The systolic pressure variation as an indicator of pulmonary capillary wedge pressure in ventilated patients

LITERATURE REVIEW Frderick

W. Cumphell,

MD, Mirot

SCIENTIFIC

ARTICLES

controlled 1993

Coles NA, Hibberd M, Russell M, et al: Potential impact of pulmonary artery catheter placement on short-term management decisions in the medical intensive care unit. Am Heart J 126:815-819,1993

Mortality

One

hundred

three

catheterization

month

period

in 56%

patients

requiring

pulmonary

intensive

care unit

over an 1X

were studied.

of the

pulmonary

consecutive in a medical

patients

artery

catheterization.

therapy

or vasoprcssor.

patients

experienced

pneumothorax

decisions

result

were changed

of data

These

vasodilator,

changes

or

complications:

inotrope

major

derived

from

involved

fluid

use.

even&

were

chest tube insertion

(1 patient)

Thc effect of pulmonary

artery

requiring

episodes of bacteremia. tion on patient

Management

as a direct

outcome

was not evaluated

Eightern limited

to

and four

catheteriza-

hy this study.

Systolic

prcssurc

indicator

of preload,

pressure

(PCWP),

intensive

care

variation

as dctermined in

ventricular

dysfunction

regression

equation

the predicted

oscilloscope without

factors

from PCWP

of SPV with

useful

he

a good

capillary

wedgc

226

included

ventilated severe

than 5 cm. Using a linear was found

(corrclation

0.87).

function

on the

and cursor

to estimate

to be a

cocfiìcient preload

in patients

monitoring.

Triiodothyronine

(0.1 mgikg)

blinded

myocardial

ischemia

utcs of reperfusion. lar

minor

axis

pressure animals,

Icvcls of 50% ventricular reticulum T

1treated

during

cardiopulmonary ctystals

returned postischemic

to

bypass and 60 min-

micromonometer

of reperfusion.

preischemic

persisted

and mitochondria

and

in a

normothermic

assess by left vcntricu-

myocardial

to 60% of baseline

dysfunction

global,

functionwas

By W minutes

had despite

was administered

to 14 pigs after

ultrasonic

catheters.

contractility

or placebo

fashion Ventricular

(odds

parallel

was

therapy

(odds

patients

receiving

patients

receiving

allocated

nat

ratio

(odds

amiodarone

pared with control

by calcium

1.04. P = 0.41).

@blockers

compared

10 control Channel

Mortality ratio

(odds

Mortality

1antiarrhyth-

10 receive class

altered

trials 01

were reviewed.

1.14. P = 0.03)

ratio

Mortality

was

pa-

blocker

reduced

in

0.81, P = O.OOOOI) and

ratio

0.71.

P = 0.03)

com-

paticnts.

Kass DA, Wolff MR, Ting CT, et al: Diastolic compliance of hypertrophied ventricle is not acutely altered by pharmacologic agents influencing active processes. Ann Int Med 119:466-473,1993 ventricular

function

tions was mcasurcd with vcntricular (3 mg!kg

determined

during

cardiac

hypertrophy

loading

reduced

contractility

30%.

Verapamil

delayed

on activc

contraction

was

were

principly

unaltered.

unchanged

determined

systolic

infusion)

Esmolol

peak filling. compliance

by pressure-volume

catheterization

and normal

and 300 kg/kg

drug effects

(10 mg) and early

In contrast

and early diastole.

baseline.

Esmolol

relaxation

time 10 peak filling.

End-diastolic

from

function.

and verapamil

slowed

rela-

in 14 patients

pressure-volume

Ventricular

hy passive structural

to

late-diastolic rcla-

compliance

elements

rather

is

than by

activc proccsscs.

Holman WL, Spruell RD, Pacifico AD: Duration of asystolic reperiùsion and reperfusate electrolyte composition influence postcardioplegia ventricular fibrillation. J Thorac Cardiovasc Surg 106:511-519,1993

in both

lcvcls groups.

were significantly

hypothcrmic

initiated

varying

cardioplegic

with

38°C

concentrations

arrest,

blood

of calcium

by infusion

of thc rcpcrfusion tion

of unmodified

period.

was less prevalent

cardioplegic

reperfusion

pump blood or ether

high-dose

group

than

cardioplegic

containing

or unmodified

reperfusion

pump bloed

Reperfusion-induced in the

reperfusion

solution

and potassium

pump bloed in Sh pigs. The cardioplegic followed

myocardial

cardioplegic

solutions

were

for the remainder ventricular

potassium-low

in animals

fibrillacalcium

reperfused

with

solutions.

tipped

left ventricular in

adenosine

in control

was

Tj

treated

triphosphatc Significant

animals. better

left

Sarcoplasmic preserved

in

Ferraris VA, Berry WR, Klingman RR: Comparison of blood reinfusion techniques used during coronary artery bypass grafiing. Ann Thorac Surg 56:433440,1993 Over

animals.

surgery

Teo KK, Yusuf S, Furberg CD: Effects of prophylactic antiarrhythmic drug therapy in acute myocardial infarction. An overview of results from randomized 246

controlled

among patients

Aftcr

Dyke CM, Ding M, Abd-Elfattah AS, et al: Effects of triiodothyronine supplementation atier myocardial ischemia. Ann Thorac Surg 56:215-222,1993 randomized

138 randomized.

agents on 98.000 patients

mic agents

tions

left

270~1589-1595,

the first half of the database.

the freeLe

may he clinically

to

of

SPV measurements

of measurcd

invasivc

group

and PEEP greater from

found

by pulmonary

Exclusion

developed

PCWP

Measurement

was

a heterogenous

patients.

good predictor

(SPV)

J Am Med Assoc

was greater

Left

Marik PE: The systolic pressure variation as an indicator of pulmonary capillary wedge pressure in ventilated patients. Anaesth Intens Care 21:405-408, 1993

data from

antiarrhythmic

tients. artery

trials.

and

a 3-year

period

were stratitied

randomized

autologous

whole

no intraoperativc improvement

100 patients

undergoing

coronary

artery

into high risk or Iow risk for bleedinggroups

to control.

autologous

blood groups. bloed

infusion

in postoperative

Journalof Cardlothoracic and VascularAnesthesia,

platelet-rich

plasma.

In the low risk for bleeding method

blood

rcsulted

or

group.

in significant

use. In the high-risk

group.

Vol 9, NO 2 (April). 1994: pp 246-247