Arterial Pulse Pressure Variation versus Central Venous Pressure as a Predictor for Fluid Responsiveness during Open Major Abdominal Operations

Abstract

Introduction: Fluid resuscitation is the cornerstone in the management of hemodynamically unstable patients. Dynamic parameters of fluid responsiveness, like pulse pressure variation, have the advantage of being more reliable index for fluid management. Objective: The aim of our study was to compare between arterial pulse pressure variation (PPV) versus central venous pressure (CVP) as a predictor for fluid responsiveness during major open abdominal operations. Patients and Methods: 60 adult patients under general anesthesia with mechanical ventilation underwent open major abdominal surgical procedures were included in our prospective randomized controlled study. Intravenous fluid was infused and monitored by CVP in control group or by PPV in the other group. Hemodynamic variables (heart rate, invasive blood pressure, PPV and CVP) were measured at baseline after anesthesia induction and every 10 min, during first hour of operation, and then every 15 min, till end of surgery. Blood loss and total i.v. fluid & blood transfusion given to patients were recorded and compared between two groups intraoperatively. Results: Patients in the PPV group required more intraoperative fluid and blood transfusion than patients in CVP group to achieve more stable hemodynamic parameters. The fall in blood pressure (>20% of baseline) and increase in heart rate are more common in CVP group (p < 0.05). Conclusion: PPV is a better predictor and a good guide for fluid responsiveness. More stable hemodynamic variables are observed in PPV group.