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Functional hemodynamic parameters do not reflect volume responsiveness in the immediate phase after acute myocardial ischemia and reperfusion

Nils Kronas, Jens C Kubitz, Stefanie Forkl, Gregor I Kemming, Alwin E Goetz, Daniel A Reuter
Journal of Cardiothoracic and Vascular Anesthesia 2011, 25 (5): 780-3
21115364

OBJECTIVE: Functional preload parameters such as stroke-volume variation (SVV) and pulse-pressure variation (PPV) are superior to filling pressures when assessing volume responsiveness in mechanically ventilated patients. This investigation studied their application in the setting of acute myocardial ischemia and reperfusion (I/R).

DESIGN AND SETTING: Experimental animal study in a university laboratory.

PARTICIPANTS: Twenty anesthetized and ventilated pigs.

INTERVENTIONS: A temporary reduction of preload was obtained by ventilation with a positive end-expiratory pressure of 10 cmH(2)O. Ischemia was induced by temporary occlusion of the left anterior descending coronary artery for 60 minutes and was followed by 30 minutes of reperfusion.

MEASUREMENTS AND MAIN RESULTS: Animals were instrumented with an ultrasonic aortic flow probe to monitor stroke volume (SV) and SVV. Arterial pressure and PPV were recorded with a microtip catheter; left ventricular volume and pressure were registered by a conductance catheter. Respective hemodynamic measurements were made before, during, and after PEEP; before and after the induction of I/R. Eleven animals survived I/R and were analyzed. Before I/R, SVV (r = 0.87, p < 0.001) and PPV (r = 0.75, p < 0.05) during PEEP correlated significantly with relative changes in SV caused by the release of PEEP. Changes in SVV (r = 0.82, p < 0.01) and PPV (r = 0.67, p < 0.05) correlated significantly with relative changes in SV. After I/R, neither the relations between changes in SV to SVV or PPV during PEEP nor the relations between changes in SVV or PPV to changes in SV reached significance.

CONCLUSIONS: SVV and PPV did not reflect volume responsiveness in an experimental model of acute myocardial I/R.

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