Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care

Bendjelid, Karim; Romand, Jacques-A.

doi:10.1007/978-3-642-28233-1_1

Cited by 36 publications

(51 citation statements)

References 83 publications

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“…In the past decades, it has been shown that static indices such as CVP, PCWP, left ventricular end diastolic area, and right ventricular end-diastolic volume are not accurate for the prediction of fluid responsiveness [13,[47][48][49][50][51]. In contrast, several studies have shown that dynamic indices, such as SVV and PPV, are able to predict fluid responsiveness accurately [52][53][54][55][56].…”

Section: Pulse Contour Analysismentioning

confidence: 99%

Guiding Goal-Directed Therapy

Suehiro

Joosten

Alexander

2014

Curr Anesthesiol Rep

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Several studies have demonstrated that perioperative hemodynamic optimization (or ''goal directed therapy'') using minimally invasive hemodynamic monitoring technologies has the ability to improve postoperative patients' outcome with lower complication rates, shorter hospital lengths of stay, and lower cost of surgery. This specific concept of goal-directed therapy (GDT) uses perioperative cardiac output monitoring and manipulation of physiologic parameters (dynamic parameters of fluid responsiveness) to guide intravenous fluids and inotropic therapy with the goal of ensuring adequate tissue perfusion. Recently, the evidence related to the implementation of GDT strategies has been considered strong enough to allow for the creation of national recommendations in the UK, in France, and by the European Society of Anaesthesiology. The aims of the programs are to apply best practices to high-risk surgical patients and requires the participation of all clinicians involved in patients' care. Considering the potential clinical and economic benefits of GDT protocols and the positive recommendations from influential scientific societies, more and more hospitals around the world have become interested in implementing hemodynamic optimization in their departments. This review provides the information about the evolution of hemodynamic monitoring from invasive to the more recent noninvasive devices, and how these devices can be used in the operating rooms through well-defined algorithms of GDT.

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Section: Pulse Contour Analysismentioning

confidence: 99%

Guiding Goal-Directed Therapy

Suehiro

Joosten

Alexander

2014

Curr Anesthesiol Rep

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“…Relying on pulmonary capillary wedge pressure to reflect ventricular volume, Perel et al [ 12 ] and Szold et al [15] showed that pulmonary capillary wedge pressure was related to SPV with both volume loading and phlebotomy in mechanically ventilated dogs. However, filling pressure cannot be used to reflect preload during mechanical ventilation (as is clear in Figure 4) or predict volume responsiveness [31][32][33][34]. Indeed, Denault et al [35] found that changes in systolic arterial pressure reflected changes in airway and intrathoracic pressure better than changes in echocardiographic enddiastolic area measurements in cardiac surgery patients.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Preload Determines Systolic Pressure Variation during Mechanical Ventilation in Acute Lung Injury

Mitchell¹,

Doig²,

Whitelaw³

2011

J Clinic Experiment Cardiol

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Although volume is commonly administered to patients with hemodynamic compromise during mechanical ventilation to improve cardiac output, excessive amounts may precipitate or aggravate pulmonary edema, especially in patients with predisposing pulmonary or cardiac conditions. The ability to predict the hemodynamic response to a volume challenge should facilitate patient management and might help to avoid harm in those who are unlikely to benefit from volume loading.Systolic arterial pressure variation (SPV) during mechanical ventilation is more pronounced in hypovolemic than in euvolemic patients [1][2][3]. Cyclical changes in left ventricular (LV) preload during mechanical ventilation and the resultant changes in stroke volume are related to complex cardiopulmonary interactions including changes in external constraint and LV afterload, as well as systemic and pulmonary venous return through series and direct ventricular interaction [4][5][6][7][8][9][10][11]. The magnitude of SPV has been shown to predict responsiveness to a volume challenge [1][2][3][12][13][14][15][16]. One might anticipate that as LV and right ventricular (RV) preload increase during volume loading, changes in intrathoracic pressure would affect ventricular filling (and output) less and thus, SPV would be less. Alternatively stated, at higher filling pressures, the ventricles are on a flatter part of the Starling curve (fiber length cannot be increased further by increasing the filling pressure further). Therefore, a given airway pressure is less likely to reduce fiber length at higher filling pressures than at lower pressures where the Starling curve is steeper.We therefore assessed the relations between LV preload, output and SPV in an oleic acid (OA) induced acute lung injury (ALI) model in which LV filling pressures and positive end-expiratory pressures (PEEP) were systematically varied. We also assessed the potential value of estimated transmural LV end-diastolic pressure [left atrial enddiastolic pressure (P LAED ) -RV end-diastolic pressure (P RVED )], which reflects LV preload, in predicting volume responsiveness in our model. MethodsThis study was approved by the institutional animal care committee whose criteria are consistent with those of the American Physiological Society. Animal preparationIn 8 mongrel dogs of either sex (20-30 kg, mean 24 kg), anesthesia was induced with thiopental sodium (25 mg/kg i.v.) and midazolam (5 mg/ml bolus) and was maintained with fentanyl citrate (0.04 mg/ml i.v., initially, followed by an infusion of 4 mg/h), which was adjusted AbstractBackground: Systolic pressure variation (SPV) predicts responsiveness to volume loading during mechanical ventilation and may be related to changes in LV preload and the resultant changes in stroke volume (SV). We, therefore, tested the relations between LV preload, output and SPV in an acute lung injury (ALI) model during mechanical ventilation.

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“…Central venous pressure is currently commonly used as guide for resuscitation, although there are recognized limitations to ventricular filling pressures estimated as surrogate for fluid resuscitations [31,32]. In mechanical ventilated patient target CVP of 12 to 15 mmHg is recommended to account for impediment of filling due to increase intrathoracic pressure [33]. Other cases to consider higher CVP include increased abdominal pressure and diastolic dysfunction [34].…”

Section: Initial Resuscitationmentioning

confidence: 99%