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CRITICAL CARE AND TRAUMA

A Comparison of Changes in Cardiac Preload Variables During Graded Hypovolemia and Hypervolemia in Mechanically Ventilated Dogs

Yoshihisa Fujita, MD^*, Tokunori Yamamoto, MD, Itsuro Sano, MD^*, Naoki Yoshioka, MD^*, and Hajime Hinenoya, MD^*

Departments of *Anesthesiology & ICM and Urology, Kawasaki Medical School, Okayama, Japan

Address correspondence and reprint requests to Yoshihisa Fujita, MD, Department of Anesthesiology & ICM, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, Okayama, 701-0192 Japan. Address e-mail to fujitay{at}med.kawasaki-m.ac.jp

We developed an online monitoring system to measure systolic blood pressure variation (SPV) and its down (dDown) and up components, along with pulse pressure variation (dPP). Using the system, we compared different cardiac preload indicators—such as stroke volume variation (SVV) and corrected flow time (FTc)—along with central venous pressure and pulmonary artery occlusion pressure in mechanically-ventilated dogs during normovolemia, graded hypovolemia (–200 and –350 mL), and hypervolemia (+200 and +350 mL). We simultaneously measured these preload indicators along with global hemodynamic variables and investigated their validity and limitations to access preload changes. SPV increased from 4.8 ± 1.4 mm Hg at baseline to 11.2 ± 1.8 mm Hg during hypovolemia (–350 mL), but it did not change significantly during hypervolemia. Similar changes were observed with dDown, dPP, and SVV. FTc, conversely, increased during hypervolemia but remained unchanged during hypovolemia. The results of this study indicate that SPV, dDown, dPP, and SVV are useful indicators of hypovolemia, but not of hypervolemia. Conversely, hypovolemia could not be detected reliably by FTc, but it does reflect blood volume changes during hypervolemia. Although SPV, dDown, and dPP measurements require no additional invasion and cost beyond arterial cannulation, their limits must be kept in mind for the monitoring of blood volume status in mechanically-ventilated patients.

IMPLICATIONS: We simultaneously monitored dynamic preload variables—such as systolic blood pressure variation, its down component, pulse pressure variation, stroke volume variation, and esophageal Doppler-derived corrected flow time—during induced hypovolemia and hypervolemia. The results demonstrated that these variables, with the exception of corrected flow time, are useful indicators of hypovolemia, but not of hypervolemia.