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Assessing volume responsiveness using right ventricular dynamic indicators of preload.

Michael F Graessler1, Karin H Wodack2, Hans O Pinnschmidt3

  • 1Department of Anesthesiology, Centre for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. m.graessler@uke.de.

Journal of Anesthesia
|May 5, 2021
PubMed
Summary

New dynamic indicators for right ventricular preload were developed and show promise in predicting fluid responsiveness in animal models. This research addresses a gap in current hemodynamic monitoring capabilities.

Keywords:
Dynamic indicatorsPulmonary artery catheterRight ventricleVolume responsiveness

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Area of Science:

  • Cardiovascular Physiology
  • Critical Care Medicine
  • Hemodynamic Monitoring

Background:

  • Current dynamic preload indicators primarily assess the left ventricle.
  • Dynamic indicators for right ventricular preload are lacking.
  • Accurate assessment of right ventricular preload is crucial for guiding fluid therapy.

Purpose of the Study:

  • To develop and validate dynamic indicators for right ventricular preload.
  • To evaluate the predictive ability of these indicators for fluid responsiveness.
  • To address the unmet need for right ventricular dynamic preload assessment.

Main Methods:

  • Experimental study conducted on 20 anesthetized pigs.
  • Utilized micro-tip catheters and ultrasonic flow probes for precise measurements.
  • Induced hypovolemia and performed volume loading challenges.
  • Employed Receiver Operating Characteristic (ROC) analysis to assess predictive performance.

Main Results:

  • Right ventricular stroke volume variation (SVVRV) demonstrated significant predictive ability (AUC = 0.82).
  • Pulmonary artery pulse pressure variation (PPVPA) also showed predictive value (AUC = 0.72).
  • Pulmonary artery systolic pressure variation (SPVPA) exhibited moderate predictive capacity (AUC = 0.66).

Conclusions:

  • Dynamic indicators of right ventricular preload can be calculated.
  • These novel indicators show promise in predicting fluid responsiveness.
  • This study provides a foundation for future clinical applications in hemodynamic management.