Predicting Fluid Responsiveness in Critically Ill Patients by Using Combined End-Expiratory and End-Inspiratory Occlusions With Echocardiography

Jozwiak, Mathieu; Dépret, François; Teboul, Jean‐Louis; Alphonsine, Jean-Emmanuel; Lai, Christopher; Richard, Christian; Monnet, Xavier

doi:10.1097/ccm.0000000000002704

Cited by 73 publications

(83 citation statements)

References 23 publications

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“…In 2009, our group showed in critically ill patients that an increase in CO ≥ 5% during a 15-s EEO reliably predicted its response to a 500-mL saline infusion [1]. Among 12 further studies, all but two confirmed these results [2][3][4][5][6][7][8][9][10][11][12][13], with areas under the receiver operating characteristic curve (AUROC) ranging from 0.90 [13] to 1.00 [11]. In two studies, the test was reliable if performed with a tidal volume at 8 and not 6 mL/kg [9,12].…”

Section: Is the Eeo Test Reliable?mentioning

confidence: 79%

“…The least significant change of the velocity time integral (VTI) obtained using echocardiography is 10% only [15], which might be too large compared to the 5% diagnostic threshold of the EEO test. To overcome this issue, our group has proposed to combine the results of two tests sequentially performed: 15-s EEO and 15-s end-inspiratory occlusion (EIO) [8]. The hypothesis was that EEO should increase VTI in preload responsive patients, whereas EIO should decrease VTI in these patients [8].…”

Section: How To Detect Eeo-related Effects?mentioning

confidence: 99%

“…To overcome this issue, our group has proposed to combine the results of two tests sequentially performed: 15-s EEO and 15-s end-inspiratory occlusion (EIO) [8]. The hypothesis was that EEO should increase VTI in preload responsive patients, whereas EIO should decrease VTI in these patients [8]. We have shown that when the percent changes in VTI induced by EEO and EIO were added, the "EEO+EIO" test was as reliable as the EEO test alone, but with a threshold of 13%, which is more compatible with the precision of the technique.…”

Section: How To Detect Eeo-related Effects?mentioning

confidence: 99%

“…With some of these tests, the relationship between CO and cardiac preload is assessed through the haemodynamic effects of mechanical ventilation. It is the case for the end-expiratory occlusion (EEO) test, which has already been investigated in a reasonable number of studies [1][2][3][4][5][6][7][8][9][10][11][12][13]. In this commentary, we will explore its haemodynamic effects, review the literature validating it and describe its practical modalities.…”

Section: Introductionmentioning

confidence: 99%

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The end-expiratory occlusion test: please, let me hold your breath!

2019

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Section: Is the Eeo Test Reliable?mentioning

confidence: 79%

Section: How To Detect Eeo-related Effects?mentioning

confidence: 99%

Section: How To Detect Eeo-related Effects?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The end-expiratory occlusion test: please, let me hold your breath!

2019

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“…Pulse contour analysis superiorly performs to echocardiography in terms of the precise detection of CO changes during EEOT [61]. However, other devices such as echocardiography, non-invasive CO measurements, and Doppler-based methods are feasible but need more confirmative studies [20,62,63].…”

Section: End-expiratory Occlusion Test (Eeot)mentioning

confidence: 99%

Management of perioperative volume therapy – monitoring and pitfalls

Sander

Schneck

Habicher

2020

Korean J Anesthesiol

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Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery, including the risk factors of the surgical procedure and those of the patient. There have been substantial developments over the last few decades regarding the risk of anesthesia. In the early days of anesthesia, the risk of the anesthetic procedure itself was high and led to a number of fatalities [1,2]. This has changed dramatically, and these days anesthesia-related deaths are extremely low. Such advances are likely related to drug advancements, an improved understanding of physiology, and better monitoring and management. However, death after surgery, including the whole perioperative process, has not substantially declined. The risk of death during the 30 days following surgery is 1,000 times more likely than during surgery itself [3]. According to recent data, death within 30 days of surgery is the third leading cause of death in the United States of America, behind cardiac diseases and malignancy [4]. Some recent studies have assessed this risk in detail. According to Weiser et al. [5], it is estimated that more than 310 million surgical procedures are performed worldwide. The exact complication rate and risk of death after these procedures are largely unknown. However, it is estimated that depending on the type of surgery and patient's comorbidities that about 30-40% of patients develop complications, of which up to 20% are severe and possibly life-threatening [6-8]. Besides, the mortality risk of surgery is not precisely known. It has been estimated that between 3 and 12 million patients die worldwide after surgery. The European Surgical Outcome study evaluated this in detail in a seven-day cohort study that included 46,539 patients from 498 European centers. Patients were followed for up to 60 days after their surgical procedure. Of this cohort, 1,855 patients died while in hospital, giving an in-hospital mortality rate of 4.7%. Additionally, the study Over 300 million surgical procedures are performed every year worldwide. Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery and aim to reduce the risk of complications. Perioperative hemodynamic and volume management can help to improve outcomes in perioperative patients. There has been ongoing discussion about goal-directed therapy. However, there is a consensus that fluid overload and severe fluid depletion in the perioperative period are harmful and can lead to adverse outcomes. This article provides an overview of how to evaluate the fluid responsiveness of patients, details which parameters could be used, and what limitations should be noted.

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A wearable carotid Doppler tracks changes in the descending aorta and stroke volume induced by end‐inspiratory and end‐expiratory occlusion: A pilot study

Kenny

Eibl

Parrotta

et al. 2020

Health Science Reports

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Background and Aims To test the feasibility of a novel, wearable carotid Doppler ultrasound to track changes in cardiac output induced by end‐inspiratory and end‐expiratory occlusion tests. Methods We observed the pattern of Doppler change of the common carotid artery during a simulated end‐inspiratory and expiratory occlusion test (sEIOT/sEEOT) in 10, nonventilated, healthy subjects. Simultaneously, we measured the Doppler signal of the descending aorta using duplex ultrasound (Xario, Toshiba Medical Systems) and stroke volume (SV) using noninvasive pulse contour analysis (Clearsight, Edwards Lifesciences, Irvine, California). Results During sEIOT, SV, maximum velocity time integral (VTI) of the descending aorta, and common carotid fell by 25.7% ( P = .0131), 26.1% ( P < .0001), and 18.5% ( P < .0001), respectively. During sEEOT, SV, maximum VTI of the descending aorta, and common carotid rose by: 41.3% ( P = .0051), 28.3% ( P < .0001), and 41.6% ( P < .0001), respectively. There was good correlation between change in aortic VTI and carotid VTI ( r 2 = 0.79); SV and aortic VTI ( r 2 = 0.82), and SV and carotid VTI ( r 2 = 0.95).The coefficient of variation of the VTI measured by the Doppler patch was roughly 60% less than that of the duplex system. Conclusions The pattern of SV change induced by a sEIOT/sEEOT in nonmechanically ventilated volunteers is reflected in the common carotid artery and descending aorta. The VTI variability of the Doppler patch was less than that of the traditional, duplex Doppler.

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Predicting Fluid Responsiveness in Critically Ill Patients by Using Combined End-Expiratory and End-Inspiratory Occlusions With Echocardiography

Cited by 73 publications

References 23 publications

The end-expiratory occlusion test: please, let me hold your breath!

The end-expiratory occlusion test: please, let me hold your breath!

Management of perioperative volume therapy – monitoring and pitfalls

A wearable carotid Doppler tracks changes in the descending aorta and stroke volume induced by end‐inspiratory and end‐expiratory occlusion: A pilot study

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