scholarly journals Proving the effectiveness of three dynamic indices to predict fluid responsiveness in septic mechanically ventilated patients

Critical Care ◽  
2009 ◽  
Vol 13 (Suppl 1) ◽  
pp. P208
Author(s):  
P Wacharasint ◽  
A Lertamornpong ◽  
A Wathanathum ◽  
A Wongsa
Keyword(s):  
Fluid Responsiveness ◽  
Predict Fluid Responsiveness ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

scholarly journals Slope analysis for the prediction of fluid responsiveness by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Sylvain Vallier ◽  
Jean-Baptiste Bouchet ◽  
Olivier Desebbe ◽  
Camille Francou ◽  
Darren Raphael ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Fluid Responsiveness ◽  
Volume Expansion ◽  
Recruitment Maneuver ◽  
Predict Fluid Responsiveness ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Slope Analysis ◽  
Ventilated Patients

Abstract Objective Assessment of fluid responsiveness is problematic in intensive care unit patients. Lung recruitment maneuvers (LRM) can be used as a functional test to predict fluid responsiveness. We propose a new test to predict fluid responsiveness in mechanically ventilated patients by analyzing the variations in central venous pressure (CVP) and systemic arterial parameters during a prolonged sigh breath LRM without the use of a cardiac output measuring device. Design Prospective observational cohort study. Setting Intensive Care Unit, Saint-Etienne University Central Hospital. Patients Patients under mechanical ventilation, equipped with invasive arterial blood pressure, CVP, pulse contour analysis (PICCO™), requiring volume expansion, with no right ventricular dysfunction. Interventions. None. Measurements and main results CVP, systemic arterial parameters and stroke volume (SV) were recorded during prolonged LRM followed by a 500 mL fluid expansion to asses fluid responsiveness. 25 patients were screened and 18 patients analyzed. 9 patients were responders to volume expansion and 9 were not. Evaluation of hemodynamic parameters suggested the use of a linear regression model. Slopes for systolic arterial pressure, pulse pressure (PP), CVP and SV were all significantly different between responders and non-responders during the pressure increase phase of LRM (STEP-UP) (p = 0.022, p = 0.014, p = 0.006 and p = 0.038, respectively). PP and CVP slopes during STEP-UP were strongly predictive of fluid responsiveness with an AUC of 0.926 (95% CI, 0.78 to 1.00), sensitivity = 100%, specificity = 89% and an AUC = 0.901 (95% CI, 0.76 to 1.00), sensibility = 78%, specificity = 100%, respectively. Combining sensitivity of PP and specificity of CVP, prediction of fluid responsiveness can be achieved with 100% sensitivity and 100% specificity (AUC = 0.96; 95% CI, 0.90 to 1.00). One patient showed inconclusive values using the grey zone approach (5.5%). Conclusions In patients under mechanical ventilation with no right heart dysfunction, the association of PP and CVP slope analysis during a prolonged sigh breath LRM seems to offer a very promising method for prediction of fluid responsiveness without the use and associated cost of a cardiac output measurement device. Trial registration NCT04304521, IRBN902018/CHUSTE. Registered 11 March 2020, Fluid responsiveness predicted by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients (STEP-PEEP)

scholarly journals Slope Analysis for the Prediction of Fluid Responsiveness by a Stepwise PEEP Elevation Recruitment Maneuver in Mechanically Ventilated Patients

2020 ◽  
Author(s):  
Sylvain VALLIER ◽  
Jean-Baptiste BOUCHET ◽  
Olivier DESEBBE ◽  
Camille FRANCOU ◽  
Darren RAPHAEL ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Output ◽  
Fluid Responsiveness ◽  
Volume Expansion ◽  
Recruitment Maneuver ◽  
Predict Fluid Responsiveness ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Slope Analysis ◽  
Ventilated Patients

Abstract Objective:Assessment of fluid responsiveness is problematic in intensive care unit patients. Lung recruitment maneuvers (LRM) can be used as a functional test to predict fluid responsiveness. We propose a new test to predict fluid responsiveness in mechanically ventilated patients, analyzing the variations of central venous pressure (CVP) and systemic arterial parameters during a prolonged sigh breath LRM without the use of a cardiac output measuring device. Design:Prospective observational cohort study.Setting:Intensive Care Unit, Saint-Etienne University Central Hospital.Patients:Patients under mechanical ventilation, equipped with invasive arterial blood pressure, CVP, pulse contour analysis (PICCOTM), requiring volume expansion, with no right ventricular dysfunction.Interventions:None.Measurements and Main Results:CVP, systemic arterial parameters and stroke volume (SV) were recorded during prolonged LRM followed by a 500mL fluid expansion to asses fluid responsiveness. 25 patients were screened, 18 patients were analyzed. 9 patients were responders to volume expansion and 9 were not. Evaluation of hemodynamics parameters suggested the use of a linear interpolation model. Slopes for systolic aortic pressure, pulse pressure (PP), CVP and SV were all significantly different between responders and non-responders during pressure increase phase of LRM (STEP-UP) (p = 0.022, p = 0.014, p= 0.006 and p = 0.038, respectively). PP and CVP slopes during STEP-UP were strongly predictive of fluid responsiveness with an AUC of 0.926 (95% CI, 0.78 to 1.00), sensitivity = 100%, specificity = 89% and an AUC = 0.901 (95% CI, 0.76 to 1.00), sensibility = 78%, specificity = 100%, respectively. Combining sensitivity of PP and specificity of CVP, fluid responsiveness prediction can be obtained with 100% sensibility and 100% specificity (AUC=0.96; 95% CI, 0.90 to 1.00). 1 patient presented inconclusive values using the grey zone approach (5.5%).Conclusions:In patients under mechanical ventilation with no right cardiac dysfunction, the association of PP and CVP slope analysis during a prolonged sigh breath lung recruitment maneuver seems to offer a very promising method for fluid responsiveness prediction without the use and cost of a cardiac output measurement device.Trial registration: NCT04304521, IRBN902018/CHUSTERegistered 11 March 2020, Fluid responsiveness predicted by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients (STEP-PEEP)https://www.clinicaltrials.gov/ct2/show/NCT04304521?term=NCT04304521&cntry=FR&draw=2&rank=1

scholarly journals Dynamic Transesophageal Echocardiographic Parameters for Predicting Fluid Responsiveness in Mechanically Ventilated Patients

2021 ◽  
Author(s):  
Yaru Li ◽  
Luyang Jiang ◽  
Yi Feng ◽  
Hai Ting ◽  
Guang Wang ◽  
...  
Keyword(s):  
Fluid Responsiveness ◽  
Venous Pressure ◽  
Fluid Challenge ◽  
Clinical Trial Registry ◽  
Predict Fluid Responsiveness ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Before And After ◽  
Echocardiographic Parameters ◽  
Ventilated Patients

Abstract Background: The aim was to investigate the feasibility of the dynamic transesophageal echocardiographic parameters to predict fluid responsiveness in mechanically ventilated patients. Methods: In the prospective study, a total of 60 patients scheduled for elective general surgery under mechanical ventilation were enrolled. All patients received 10ml/kg Ringer’s lactate. The data including central venous pressure (CVP), cardiac index (CI), stroke volume variation (SVV), SVC-CI, E velocity, and the ratio of E/e’ was recorded before and after fluid challenge. Patients were classified as Responders (FR group) if their CI increased by at least 15% after fluid challenge. Results: 25/52(48%) were Responders and 27 were non-Responders (52%). The SVC-CI was higher in the Responders (41.90±11.48% vs 28.92±9.05%, P＜0.01). SVC-CI was significantly correlated with △CI (r=0.568, P＜0.01). The area under the ROC curve (AUROC) of SVC-CI was 0.838 (95% CI: 0.728～0.947, P＜0.01) with the optimal cut-off value of 39.4% (sensitivity 64%, specificity 92.6%). The best cut-off value for SVV was 12.5% (sensitivity 40%, specificity 89%) with the AUROC of 0.68 (95% CI 0.53～0.826, P＜0.05). Conclusion: The SVC-CI and SVV can predict fluid responsiveness effectively in mechanically ventilated patients. And SVC-CI is superior in predicting fluid responsiveness compared with SVV. Trial registration: Chinese Clinical Trial Registry, ChiCTR2000034940, Registered 25 July 2020, https://www.chictr.org.cn/index.aspx

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