Dynamic preload indicators decrease when the abdomen is opened

Martijn van Lavieren, Jeroen Veelenturf, Charlotte Hofhuizen, Marion van der Kolk, Johannes van der Hoeven, Peter Pickkers, Joris Lemson, Benno Lansdorp, Martijn van Lavieren, Jeroen Veelenturf, Charlotte Hofhuizen, Marion van der Kolk, Johannes van der Hoeven, Peter Pickkers, Joris Lemson, Benno Lansdorp

Abstract

Background: Optimizing cardiac stroke volume during major surgery is of interest to many as a therapeutic target to decrease the incidence of postoperative complications. Because dynamic preload indicators are strongly correlated with stroke volume, it is suggested that these indices can be used for goal directed fluid therapy. However, threshold values of these indicators depend on many factors that are influenced by surgery, including opening of the abdomen. The aim of this study was therefore to assess the effect of opening the abdomen on arterial pressure variations in patients undergoing abdominal surgery.

Methods: Blood pressure and bladder pressure were continuously recorded just before and after opening of the abdomen in patients undergoing elective laparotomy. Based on waveform analysis of the non-invasively derived blood pressure, the stroke volume index, pulse pressure variation (PPV) and stroke volume variation (SVV) were calculated off-line.

Results: Thirteen patients were included. After opening the abdomen, PPV and SVV decreased from 11.5 ± 5.8% to 6.4 ± 2.9% (p < 0.005, a relative decrease of 40 ± 19%) and 12.7 ± 6.1% to 4.8 ± 1.6% (p < 0.05, a relative decrease of 53 ± 26%), respectively. Although mean arterial pressure and stroke volume index tended to increase (41 ± 6 versus 45 ± 4 ml/min/m2, p = 0.14 and 41 ± 6 versus 45 ± 4 ml/min/m2, p = 0.05), and heart rate tended to decrease (73 ± 15 versus 68 ± 11 1/min, p = 0.05), no significant change was found. No significant change was found in respiratory parameter (tidal volume, respiratory rate or inspiratory pressure; p = 0.36, 0.34 and 0.17, respectively) or bladder pressure (6.0 ± 3.7 versus 5.6 ± 2.7 mmHg, p = 0.6) either.

Conclusions: Opening of the abdomen decreases PPV and SVV. During goal directed therapy, current thresholds for fluid responsiveness should be changed accordingly.

Figures

Figure 1
Figure 1
Comparison of main hemodynamic variables during a closed abdomen and opened abdomen. MAP = mean arterial pressure, CI = Cardiac Index, HR = heart rate, SVI = Stroke Volume Index, p-values were not significant and mentioned in the figure.
Figure 2
Figure 2
Comparison of waveform derived preload indicators at closed abdomen and at opened abdomen. PPV = pulse pressure variation, SVV = stroke volume variation, * = p < 0.01.

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Pre-publication history
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Source: PubMed

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