Correlation of pulse pressure variation with central venous pressure for intra–operative fluid management in adult neurosurgical patients
Abstract
Background & Objectives: Neurosurgical operations involve major fluid shifts. Fluid management in such critical brain-injured patients is aimed at maintaining sufficient cerebral blood flow and oxygenation. Goal directed fluid strategies are beneficial in rationalization of the way the patients are treated. With availability of less invasive methods for monitoring, use of parameters like Stroke Volume Variation (SVV) and Pulse Pressure Variation (PPV) have been used to guide fluid management as these are more useful than central venous pressure (CVP) measurement. This study correlated an easily established monitoring technique like PPV with CVP for intra-operative fluid management in adult neurosurgical patients undergoing elective craniotomies.
Methodology: This prospective, observational study was carried out in 60 patients of either sex, age group 18 to 65 y, planned for elective craniotomies conducted in neurosurgical operation theatre. After anesthesia induction radial arterial cannulation was carried out to monitor the invasive arterial blood pressure and PPV (normal less than 13%). Central venous cannulation was carried out and transduced to measure the CVP.
Results: The sensitivity of CVP after calculating entirely was 5.0% and the specificity was 90%. The positive predictive value of CVP was 50.0% and the negative predictive value was a mere 32.14 %. The sensitivity of PPV was 50.0% and specificity was 32.14%. The positive predictive value was 5.00% and negative predictive value was 90%.
Conclusion: PPV is a reliable index of fluid management guidance in adult neurosurgical patients undergoing elective craniotomies as compared to CVP, which can lead to excessive administration of fluids.
Abbreviations: SVV – Stroke Volume Variation; PPV – Pulse Pressure Variation; CVP – Central venous pressure; VBG – Venous blood gas; HR – Heart Rate;
Keywords: Neurosurgery, fluid therapy, central venous pressure, arterial pressure, pulse pressure variation.
Citation: Bhokare PP, Nellore S, Karnik H. Correlation of pulse pressure variation with central venous pressure for intra–operative fluid management in adult neurosurgical patients. Anaesth. pain intensive care 2021;25(3):329–337. DOI: doi.org/10.35975/apic.v25i3.1483
Received: April 4, 2021; Reviewed: April 25, 2021; Accepted: May 15, 2021
