Pulse pressure variation–guided fluid therapy after cardiac surgery: A pilot before-and-after trial

Abstract

PurposeThe aim of this study is to study the feasibility, safety, and physiological effects of pulse pressure variation (PPV)–guided fluid therapy in patients after cardiac surgery. Materials and methodsWe conducted a pilot prospective before-and-after study during mandatory ventilation after cardiac surgery in a tertiary intensive care unit. We introduced a protocol to deliver a fluid bolus for a PPV ≥13% for at least >10 minutes during the intervention period. ResultsWe studied 45 control patients and 53 intervention patients. During the intervention period, clinicians administered a fluid bolus on 79% of the defined PPV trigger episodes. Median total fluid intake was similar between 2 groups during mandatory ventilation (1297 mL [interquartile range 549-1968] vs 1481 mL [807-2563]; P = .17) and the first 24 hours (3046 mL [interquartile range 2317-3982] vs 3017 mL [2192-4028]; P = .73). After adjusting for several baseline factors, PPV-guided fluid management significantly increased fluid intake during mandatory ventilation (P = .004) but not during the first 24 hours (P = .47). Pulse pressure variation–guided fluid therapy, however, did not significantly affect hemodynamic, renal, and metabolic variables. No serious adverse events were noted. ConclusionsPulse pressure variation–guided fluid management was feasible and safe during mandatory ventilation after cardiac surgery. However, its advantages may be clinically small.