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Dynamic preload indicators decrease when the abdomen is opened.

Martijn van Lavieren1, Jeroen Veelenturf1, Charlotte Hofhuizen2

  • 1University of Twente, MIRA - Institute for Biomedical Technology and Technical Medicine, PO box 217, Enschede, 7500 AE The Netherlands.

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Summary
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Opening the abdomen significantly decreases pulse pressure variation (PPV) and stroke volume variation (SVV) in surgical patients. These findings necessitate adjusting fluid therapy thresholds during surgery to optimize patient outcomes.

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Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Surgical Physiology

Background:

  • Optimizing cardiac stroke volume is crucial for reducing postoperative complications during major surgery.
  • Dynamic preload indicators like pulse pressure variation (PPV) and stroke volume variation (SVV) are used for goal-directed fluid therapy.
  • Surgical factors, such as abdominal opening, can influence the reliability of these dynamic indicators.

Purpose of the Study:

  • To investigate the impact of opening the abdomen on arterial pressure variations.
  • To assess changes in PPV and SVV following abdominal cavity opening during surgery.

Main Methods:

  • Continuous recording of blood pressure and bladder pressure before and after abdominal opening in patients undergoing elective laparotomy.
  • Off-line calculation of stroke volume index, PPV, and SVV using non-invasive blood pressure waveform analysis.

Main Results:

  • PPV decreased from 11.5% to 6.4% (p<0.005) and SVV decreased from 12.7% to 4.8% (p<0.05) after abdominal opening.
  • Mean arterial pressure and stroke volume index showed a trend towards increase, while heart rate tended to decrease, without reaching statistical significance.
  • No significant changes were observed in respiratory parameters or bladder pressure.

Conclusions:

  • Abdominal opening leads to a significant decrease in PPV and SVV.
  • Current thresholds for fluid responsiveness in goal-directed therapy may need adjustment when the abdomen is open during surgery.