A comparative study of pulse pressure variation, stroke volume variation and central venous pressure in patients undergoing kidney transplantation
Introduction: Optimal intraoperative fluid management guided by central venous pressure (CVP), a traditional intravascular volume status indicator, has improved transplanted graft function during kidney transplantation (KT). Pulse pressure variation (PPV) and stroke volume variation (SVV) – dynamic...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer – Medknow Publications
2022-12-01
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| Series: | Singapore Medical Journal |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.11622/smedj.2021221 |
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| Summary: | Introduction:
Optimal intraoperative fluid management guided by central venous pressure (CVP), a traditional intravascular volume status indicator, has improved transplanted graft function during kidney transplantation (KT). Pulse pressure variation (PPV) and stroke volume variation (SVV) – dynamic preload indexes – are robust predictors of fluid responsiveness. This study aimed to compare the accuracy of PPV and CVP against SVV in predicting fluid responsiveness in terms of cost-effectiveness after a standardised empiric volume challenge in KT patients.
Methods:
36 patients undergoing living-donor KT were analysed. PPV, SVV, CVP and cardiac index (CI) were measured before and after fluid loading with a hydroxyethyl starch solution (7 mL/kg of ideal body weight). Patients were classified as responders (n = 12) or non-responders (n = 24) to fluid loading when CI increases were ≥10% or <10%, respectively. The ability of PPV, SVV and CVP to predict fluid responsiveness was assessed using receiver operating characteristic (ROC) curves.
Results:
SVV and CVP measured before fluid loading were correlated with changes in CI caused by fluid expansion (r = 0.33, P = 0.049 and r = −0.37, P = 0.026) in contrast to PPV (r = 0.14, P = 0.429). The ROC analysis showed that SVV and CVP predicted response to volume loading (area under the ROC curve = 0.781 and 0.727, respectively; P < 0.05).
Conclusion:
Under the conditions of our study, SVV and CVP exhibited similar performance in predicting fluid responsiveness and could inform fluid management during KT as compared with PPV. |
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| ISSN: | 0037-5675 2737-5935 |