Pulse Pressure Variation Adjusted by Respiratory Changes in Pleural Pressure, Rather Than by Tidal Volume, Reliably Predicts Fluid Responsiveness in Patients With Acute Respiratory Distress Syndrome*

Liu, Yang; Wei, Luqing; Li, Guoqiang; Yu, Xin; Li, Guofeng; Li, Yuming

doi:10.1097/ccm.0000000000001371

Cited by 38 publications

(22 citation statements)

References 42 publications

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“…Although an absence of spontaneous breathing was confirmed clinically by observing the capnograph waveform, variations in PIP, and the animal's chest movements, it is possible that small respiratory efforts affected values of PPV and PVI because a neuromuscular blocking agent was not used. Second, the measurement of PPV and PVI can be directly affected by a change in TV, PIP, and a pleural pressure . In this study, the relatively high VT of 15 mL/kg was set in order to avoid a low VT that may produce unreliable PPV, but the current study's setting resulted in clinically acceptable PIP and P ETCO2 (Table ).…”

Section: Discussionmentioning

confidence: 96%

Evaluation of pulse pressure variation and pleth variability index to predict fluid responsiveness in mechanically ventilated isoflurane‐anesthetized dogs

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Wightman

et al. 2018

J Vet Emergen Crit Care

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Section: Discussionmentioning

confidence: 96%

Evaluation of pulse pressure variation and pleth variability index to predict fluid responsiveness in mechanically ventilated isoflurane‐anesthetized dogs

Sano

Seo

Wightman

et al. 2018

J Vet Emergen Crit Care

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“…This finding is not unexpected since cardiopulmonary interactions under mechanical ventilation (the underlying physiological mechanism behind PPV) are dependent on both ventilatory settings and transmission of airway pressure to cardiac filling pressures. This transmission is inversely related to respiratory system elastance [ 15 ], and linearly related to the ratio of chest wall to respiratory system elastances [ 36 ]. In conditions combining low VT and low respiratory system elastance as observed in patients with ARDS under protective ventilation, a high rate of false negative patients is expected.…”

Section: Discussionmentioning

confidence: 99%

Change in cardiac output during Trendelenburg maneuver is a reliable predictor of fluid responsiveness in patients with acute respiratory distress syndrome in the prone position under protective ventilation

et al. 2017

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BackgroundPredicting fluid responsiveness may help to avoid unnecessary fluid administration during acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate the diagnostic performance of the following methods to predict fluid responsiveness in ARDS patients under protective ventilation in the prone position: cardiac index variation during a Trendelenburg maneuver, cardiac index variation during an end-expiratory occlusion test, and both pulse pressure variation and change in pulse pressure variation from baseline during a tidal volume challenge by increasing tidal volume (VT) to 8 ml.kg-1.MethodsThis study is a prospective single-center study, performed in a medical intensive care unit, on ARDS patients with acute circulatory failure in the prone position. Patients were studied at baseline, during a 1-min shift to the Trendelenburg position, during a 15-s end-expiratory occlusion, during a 1-min increase in VT to 8 ml.kg-1, and after fluid administration. Fluid responsiveness was deemed present if cardiac index assessed by transpulmonary thermodilution increased by at least 15% after fluid administration.ResultsThere were 33 patients included, among whom 14 (42%) exhibited cardiac arrhythmia at baseline and 15 (45%) were deemed fluid-responsive. The area under the receiver operating characteristic (ROC) curve of the pulse contour-derived cardiac index change during the Trendelenburg maneuver and the end-expiratory occlusion test were 0.90 (95% CI, 0.80–1.00) and 0.65 (95% CI, 0.46–0.84), respectively. An increase in cardiac index ≥ 8% during the Trendelenburg maneuver enabled diagnosis of fluid responsiveness with sensitivity of 87% (95% CI, 67–100), and specificity of 89% (95% CI, 72–100). The area under the ROC curve of pulse pressure variation and change in pulse pressure variation during the tidal volume challenge were 0.52 (95% CI, 0.24–0.80) and 0.59 (95% CI, 0.31–0.88), respectively.ConclusionsChange in cardiac index during a Trendelenburg maneuver is a reliable test to predict fluid responsiveness in ARDS patients in the prone position, while neither change in cardiac index during end-expiratory occlusion, nor pulse pressure variation during a VT challenge reached acceptable predictive performance to predict fluid responsiveness in this setting.Trial registrationClinicalTrials.gov, NCT01965574. Registered on 16 October 2013. The trial was registered 6 days after inclusion of the first patient.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1881-0) contains supplementary material, which is available to authorized users.

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“…De Baker and Scolletta [38] demonstrated that low tidal volume (<8 ml/kg) invalidates the cutoff value of 12 % for pulsed pressure variation (PPV) (a surrogate of stroke volume variation). In an attempt to solve this problem, Liu et al [39] suggested estimating pleural pressure variations as a surrogate of thoracic pressure variations in ARDS patients and then adjusting the PPV accordingly in order to improve prediction and prevent false negatives for fluid responsiveness. This approach, however, requires measurement of esophageal pressure using a balloon catheter, increasing the complexity of care, and is therefore used clinically in a small number of centers.…”

Section: Clinical Methods At the Bedside To Assess Volume Responsementioning

confidence: 99%

Echocardiography as a guide for fluid management

et al. 2016

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BackgroundIn critically ill patients at risk for organ failure, the administration of intravenous fluids has equal chances of resulting in benefit or harm. While the intent of intravenous fluid is to increase cardiac output and oxygen delivery, unwelcome results in those patients who do not increase their cardiac output are tissue edema, hypoxemia, and excess mortality. Here we briefly review bedside methods to assess fluid responsiveness, focusing upon the strengths and pitfalls of echocardiography in spontaneously breathing mechanically ventilated patients as a means to guide fluid management. We also provide new data to help clinicians anticipate bedside echocardiography findings in vasopressor-dependent, volume-resuscitated patients.ObjectiveTo review bedside ultrasound as a method to judge whether additional intravenous fluid will increase cardiac output. Special emphasis is placed on the respiratory effort of the patient.ConclusionsPoint-of-care echocardiography has the unique ability to screen for unexpected structural findings while providing a quantifiable probability of a patient’s cardiovascular response to fluids. Measuring changes in stroke volume in response to either passive leg raising or changes in thoracic pressure during controlled mechanical ventilation offer good performance characteristics but may be limited by operator skill, arrhythmia, and open lung ventilation strategies. Measuring changes in vena caval diameter induced by controlled mechanical ventilation demands less training of the operator and performs well during arrythmia. In modern delivery of critical care, however, most patients are nursed awake, even during mechanical ventilation. In patients making respiratory efforts we suggest that ventilator settings must be standardized before assessing this promising technology as a guide for fluid management.

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Pulse Pressure Variation Adjusted by Respiratory Changes in Pleural Pressure, Rather Than by Tidal Volume, Reliably Predicts Fluid Responsiveness in Patients With Acute Respiratory Distress Syndrome*

Cited by 38 publications

References 42 publications

Evaluation of pulse pressure variation and pleth variability index to predict fluid responsiveness in mechanically ventilated isoflurane‐anesthetized dogs

Evaluation of pulse pressure variation and pleth variability index to predict fluid responsiveness in mechanically ventilated isoflurane‐anesthetized dogs

Change in cardiac output during Trendelenburg maneuver is a reliable predictor of fluid responsiveness in patients with acute respiratory distress syndrome in the prone position under protective ventilation

Echocardiography as a guide for fluid management

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