Augmented Pulse Pressure Variation to Predict Fluid Responsiveness in Open Laparotomy

Samsung Medical Center38 enrolled

Overview

Pulse pressure variation (PPV) is a well-known and widely used dynamic preload indicator based on heart-lung interaction to predict fluid responsiveness. Generally, patients are considered to be fluid-responsive when the PPV value larger than 11-13%. However, several previous researches demonstrated that there is a zone of uncertainty (grey zone) in PPV. To predict fluid-responsiveness accurately in the patients with PPV within grey zone (9-13%), the investigators would evaluate the augmented PPV using augmented ventilation.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Gynecologic Neoplasms Abdominal Neoplasms

Interventions

Augmented ventilationOTHER

When the patient's PPV is within grey zone, patient's tidal volume is maintained with augmented tidal volume of 12 ml/kg (from normal ventilation of 8ml/kg) for 2min duration.

Fluid loadingOTHER

We record the stroke volume index (SVI) values before and after volume expansion with 6ml/kg of balanced crystalloid

Eligibility

Sex: ALLMin age: 20 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients undergoing elective open laparotomy surgery. Exclusion Criteria: * Irregular heart beats, * cardiac arrhythmia, * moderate or severe valvular heart disease, * preoperative left ventriular ejection fraction less than 40%, * moderate t severe obstructive pulmonary disease, * preoperative need of inotropics infusion, * preoperative serum Cr \> 1.3ml/dl, * moderate to severe renal or liver disease, * acute lung injury or acute lung problem, * coexisting open chest condition, * severe bradycardia, * patients with spontaneous breathing

Locations (1)

Samsung Medical Center

Seoul, South Korea

Outcomes

Primary Outcomes

Augmented PPV (Pulse Pressure Variation) to predict fluid responsiveness

Augmented ventilation (12ml/kg) will be performed when the participant's PPV is within grey zone (9-13%). PPV value will be collected automatically by Intelivue philips patient monitor. Percentage changes in stroke volume index by EV1000 according to fluid loading were used as principal indicators of fluid responsiveness. Patients were classified as responders or non-responders when increases in SVI were ≥ 10% or \<10% after volume loading (crystalloid iv 6ml/kg). To test the abilities of augmented PPV to predict fluid responsiveness, areas under the receiver operating characteristics (ROC) curves of the responders \[area under the curve (AUC) = 0.5: no better than chance, no prediction possible; AUC = 1.0: best possible prediction\] will be calculated.

Time frame: within 2 min from augmented ventilation

Secondary Outcomes

Conventional baseline PPV to predict fluid responsiveness

PPV value will be collected automatically by Intelivue philips patient monitor.

Time frame: when patients PPV in grey zone, before augmented ventilation

Data from ClinicalTrials.gov

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