Skip to main content

Comparison between pulse pressure variation and conventional parameters as guides to resuscitation in a pig model of acute hemorrhagic shock with endotoxemia

Introduction

Volume expansion is often used in anesthesia and critical care to improve oxygen delivery and, in mechanically ventilated patients, pulse pressure variation (PPV) has been proposed as an index to aid in the assessment of the appropriate amount of fluids to be administered to this end [1]. The objective of this study was to compare PPV with conventional parameters as guides to resuscitation, in an experimental model of severe hemorrhagic shock with endotoxemia.

Methods

Twenty-seven anesthetized, mechanically ventilated pigs were submitted to acute hemorrhagic shock with infusion of endotoxin. Animals were randomly allocated to three groups: control (n = 9); conventional treatment with lactated Ringer's (LR) to achieve and maintain central venous pressure (CVP) ≥12 mmHg, mean arterial pressure (MAP) ≥65 mmHg and SvO2 ≥65% (CNV, n = 9); or LR to achieve and maintain PPV ≤13% and MAP ≥65 mmHg (dPP, n = 9). Hemodynamic parameters, measured by pulmonary artery catheter and femoral arterial catheter, and blood gases were assessed at baseline (TB), 1 hour after hemorrhage (TS), and hourly during the treatment period (T1 to T3). Groups and times were compared with two-way ANOVA followed by Tukey test and t test was used for comparisons of treatment times and LR amounts (P < 0.05).

Results

At TS all groups presented equivalent, significant decreases in cardiac index (CI), MAP, CVP, SvO2 and oxygen delivery index (DO2I) and an increase in PPV (all P < 0.001). At T3, both treated groups presented hemodynamic recovery, with no statistical difference from TB or each other for CI, MAP, SvO2, DO2I or PPV. Statistically, there were no differences in times or amounts of LR to achieve endpoints, for maintenance or in total amounts of LR given. The only statistical difference between treatment groups involved CVP, which was higher in group CNV than in group dPP at T2 (P = 0.009) and T3 (P < 0.001). CVP was also higher at T3, in group CNV, when compared with TB (P = 0.006).

Conclusions

Although early fluid management guided by PPV yielded similar hemodynamic results to those achieved by management through conventional parameters, a difference could be noted regarding CVP, which was maintained higher in group CNV, but was restored to baseline values by PPV-guided therapy. The clinical impacts of such occurrences remain to be determined.

References

  1. 1.

    Cannesson M: J Cardiothorac Vasc Anesth. 2010, 24: 487-497. 10.1053/j.jvca.2009.10.008

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Grants received from FAPESP 08/50063-0, 08/50062-4, and LIM08/FMUSP.

Author information

Affiliations

Authors

Corresponding author

Correspondence to J Noel-Morgan.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Noel-Morgan, J., Fantoni, D., Otsuki, D. et al. Comparison between pulse pressure variation and conventional parameters as guides to resuscitation in a pig model of acute hemorrhagic shock with endotoxemia. Crit Care 15, P50 (2011). https://doi.org/10.1186/cc9470

Download citation

Keywords

  • Mean Arterial Pressure
  • Cardiac Index
  • Central Venous Pressure
  • Oxygen Delivery
  • Hemorrhagic Shock