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

Autor: Vallier S; Department of Anesthesiology and Intensive Care, Elsan Alpes-Belledonne Clinic, Grenoble, France. vallier.sylvain@gmail.com., Bouchet JB; Department of Anesthesiology and Intensive Care, Etienne University Hospital, Jean-Monnet University, SaintSaint-Etienne, France., Desebbe O; Department of Anesthesiology and Intensive Care, Ramsay Sante Sauvegarde Clinic, Lyon, France., Francou C; Department of Anesthesiology and Intensive Care, Etienne University Hospital, Jean-Monnet University, SaintSaint-Etienne, France., Raphael D; Department of Anesthesiology & Perioperative Care, University of California, Irvine, USA., Tardy B; Centre d'Investigation Clinique - CIC 1408, Etienne University Hospital, Jean-Monnet University, SaintSaint-Etienne, France., Gergele L; Department of Anesthesiology and Intensive Care, Ramsay Sante HPL Clinic, Saint-Etienne, France., Morel J; Department of Anesthesiology and Intensive Care, Etienne University Hospital, Jean-Monnet University, SaintSaint-Etienne, France.
Jazyk: angličtina
Zdroj: BMC anesthesiology [BMC Anesthesiol] 2022 Jan 03; Vol. 22 (1), pp. 4. Date of Electronic Publication: 2022 Jan 03.
DOI: 10.1186/s12871-021-01544-x
Abstrakt: 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).
(© 2021. The Author(s).)
Databáze: MEDLINE
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