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Intensive Care Med. 2010 Mar;36(3):496-503. doi: 10.1007/s00134-009-1686-y. Epub 2009 Oct 22.

The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness.

Author information

1
Division Anesthésie Réanimation Douleur Urgences, Groupe Hospitalo-Universitaire Caremeau, CHU Nîmes, Place du Professeur Robert Debré, 30029, Nîmes Cedex 9, France.

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 (P(plat) - 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) >or=15%. Receiver-operating characteristic (ROC) curves were generated for PPV and central venous pressure (CVP).

RESULTS:

The stroke index was increased >or=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 (P(plat)--PEEP) was the sole independent factor associated with a PPV value <13% in responders. In these responders, (P(plat)--PEEP) was <or=20 cmH(2)O.

CONCLUSION:

In patients mechanically ventilated with low VT, PPV values <13% do not rule out fluid responsiveness, especially when (P(plat)--PEEP) is <or=20 cmH(2)O.

PMID:
19847400
DOI:
10.1007/s00134-009-1686-y
[Indexed for MEDLINE]

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