The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2012-02-17

AUTHORS

Laurent Muller , Guillaume Louart , Philippe-Jean Bousquet , Damien Candela , Lana Zoric , Jean-Emmanuel de La Coussaye , Samir Jaber , Jean-Yves Lefrant

ABSTRACT

Objective: Assessing pulse pressure variation (PPV) to predict fluid responsiveness in mechanically ventilated patients with tidal volume (VT) and the impact of VT and airway driving pressure (Pplat - PEEP) on the ability of PPV for predicting fluid responsiveness. Design: Prospective interventional study. Setting: ICU of a university hospital. Patients: Fifty-seven mechanically ventilated and sedated patients with acute circulatory failure requiring cardiac output (CO) measurement. Intervention: Fluid challenge was given in patients with signs of hypoperfusion (oliguria <0.5 ml kg-1 h-1, attempt to decrease vasopressor infusion rate). Fluid responsiveness was defined as an increase in the stroke index (SI) ≥15%. Receiver-operating characteristic (ROC) curves were generated for PPV and central venous pressure (CVP). Results: The stroke index was increased ≥15% in 41 patients (71%). At baseline, CVP was lower and PPV was higher in responders. The areas under the ROC curves of PPV and CVP were 0.77 (95% CI 0.65–0.90) and 0.76 (95% CI 0.64– 0.89), respectively (P = 0.93). The best cutoff values of PPV and CVP were 7% and 9 mmHg, respectively. In 30 out of 41 responders, PPV was<13%. Using a polytomic logistic regression (Pplat - PEEP) was the sole independent factor associated with a PPV value<13% in responders. In these responders, (Pplat - PEEP) was ≤20 cmH2O. Conclusion: In patients mechanically ventilated with low VT, PPV values<13% do not rule out fluid responsiveness, especially when (Pplat - PEEP) is ≤20 cmH2O. More... »

PAGES

217-224

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-3-642-28270-6_41

DOI

http://dx.doi.org/10.1007/978-3-642-28270-6_41

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1049827126


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