Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Pulse-pressure variation and hemodynamic response in patients with elevated pulmonary artery pressure: a clinical study. | Wyler von Ballmoos et al. Critical Care 2010 14 R111 http content 14 3 R111 RESEARCH Open Access Pulse-pressure variation and hemodynamic response in patients with elevated pulmonary artery pressure a clinical study Moritz Wyler von Ballmoos 1 Jukka Takala1 Margareta Roeck1 Francesca Porta1 David Tueller1 Christoph C Ganter1 Ralph Schroder1 Hendrik Bracht1 Bertram Baenziger2 and Stephan M Jakob 1 Abstract Introduction Pulse-pressure variation PPV due to increased right ventricular afterload and dysfunction may misleadingly suggest volume responsiveness. We aimed to assess prediction of volume responsiveness with PPV in patients with increased pulmonary artery pressure. Methods Fifteen cardiac surgery patients with a history of increased pulmonary artery pressure mean pressure 27 5 mm Hg mean SD before fluid challenges and seven septic shock patients mean pulmonary artery pressure 33 10 mm Hg were challenged with 200 ml hydroxyethyl starch boli ordered on clinical indication. PPV right ventricular ejection fraction EF and end-diastolic volume EDV stroke volume SV and intravascular pressures were measured before and after volume challenges. Results Of 69 fluid challenges 19 28 increased SV 10 . PPV did not predict volume responsiveness area under the receiver operating characteristic curve P . PPV was 13 before 46 67 fluid challenges and SV increased in 13 28 . Right ventricular EF decreased in none of the fluid challenges resulting in increased SV and in 44 of those in which SV did not increase P . EDV increased in 28 of fluid challenges resulting in increased SV and in 44 of those in which SV did not increase P . Conclusions Both early after cardiac surgery and in septic shock patients with increased pulmonary artery pressure respond poorly to fluid administration. Under these conditions PPV cannot be used to predict fluid responsiveness. The frequent reduction in right ventricular EF when SV did not increase suggests that right
