Predictor of fluid responsiveness in the ‘grey zone’: augmented pulse pressure variation through a temporary increase in tidal volume
| Autor: | Jong-Hwan Lee, N.-S. Gil, Jeong Jin Min, D.K. Ryu, Chung Su Kim, Sangmin M. Lee |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Cardiac output medicine.medical_treatment Blood Pressure Positive-Pressure Respiration Young Adult 03 medical and health sciences 0302 clinical medicine Heart Rate 030202 anesthesiology Tidal Volume Humans Medicine Tidal volume Aged Aged 80 and over Mechanical ventilation Receiver operating characteristic business.industry Editorials Area under the curve 030208 emergency & critical care medicine Stroke volume Middle Aged Pulse pressure Anesthesiology and Pain Medicine Anesthesia Breathing Fluid Therapy Female business |
| Zdroj: | BJA: British Journal of Anaesthesia |
| ISSN: | 0007-0912 |
| Popis: | Background Pulse pressure variation (PPV) is widely used as a predictor of fluid responsiveness. However, a previous study has suggested a ‘grey zone' between 9 and 13% in which PPV would be inconclusive to predict fluid responsiveness. Considering PPV is based on cardiopulmonary interactions, we evaluated whether an augmented PPV using a temporary increase in tidal volume (VT) from 8 to 12 ml kg−1 has the predictability for fluid responsiveness in patients within the grey zone. Methods Adult patients requiring general anaesthesia were enrolled. During the period when PPV was within the range of 9–13%, haemodynamic variables such as stroke volume index (SVI) and PPV with an 8 ml kg−1 tidal volume ventilation (PPV8) were obtained before and after volume expansion (6 ml kg−1) under mechanical ventilation. Augmented PPV induced by 2-min ventilation with a VT of 12 ml kg−1 (PPV12) was also recorded immediately before volume loading. The patients whose SVI increased ≥10% after volume expansion were considered responders. Results In 38 enrolled patients, 20 were responders. Receiver operating characteristic curve analysis showed PPV12 had an excellent predictability for fluid responsiveness {area under the curve [AUC]=0.935 [95% confidence interval (CI) 0.805–0.989]; sensitivity 95%; specificity 72%; P 17%. However, PPV8 failed to show significant predictability [AUC=0.668 (95% CI 0.497–0.812); sensitivity 65%; specificity 61%; P=0.06]. Conclusion In mechanically ventilated patients, our augmented PPV successfully predicted fluid responsiveness in the previously suggested grey zone. Clinical trial registration ClinicalTrials.gov, NCT02653469. |
| Databáze: | OpenAIRE |
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