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


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2009-10-22

AUTHORS

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

ABSTRACT

ObjectiveAssessing 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.DesignProspective interventional study.SettingICU of a university hospital.PatientsFifty-seven mechanically ventilated and sedated patients with acute circulatory failure requiring cardiac output (CO) measurement.InterventionFluid 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).ResultsThe 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.ConclusionIn patients mechanically ventilated with low VT, PPV values <13% do not rule out fluid responsiveness, especially when (Pplat − PEEP) is ≤20 cmH2O. More... »

PAGES

496-503

References to SciGraph publications

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  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00134-009-1686-y

    DOI

    http://dx.doi.org/10.1007/s00134-009-1686-y

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1024006807

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/19847400


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