We read with interest the report from Piraccini et al. and congratulate them on their management of severe postpartum haemorrhage in a Jehovah’s Witness patient.
1Their management of this difficult scenario was guided largely by the Flotrac/Vigileo cardiac output monitoring system (Edwards Lifesciences, Irvine, CA, USA). Specifically, optimization of preload was directed by stroke volume variation (SVV) which occurs due to changes in intrathoracic pressure during the respiratory cycle causing variation in caval blood flow with subsequent effects on preload. SVV has been validated as a predictor of fluid responsiveness in mechanically-ventilated patients in a number of studies.
- Piraccini E.
- Corso R.M.
- Agnoletti V.
- Terzitta M.
- Valtancoli E.
- Gambale G.
Cardiac output and fluid replacement in a Jehovah’s Witness with severe postpartum hemorrhage.
Int J Obstet Anesth. 2010; 19: 462-463
- Berkenstadt H.
- Margalit N.
- Hadani M.
- et al.
Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery.
Anesth Analg. 2001; 92: 984-989
- Michard F.
Changes in arterial pressure during mechanical ventilation.
Anesthesiology. 2005; 103: 419-428
4Generally, tidal volumes >8 mL/kg and fixed respiratory rates are specified.
- Reuter D.A.
- Kirchner A.
- Felbinger T.W.
- et al.
Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function.
Crit Care Med. 2003; 31: 1399-1404
5The rationale for this is the need for consistent change in intrathoracic pressure from one respiratory cycle to the next, and a sufficiently large change in pressure to cause a measurable change in stroke volume (SV). It is normally calculated using the formula: . Currently the literature does not support the use of SVV in spontaneously-breathing patients as intrathoracic pressure changes are irregular in size and duration.
- Chikhani M.
- Moppett I.K.
Minimally invasive cardiac output monitoring: what evidence do we need?.
Br J Anaesth. 2011; 106: 451-453
- Eyre L.
- Breen A.
Optimal volaemic status and predicting fluid responsiveness.
Contin Educ Anaesth Crit Care Pain. 2010; 10: 59-62
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- Cardiac output and fluid replacement in a Jehovah’s Witness with severe postpartum hemorrhage.Int J Obstet Anesth. 2010; 19: 462-463
- Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery.Anesth Analg. 2001; 92: 984-989
- Changes in arterial pressure during mechanical ventilation.Anesthesiology. 2005; 103: 419-428
- Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function.Crit Care Med. 2003; 31: 1399-1404
- Minimally invasive cardiac output monitoring: what evidence do we need?.Br J Anaesth. 2011; 106: 451-453
- Optimal volaemic status and predicting fluid responsiveness.Contin Educ Anaesth Crit Care Pain. 2010; 10: 59-62
- Volume responsiveness.Curr Opin Crit Care. 2007; 13: 549-553
Published online: August 12, 2011
© 2011 Published by Elsevier Inc. All rights reserved.