Predicting cardiac output responses to passive leg raising by a PEEP-induced increase in central venous pressure, in cardiac surgery patients B.F. Geerts,

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Predicting cardiac output responses to passive leg raising by a PEEP-induced increase in central venous pressure, in cardiac surgery patients B.F. Geerts, L.P.H.J. Aarts, A.B. Groeneveld, J.R.C. Jansen British Journal of Anaesthesia Volume 107, Issue 2, Pages 150-156 (August 2011) DOI: 10.1093/bja/aer125 Copyright © 2011 The Author(s) Terms and Conditions

Fig 1 In the first graph (a), the relationship between Baseline CVP and change in thermodilution CO by PLR (dCO, PLR) is shown (r=−0.63, P=0.003); in the second graph (b), the relationship between baseline SVV and dCO, PLR (r=0.67, P=0.002). In the third graph (c), the relationship between the PEEP-induced change in CVP (dCVP, PEEP) and dCO, PLR is depicted (r=0.77, P<0.001). Baseline values of CVP and SVV were the averaged results of baseline measurements before and after the PEEP challenge. dCVP is the change in CVP due to PEEP compared with the averaged baseline value. The horizontal dashed line in the graphs indicates the cut-off between responders and non-responders. British Journal of Anaesthesia 2011 107, 150-156DOI: (10.1093/bja/aer125) Copyright © 2011 The Author(s) Terms and Conditions

Fig 2 ROC curve of baseline CVP (dotted line), baseline SVV (dashed line), and change in CVP (straight line) upon a PEEP challenge to predict responsiveness to PLR. The AUC is 0.85 (with a 95% CI of 0.68–1.00) for baseline CVP, 0.99 (with a 95% CI of 0.94–1.00) for changes in CVP, and 0.90 (with a 95% CI of 0.76 and 1.00) for baseline SVV. British Journal of Anaesthesia 2011 107, 150-156DOI: (10.1093/bja/aer125) Copyright © 2011 The Author(s) Terms and Conditions

Fig 3 A simplified model of the interaction of the heart function curve and venous return curve. The effects of (a) PEEP and (b) fluid loading by PLR on CVP and CO are indicated. From hypovolaemia (hypo) to normovolaemia (normo), the venous return curve (straight line) moves up and the intersection with the cardiac function curve (curved line) increases to a higher CO and CVP level. (a) Addition of PEEP shifts the heart function curve to the right (dashed line) altering the intersection with the venous return curve to a lower CO and a higher CVP. With the application of PEEP, the change in CVP (dCVP) and the change in CO (dCO) are larger during hypovolaemia (dCVP1 and dCO1) than during normovolaemia (dCVP2 and dCO2). This suggests that the value of dCVP is an indicator for fluid loading responsiveness. (b) Addition of PLR (dashed lines) results in an increase in CVP and CO. With fluid loading by PLR during normovolaemia, a greater dCVP (dCVP2) and a smaller dCO (dCO2) are observable than during hypovolaemia (dCVP1 and dCO1). dCO with PLR have been shown to be an indicator of fluid loading responsiveness. For further explanation, see text. British Journal of Anaesthesia 2011 107, 150-156DOI: (10.1093/bja/aer125) Copyright © 2011 The Author(s) Terms and Conditions