Comparison of arterial pressure and plethysmographic waveform-based dynamic preload variables in assessing fluid responsiveness and dynamic arterial tone in patients undergoing major hepatic resection

Br J Anaesth. 2013 Jun;110(6):940-6. doi: 10.1093/bja/aes508. Epub 2013 Jan 24.


Background: Dynamic preload variables to predict fluid responsiveness are based either on the arterial pressure waveform (APW) or on the plethysmographic waveform (PW). We compared the ability of APW-based variations in stroke volume (SVV) and pulse pressure (PPV) and of PW-based plethysmographic variability index (PVI) to predict fluid responsiveness and to track fluid changes in patients undergoing major hepatic resection. Furthermore, we assessed whether the PPV/SVV ratio, as a measure of dynamic arterial elastance (Eadyn), could predict a reduction in norepinephrine requirement after fluid administration.

Methods: Thirty patients received i.v. fluid (15 ml kg(-1) in 30 min) after hepatic resection and were considered responders when stroke volume index (SVI) increased ≥20% after fluid administration. SVV and SVI were measured by the FloTrac-Vigileo(®) device, and PVI was measured by the Masimo Radical 7 pulse co-oximeter(®).

Results: The areas under a receiver operating characteristic curve for SVV, PPV, and PVI were 0.81, 0.77, and 0.78, respectively. In responders, all dynamic variables, except PVI, decreased after fluid administration. Eadyn predicted a reduced norepinephrine requirement (AUC = 0.81).

Conclusions: In patients undergoing major hepatic resection, both APW- and PW-based dynamic preload variables predict fluid responsiveness (preload) to a similar extent. Most variables (except PVI) also tracked fluid changes. Eadyn, as a measure of arterial elastance (afterload), might be helpful to distinguish the origin of hypotension.

Clinical trial registration:, NCT01060683.

Keywords: arterial pressure; circulation; fluid therapy; measurement techniques; monitoring; cardiopulmonary.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arterial Pressure*
  • Female
  • Fluid Therapy*
  • Hepatectomy*
  • Humans
  • Male
  • Norepinephrine / pharmacology
  • Plethysmography*
  • ROC Curve
  • Stroke Volume


  • Norepinephrine

Associated data