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

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

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Muller L,Louart G,Bousquet PJ,Candela D,Zoric L,de La Coussaye JE,Jaber S,Lefrant JY

doi

10.1007/s00134-009-1686-y

subject

Has Abstract

pub_date

2010-03-01 00:00:00

pages

496-503

issue

3

eissn

0342-4642

issn

1432-1238

journal_volume

36

pub_type

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