Related Experiment Video
Updated: Jun 26, 2026
09:32
Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge
Published on: January 20, 2023
Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions.
Eric E C de Waal1, Steffen Rex, Cas L J J Kruitwagen
1Division of Perioperative and Emergency Care, University Medical Center, Utrecht, The Netherlands. e.e.c.dewaal@azu.nl
Critical Care Medicine
|December 31, 2008
Summary
Dynamic preload indicators like pulse pressure variation (PPV) and stroke volume variation (SVV) predict fluid responsiveness in closed-chest conditions but not in open-chest settings. These findings are crucial for optimizing fluid management in cardiac surgery patients.
Area of Science:
- Cardiovascular Physiology
- Critical Care Medicine
- Anesthesiology
Background:
- Dynamic preload indicators, such as pulse pressure variation (PPV) and stroke volume variation (SVV), are widely used to guide fluid administration.
- Their efficacy in predicting fluid responsiveness during open-chest conditions, common in cardiac surgery, remains largely unexamined.
Purpose of the Study:
- To evaluate the ability of PPV and SVV to predict fluid responsiveness in both open- and closed-chest conditions.
- To compare the predictive performance of dynamic preload indicators against static and volumetric measures.
Main Methods:
- Prospective, controlled clinical study involving 22 patients undergoing coronary artery bypass graft surgery.
- Volume loads (10 mL/kg) were administered intraoperatively (open-chest) and postoperatively (closed-chest).
- PPV, SVV, central venous pressure, and global end-diastolic volume were measured; fluid responsiveness was defined as a ≥12% increase in stroke volume index.
Main Results:
- In open-chest conditions, PPV and SVV, along with static and volumetric preload indicators, failed to predict fluid responsiveness.
- Under closed-chest conditions, PPV and SVV demonstrated significant predictive ability (AUC for PPV: 0.884, SVV: 0.911).
- A PPV ≥10% yielded 64% sensitivity and 100% specificity; an SVV >8% yielded 100% sensitivity and 78% specificity for predicting fluid responsiveness.
Conclusions:
- Dynamic preload indicators (PPV and SVV) are effective in predicting fluid responsiveness in closed-chest conditions.
- These dynamic indices, along with static measures, are unreliable for predicting fluid responsiveness in open-chest scenarios.
- Findings suggest careful consideration of chest status when utilizing PPV and SVV for fluid management decisions.
Related Concept Videos
01:17Measurement of Blood Pressure
Assessing blood pressure is a standard procedure executed in virtually all medical environments. The method utilized today was established over a hundred years ago by an innovative Russian doctor, Dr. Nikolai Korotkoff. The soft ticking noise, known as Korotkoff sounds, heard while taking blood pressure readings results from turbulent blood flow within the vessels. The apparatus required for this procedure includes a sphygmomanometer, a blood pressure cuff attached to a gauge, and a stethoscope.
01:26Imbalances in Cardiac Output
The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send blood...
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send blood...
01:29Cardiovascular System Abnormal Findings I: Inspection and Palpation
In a cardiovascular examination, inspection and palpation are crucial for identifying abnormalities.
Abnormal findings observed during an inspection
Abnormal findings observed during an inspection
01:27Assessment of the Cardiovascular System III: Palpation
Palpation involves feeling the body to evaluate texture, size, consistency, and tenderness for assessing cardiovascular health. The following steps are organized in a head-to-toe order:
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...
01:30Equipments Used To Measure Blood Pressure
Direct Method
This invasive approach involves cannulating a peripheral artery. During each cardiac contraction, pressure generates mechanical motion within the catheter, transmitted through rigid, fluid-filled tubing to a transducer. This transducer converts mechanical motion into electrical signals displayed as waveforms on a monitor. An automatic flushing system prevents blood backflow. Due to the potential risk of unexpected arterial blood loss, this method is primarily used in intensive...
This invasive approach involves cannulating a peripheral artery. During each cardiac contraction, pressure generates mechanical motion within the catheter, transmitted through rigid, fluid-filled tubing to a transducer. This transducer converts mechanical motion into electrical signals displayed as waveforms on a monitor. An automatic flushing system prevents blood backflow. Due to the potential risk of unexpected arterial blood loss, this method is primarily used in intensive...
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
Accurate blood pressure assessment is crucial for diagnosing and managing various health conditions. To ensure the reliability of these measurements, healthcare professionals must adhere to standardized pre-procedural guidelines. These guidelines enhance patient safety and improve the overall quality of healthcare. The following steps are essential for obtaining accurate and consistent blood pressure readings, from using the appropriate tools to ensuring effective communication with the patient.