Abstract
Introduction. Adequate circulating blood volume is essential for the good outcome in postoperative patients. Therefore, the primary resuscitation question is how to assess the circulating volume. The aim of this study was to compare the central ve-nous pressure (CVP) and dynamic LIDCO parameters as markers indicating preload in surgical patients.Materials and Methods. This prospective study included 24 patients hospitalized af-ter major surgery at the surgical intensive care unit of the University hospital Zagreb, Croatia. The patients were mechanically ventilated, without spontaneous breath-ing attempts and in sinus rhythm. Patients were divided into 2 groups, hemodynami-cally stable and hemodynamically unsta-ble. The CVP was measured as a static pa-rameter while the stroke volume variation (SVV) and pulse pressure variation (PPV) were measured as the dynamic parameters. Results. Study groups were comparable in terms of gender, age and body mass in-dex. The difference in the CVP between the hemodynamically stable (13,2±3,74 mmHg) and hemodynamically unstable group of patients (10,1±5,6 mmHg) was statistically insignificant (p=0,144). Differ-ences in SVV (10,2±6,48% in stable com-pared to 18,8±7,04% in unstable group) and PPV (11,5±6,65% in stable compared to 18±6,32% in unstable group) were both statistically significant with p values of 0,005 and 0,022 respectively. Conclusion. The study confirmed the inability of CVP to provide valid assessment of the preload as a reason for hemodynam-ic instability in comparison to dynamic LiDCOTMplus system parameters in me-chanically ventilated major surgical pa-tients.
Highlights
Adequate circulating blood volume is essential for the good outcome in postoperative patients
The study confirmed the inability of central venous pressure (CVP) to provide valid assessment of the preload as a reason for hemodynamic instability in comparison to dynamic LiDCOTMplus system parameters in mechanically ventilated major surgical patients
The hemodynamically stable group compared to hemodynamically unstable group showed statistically significant different values of the stroke volume variation (SVV) (10,2±6,48% in stable group compared to 18,8±7,04% in unstable group) and pulse pressure variation (PPV) (11,5±6,65% in stable group compared to 18±6,32% in unstable group) with p values of 0,005 and 0,022 respectively
Summary
Adequate circulating blood volume is essential for the good outcome in postoperative patients. The study confirmed the inability of CVP to provide valid assessment of the preload as a reason for hemodynamic instability in comparison to dynamic LiDCOTMplus system parameters in mechanically ventilated major surgical patients. Over the last decade there was a significant advancement in the technology of ICU monitoring with the introduction of many devices used for hemodynamic monitoring [6] In this context, newer methods are expected to measure the dynamic parameters, be less invasive, associated with less complications, easier to perform and, most importantly, to improve the clinical outcome of treatment. The system uses an indicator dilution method and software analysis to measure the cardiac output and dynamic preload parameters stroke volume variation (SVV) and pulse pressure variation (PPV) of the patient [8]. The goal of this study was to compare static (CVP) with dynamic (SVV, PPV) parameters in assessment of the preload
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