Systolic pressure variation in hemodynamic monitoring after severe blast injury

Fluid management in patients following blast injury is a major challenge. F luid overload can exacerbate pulmonary dysfunction, whereas suboptimal resu scitation may exacerbate tissue damage. In three patients, we compared thre e methods of assessing volume status: central venous (CVP) and pulmonary ar tery occlusion (PAOP) pressures, left ventricular end-diastolic area (LVEDA ) as measured by transesophageal echocardiography, and systolic pressure va riation (SPV) of arterial blood pressure. All three patients were mechanica lly ventilated with high airway pressures (positive end-expiratory pressure 13 to 15 cm H2O, pressure control ventilation of 25 to 34 cm H2O, and I:E 2:1). Central venous pressure and PAOP were elevated in two of the patients (CVP 14 and 18 mmHg, PAOP 25 and 17 mmHg), Transesophageal echocardiograph y was performed in two patients and suggested a diagnosis of hypovolemia (L VEDA 2.3 and 2.7 cm(2), shortening fraction 52% and 40%). Systolic pressure variation was elevated in all three patients (15 mmHg, 15 mmHg, and 20 mmH g), with very prominent dDown (23, 40, and 30 mmHg) and negative dUp compon ents, thus corroborating the diagnosis of hypovolemia. Thus, in patients wh o are mechanically ventilated with high airway pressures, SPV may be a help ful tool in the diagnosis of hypovolemia. (C) 1999 by Elsevier Science Inc.