Spontaneous Variability in Functional Hemodynamic Indices: Enhancing Interpretation of Hemodynamic Changes

2.50
Hdl Handle:
http://hdl.handle.net/10755/157155
Category:
Abstract
Type:
Presentation
Title:
Spontaneous Variability in Functional Hemodynamic Indices: Enhancing Interpretation of Hemodynamic Changes
Author(s):
Pambianco, Susan; Sprow, Sarah; Barnes, Sarah; Sawin, Laura; Harris, Renee; Greco, Sheryl
Author Details:
Susan Pambianco, University of Washington Medical Center, Seattle, Washington, USA, email: sbeaty29@hotmail.com; Sarah Sprow; Sarah Barnes; Laura Sawin; Renee Harris; Susan Pambianco; Sheryl Greco
Abstract:
PURPOSE: Describe the spontaneous variability in systolic pressure variation (SPV and SPV%) over time in hemodynamically stable, mechanically ventilated medical-surgical ICU patients BACKGROUND: The SPV and SPV% are functional hemodynamic indices that are sensitive and specific predictors of fluid responsiveness and may also be indicators of occult hemorrhage. Similar to research that has described the variability in PA pressure, CO and SvO2, description of the normal fluctuation of SPV/SPV% may aid in the interpretation of changes in these indices and may serve to alert the nurse to an occult change in the patient's status. METHODS: Observational, repeated measures design. 30 stable (change in HR < 10%, no arrhythmias) ventilated medical-surgical ICU patients were studied. Over 30 minutes, SBP (from a referenced and optimized a-line) and airway pressure measurements were obtained every 5 minutes. At each time SBP from 9 ventilator cycles was recorded. No interventions occurred during the study. Analog copies of the waveforms were printed and the indices were measured offline using a digitized copy. The variability for each subject between the 9 measures was averaged and then the differences between each 5 and 10 minute period were compared using a lag function. RESULTS: Data from 28 patients were analyzed (2 excluded due to poor quality tracings or ectopy). Patients on assist control ventilation (tidal volume = 570 +/- 150 ml). SBP 136 +/- 22 mm Hg. One patient was receiving a vasopressor. The average SPV was 4.8 +/-3.6 mm Hg and the SPV% was 3.8 +/- 3.1%. The differences in average fluctuations between each 5 minute period (indicating the variability in the SPV and SPV% overtime) was 0.1 +/- 1.4 mm Hg (95% CI -2.8 mm Hg, 3.0 mm Hg) and SPV% 0.1 +/- 1.0% (95% CI -1.3%, 3.0%). For a 10 minute lag the average variability of the difference was SPV (0.2 +/- 1.7 mm Hg; 95% CI -3.1, 3.5 mm Hg) and SPV% (0.2 +/- 1.2%, 95% CI -2.0, 2.5%). CONCLUSIONS: The SPV and SPV% were below thresholds indicative of fluid responsiveness, suggesting adequacy of resuscitation. The 95% CI indicate that a change in the SPV > +/- 3 mm Hg or SPV > +/- 3% over 5 -10 minutes would be greater than expected variability, indicating a need to assess the patient for occult intravascular fluid loss or change in vascular tone. Results confirm research that found a change in SPV > 4 mm Hg occurred with significant blood loss and suggests an additional use for these indices.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleSpontaneous Variability in Functional Hemodynamic Indices: Enhancing Interpretation of Hemodynamic Changesen_GB
dc.contributor.authorPambianco, Susanen_GB
dc.contributor.authorSprow, Sarahen_GB
dc.contributor.authorBarnes, Sarahen_GB
dc.contributor.authorSawin, Lauraen_GB
dc.contributor.authorHarris, Reneeen_GB
dc.contributor.authorGreco, Sherylen_GB
dc.author.detailsSusan Pambianco, University of Washington Medical Center, Seattle, Washington, USA, email: sbeaty29@hotmail.com; Sarah Sprow; Sarah Barnes; Laura Sawin; Renee Harris; Susan Pambianco; Sheryl Grecoen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157155-
dc.description.abstractPURPOSE: Describe the spontaneous variability in systolic pressure variation (SPV and SPV%) over time in hemodynamically stable, mechanically ventilated medical-surgical ICU patients BACKGROUND: The SPV and SPV% are functional hemodynamic indices that are sensitive and specific predictors of fluid responsiveness and may also be indicators of occult hemorrhage. Similar to research that has described the variability in PA pressure, CO and SvO2, description of the normal fluctuation of SPV/SPV% may aid in the interpretation of changes in these indices and may serve to alert the nurse to an occult change in the patient's status. METHODS: Observational, repeated measures design. 30 stable (change in HR < 10%, no arrhythmias) ventilated medical-surgical ICU patients were studied. Over 30 minutes, SBP (from a referenced and optimized a-line) and airway pressure measurements were obtained every 5 minutes. At each time SBP from 9 ventilator cycles was recorded. No interventions occurred during the study. Analog copies of the waveforms were printed and the indices were measured offline using a digitized copy. The variability for each subject between the 9 measures was averaged and then the differences between each 5 and 10 minute period were compared using a lag function. RESULTS: Data from 28 patients were analyzed (2 excluded due to poor quality tracings or ectopy). Patients on assist control ventilation (tidal volume = 570 +/- 150 ml). SBP 136 +/- 22 mm Hg. One patient was receiving a vasopressor. The average SPV was 4.8 +/-3.6 mm Hg and the SPV% was 3.8 +/- 3.1%. The differences in average fluctuations between each 5 minute period (indicating the variability in the SPV and SPV% overtime) was 0.1 +/- 1.4 mm Hg (95% CI -2.8 mm Hg, 3.0 mm Hg) and SPV% 0.1 +/- 1.0% (95% CI -1.3%, 3.0%). For a 10 minute lag the average variability of the difference was SPV (0.2 +/- 1.7 mm Hg; 95% CI -3.1, 3.5 mm Hg) and SPV% (0.2 +/- 1.2%, 95% CI -2.0, 2.5%). CONCLUSIONS: The SPV and SPV% were below thresholds indicative of fluid responsiveness, suggesting adequacy of resuscitation. The 95% CI indicate that a change in the SPV > +/- 3 mm Hg or SPV > +/- 3% over 5 -10 minutes would be greater than expected variability, indicating a need to assess the patient for occult intravascular fluid loss or change in vascular tone. Results confirm research that found a change in SPV > 4 mm Hg occurred with significant blood loss and suggests an additional use for these indices.en_GB
dc.date.available2011-10-26T19:28:14Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:28:14Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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