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According to the Frank-Starling relationship, a patient is a 'responder' to volume expansion only if both ventricles are preload dependent. Mechanical ventilation induces cyclic changes in left ventricular (LV) stroke volume, which are mainly related to the expiratory decrease in LV preload due to the inspiratory decrease in right ventricular (RV) filling(More)
INTRODUCTION Several studies have shown that maximizing stroke volume (or increasing it until a plateau is reached) by volume loading during high-risk surgery may improve post-operative outcome. This goal could be achieved simply by minimizing the variation in arterial pulse pressure (deltaPP) induced by mechanical ventilation. We tested this hypothesis in(More)
In mechanically ventilated patients with acute circulatory failure related to sepsis, we investigated whether the respiratory changes in arterial pressure could be related to the effects of volume expansion (VE) on cardiac index (CI). Forty patients instrumented with indwelling systemic and pulmonary artery catheters were studied before and after VE.(More)
INTRODUCTION Dynamic predictors of fluid responsiveness, namely systolic pressure variation, pulse pressure variation, stroke volume variation and pleth variability index have been shown to be useful to identify in advance patients who will respond to a fluid load by a significant increase in stroke volume and cardiac output. As a result, they are(More)
PURPOSE Second-generation FloTrac software has been shown to reliably measure cardiac output (CO) in cardiac surgical patients. However, concerns have been raised regarding its accuracy in vasoplegic states. The aim of the present multicenter study was to investigate the accuracy of the third-generation software in patients with sepsis, particularly when(More)
In anesthetized patients without cardiac arrhythmia the arterial pulse pressure variation (PPV) induced by mechanical ventilation has been shown the most accurate predictor of fluid responsiveness. In this respect, PPV has so far been used mainly in the decision-making process regarding volume expansion in patients with shock. As an indicator of the(More)
INTRODUCTION A new system has been developed to assess global end-diastolic volume (GEDV), a volumetric marker of cardiac preload, and extravascular lung water (EVLW) from a transpulmonary thermodilution curve. Our goal was to compare this new system with the system currently in clinical use. METHODS Eleven anesthetized and mechanically ventilated pigs(More)
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Since its first description in 1999 [1], many studies have demonstrated the value of pulse pressure variation (PPV) as a predictor of fluid responsiveness. These studies were pooled together in a recent meta-analysis [2] concluding that PPV predicts fluid responsiveness accurately (sensitivity 88%, specificity 89%), so long as limitations to its use [3,4](More)
read with interest two recent studies suggesting that pulse pressure variation (PPV) is not an accurate pre-dictor of fl uid responsiveness in subjects with pulmonary hypertension [1,2]. We agree that PPV and stroke volume variation (SVV) may not work in patients with right ventricular (RV) failure. Indeed, when PPV and SVV are related to an inspiratory(More)