scholarly journals Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients

Critical Care ◽  
2009 ◽  
Vol 13 (5) ◽  
pp. R142 ◽  
Author(s):  
Manuel Ignacio Monge García ◽  
Anselmo Gil Cano ◽  
Juan Carlos Díaz Monrové
Keyword(s):  
Fluid Responsiveness ◽  
Brachial Artery ◽  
Peak Velocity ◽  
Velocity Variation ◽  
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)

Sign in / Sign up

Export Citation Format

Share Document