Anesthesiology, August 2011 CME
The focus of Journal CME is to educate readers on current developments in the science and clinical practice of anesthesiology.
Read the article by by Cannesson et al. entitled “Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: A ‘gray zone’ approach,” on page 231 and the accompanying editorial by De Hert entitled “Assessment of fluid responsiveness: Insights in a ‘gray zone,’ ” on page 229 of this issue.
In mechanically ventilated patients undergoing general anesthesia, the best predictors of fluid responsiveness are respiratory arterial pulse pressure variations (PPV). However, previous studies on the subject were conducted using a small number of patients and determined a single cutoff point to make clinical discrimination. In contrast, the goal of the authors of the present study was to test the predictive value of PPV in a large, multicenter study and to express it using a gray zone approach. The gray zone approach identified a range of PPV values (between 9% and 13%) for which fluid responsiveness could not be predicted reliably; such values were seen in 24% of patients.
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After completing this activity, the learner should be able to:
- identify patients who would benefit from use of pulse pressure variation analysis,
- explain when to administer a fluid bolus to optimize cardiac output, and be able to compare patient responses to fluids in specific clinical situations.
Faculty & Credentials:
Article Authors: Maxime Cannesson, M.D., Ph.D., Yannick Le Manach, M.D., Ph.D., Christoph K. Hofer, M.D., Benoît Vallet, M.D., Ph.D., Benoît Tavernier, M.D., Ph.D., Jean Pierre Goarin, M.D., and Jean-Jacques Lehot, M.D., Ph.D.
Editorial Author: Stefan G. De Hert, M.D., Ph.D.
Editor-in-Chief: James C. Eisenach, M.D.
CME Editors: Leslie C. Jameson, M.D., and Dan J. Kopacz, M.D.
Core Competencies:Medical knowledge
CME Credit:1.00 AMA PRA Category 1 Credit™
The American Society of Anesthesiologists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The American Society of Anesthesiologists designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Required Hardware / Software:
Internet connection, Adobe Acrobat Reader