The respiratory change in preejection period: a new method to predict fluid responsiveness.
The accuracy and clinical utility of preload indexes as bedside indicators of fluid responsiveness in patients after cardiac surgery is controversial. This study evaluates whether respiratory changes (Delta) in the preejection period (PEP; DeltaPEP) predict fluid responsiveness in mechanically ventilated patients. Sixteen postcoronary artery bypass surgery patients, deeply sedated under mechanical ventilation, were enrolled. PEP was defined as the time interval between the beginning of the Q wave on the electrocardiogram and the upstroke of the radial arterial pressure. DeltaPEP (%) was defined as the difference between expiratory and inspiratory PEP measured over one respiratory cycle. We also measured cardiac output, stroke volume index, right atrial pressure, pulmonary arterial occlusion pressure, respiratory change in pulse pressure, systolic pressure variation, and the Deltadown component of SPV. Data were measured without positive end-expiratory pressure (PEEP) and after application of a PEEP of 10 cmH2O (PEEP10). When PEEP10 induced a decrease of >15% in mean arterial pressure value, then measurements were re-performed before and after volume expansion. Volume loading was done in eight patients. Right atrial pressure and pulmonary arterial occlusion pressure before volume expansion did not correlate with the change in stroke volume index after the fluid challenge. Systolic pressure variation, DeltaPEP, Deltadown, and change in pulse pressure before volume expansion correlated with stroke volume index change after fluid challenge (r2 = 0.52, 0.57, 0.68, and 0.83, respectively). In deeply sedated, mechanically ventilated patients after cardiac surgery, DeltaPEP, a new method, can be used to predict fluid responsiveness and hemodynamic response to PEEP10.
Bendjelid
Karim
K
Division of Surgical Intensive Care, Geneva University Hospital, CH-1211 Geneva 14 Switzerland. karim.bendjelid@hcuge.ch
Suter
Peter M
PM
Romand
Jacques A
JA
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001810:Blood Volume; D006348:Cardiac Surgical Procedures; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006321:Heart / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods* / Q000592:standards; D019095:Point-of-Care Systems; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011654:Pulmonary Edema / Q000517:prevention & control; D015203:Reproducibility of Results