PMID- 19032557
OWN - NLM
STAT- MEDLINE
DCOM- 20090212
LR  - 20090630
IS  - 1399-6576 (Electronic)
IS  - 0001-5172 (Linking)
VI  - 53
IP  - 1
DP  - 2009 Jan
TI  - Fluid therapy in acute myocardial infarction: evaluation of predictors of volume 
      responsiveness.
PG  - 26-33
LID - 10.1111/j.1399-6576.2008.01824.x [doi]
AB  - BACKGROUND: Static vascular filling pressures suffer from poor predictive power 
      in identifying the volume-responsive heart. The use of dynamic arterial pressure 
      variables, including pulse pressure variation (PPV) has instead been suggested to 
      guide volume therapy. The aim of the present study was to evaluate the 
      performance of several clinically applicable haemodynamic parameters to predict 
      volume responsiveness in a pig closed chest model of acute left ventricular 
      myocardial infarction. METHODS: Fifteen anaesthetized, mechanically ventilated 
      pigs were studied following acute left myocardial infarction by temporary 
      coronary occlusion. Animals were instrumented to monitor central venous (CVP) and 
      pulmonary artery occlusion (PAOP) pressures and arterial systolic variations 
      (SPV) and PPV. Cardiac output (CO) was measured using the pulmonary artery 
      catheter and by using the PiCCO monitor also giving stroke volume variation 
      (SVV). Variations in the velocity time integral by pulsed-wave Doppler 
      echocardiography were determined in the left (DeltaVTI(LV)) and right 
      (DeltaVTI(RV)) ventricular outflow tracts. Consecutive boluses of 4 ml/kg 
      hydroxyethyl starch were administered and volume responsiveness was defined as a 
      10% increase in CO. RESULTS: Receiver-operator characteristics (ROC) demonstrated 
      the largest area under the curve for DeltaVTI(RV) [0.81 (0.70-0.93)] followed by 
      PPV [0.76 (0.64-0.88)] [mean (and 95% CI)]. SPV, DeltaVTI(LV) and SVV did not 
      change significantly during volume loading. CVP and PAOP increased but did not 
      demonstrate significant ROC. CONCLUSION: PPV may be used to predict the response 
      to volume administration in the setting of acute left ventricular myocardial 
      infarction.
FAU - Snygg, J
AU  - Snygg J
AD  - Department of Anaesthesiology and Intensive Care, Shalgrenska University 
      Hospital, Goteborg, Sweden.
FAU - Bech-Hanssen, O
AU  - Bech-Hanssen O
FAU - Lonn, L
AU  - Lonn L
FAU - Andersson, B
AU  - Andersson B
FAU - Aneman, A
AU  - Aneman A
LA  - eng
PT  - Journal Article
DEP - 20081111
PL  - England
TA  - Acta Anaesthesiol Scand
JT  - Acta anaesthesiologica Scandinavica
JID - 0370270
SB  - IM
CIN - Acta Anaesthesiol Scand. 2009 Jul;53(6):836; author reply 836-7. PMID: 19563577
MH  - Acute Disease/therapy
MH  - Animals
MH  - Female
MH  - Fluid Therapy/*methods
MH  - Male
MH  - Myocardial Infarction/*therapy
MH  - Swine
MH  - Treatment Outcome
EDAT- 2008/11/27 09:00
MHDA- 2009/02/13 09:00
CRDT- 2008/11/27 09:00
PHST- 2008/11/27 09:00 [pubmed]
PHST- 2009/02/13 09:00 [medline]
PHST- 2008/11/27 09:00 [entrez]
AID - AAS1824 [pii]
AID - 10.1111/j.1399-6576.2008.01824.x [doi]
PST - ppublish
SO  - Acta Anaesthesiol Scand. 2009 Jan;53(1):26-33. doi: 
      10.1111/j.1399-6576.2008.01824.x. Epub 2008 Nov 11.