Pulse Pressure Variation is a Valuable Marker for Predicting Fluid Responsiveness in Brain-Dead Donors

Abstract

PurposeHemodynamic management in brain-dead donors (BDDs) is challenging due to hemodynamic instabilities. We compared functional parameters with traditional parameters for hemodynamic monitoring in BDDs. Materials and methodsSeventeen BDDs with a positive balance of >500 mL for 8 hours were included. Functional hemodynamic monitoring, including pulse pressure variation (PPV), stroke volume variation (SVV), cardiac output, and systemic vascular resistance index (SVRI) was performed in the setting of tidal volume of 6 mL/kg to 8 mL/kg and minimal positive end-expiratory pressure of 5 cm to 8 cm H2O. Responders were defined by a cardiac output increase of >15% after fluid therapy. ResultsAmong the 17 BDDs (mean age, 46.80±13.91 years), 15 were male. Seven responders out of 17 (41.1%) had a significantly higher PPV (22.8±8.4 vs 13.4±5.9%, P = .038) and serum albumin level (3.2±0.6 vs 2.6±0.5 g/L, P = .040) at baseline than nonresponders. However, other hemodynamic markers such as SVV and SVRI were similar between groups. Traditional markers of volume status, such as heart rate, central venous pressure, hemoglobin, and serum uric acid level were also similar between the 2 groups. Hemodynamic markers including PPV, SVV, and SVRI were significantly reduced in responders. ConclusionsPPV was the most valuable hemodynamic marker for predicting volume responsiveness in BDDs.