Hemodynamic pressure waveform analysis in predicting fluid responsiveness

Sébastien Roy, Pierre Couture, Baqir Qizilbash, Francis Toupin, Sylvie Levesque, Michel Carrier, Jean Lambert, André Y Denault
Journal of Cardiothoracic and Vascular Anesthesia 2013, 27 (4): 676-80

OBJECTIVE: To assess the usefulness of central venous pressure (CVP), diastolic right ventricular pressure, and pulmonary capillary wedge pressure (PCWP) waveform analysis in predicting fluid responsiveness.

DESIGN: A prospective observational study.

SETTING: Tertiary care university hospital.

PATIENTS: Forty-four patients undergoing coronary artery bypass grafting.

INTERVENTIONS: Analysis of the a/v wave ratio of the PCWP, CVP, and right ventricular dP/dt to predict an increase in stroke volume >15% after the administration of 500 mL of colloid.

MEASUREMENTS AND MAIN RESULTS: Forty-four patients were enrolled in this study and 7 were excluded. There were 24 responders and 13 nonresponders. No differences in mean CVP and PCWP values between the responders and the nonresponders were found. The only parameter associated with a significant response to volume infusion was the ratio of the a/v waves of the PCWP tracing (p = 0.0001). The performance of the a/v wave ratio>1 of the PCWP tracing in predicting fluid responsiveness was evaluated by constructing a receiver operating characteristic curve. The area under the receiver operating characteristic curve was 0.89 (95% confidence interval, 0.79-0.99; p<0.05).

CONCLUSIONS: The a/v ratio measured on the PCWP tracing is a predictor of fluid responsiveness in patients with preserved left ventricular function undergoing coronary artery bypass grafting.


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