2011, Number 2
Med Crit 2011; 25 (2)
Santiago TJ, Monares ZE, Olvera GC, Salinas MC, Montes OSMA, Franco GJ
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ABSTRACTIntroduction: The pulse pressure variation (PPV) is an indicator of intravascular volume. When PPV is › 13%, we assume that cardiac output (CO) increases in respond to volume infusion; if PPV is ‹ 7%, there is no effect to volume changes.
Methods: Patients with shock under mechanical ventilation in whom staff decided to use Swan-Ganz catheter were included; patients with mitral valve disease, arrhythmias and COPD excluded. CO, PCWP and VPP were obtained every hour during first 6 hours of reanimation. Values are expressed in means ± standard deviation.
Results: 730 patients were admitted to the ICU and 243 were diagnosed with shock; 16 had Swan-Ganz catheter and were under mechanical ventilation: 50% female, mean age: 60 ± 15 (23-82), APACHE II score: 18 ± 9 (5-44), ICU length of stay: 15 ± 5 (9-25); 50% had septic, 31% myocardial and 19% hypovolemic shock. Mortality in 28 days was 12.5%. Correlation between PCWP and PPV was r = 0.9, p = 0.05. Once PPV is obtained, PCWP can be calculated as correlation with real PCWP is: r = 0.91 p = 0.01.
Conclusion: When PPV is ‹ 6.5, PCWP is ›18 mmHg (r = 0.9, p = 0.05) there is an adequate correlation, and it is a reliable and less invasive measurement for reanimation in shock patients.