myocardial infarction. METHODS: Fifteen anaesthetized, mechanically ventilated pigs were studied following acute left myocardial infarction by temporary coronary occlusion. Animals were instrumented to monitor central venous (CVP) and pulmonary artery occlusion (PAOP) pressures and arterial systolic variations (SPV) and PPV. Cardiac output (CO) was measured using the pulmonary artery catheter and by using the PiCCO monitor also giving stroke volume variation (SVV). Variations in the velocity time integral by pulsed-wave Doppler echocardiography were determined in the left (DeltaVTI(LV)) and right (DeltaVTI(RV)) ventricular outflow tracts. Consecutive boluses of 4 ml/kg hydroxyethyl starch were administered and volume responsiveness was defined as a 10% increase in CO. RESULTS: Receiver-operator characteristics (ROC) demonstrated the largest area under the curve for DeltaVTI(RV) [0.81 (0.70-0.93)] followed by PPV [0.76 (0.64-0.88)] [mean (and 95% CI)]. SPV, DeltaVTI(LV) and SVV did not change significantly during volume loading. CVP and PAOP increased but did not demonstrate significant ROC. CONCLUSION: PPV may be used to predict the response to volume administration in the setting of acute left ventricular myocardial infarction.

U2 - 10.1111/j.1399-6576.2008.01824.x

DO - 10.1111/j.1399-6576.2008.01824.x

M3 - Journal article

C2 - 19032557

SN - 0001-5172

VL - 53

SP - 26

EP - 33

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 1

ER -