Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients.
OBJECTIVE
In septic patients, reliable non-invasive predictors of fluid responsiveness are needed. We hypothesised that the respiratory changes in the amplitude of the plethysmographic pulse wave (DeltaP(PLET)) would allow the prediction of changes in cardiac index following volume administration in mechanically ventilated septic patients.


METHODS
Prospective clinical investigation.


METHODS
An 11-bed hospital medical intensive care unit.


METHODS
Twenty-three deeply sedated septic patients mechanically ventilated with tidal volume >or=8 ml/kg and equipped with an arterial catheter and a pulse oximetry plethysmographic sensor.


METHODS
Respiratory changes in pulse pressure (DeltaPP), DeltaP(PLET) and cardiac index (transthoracic Doppler echocardiography) were determined before and after volume infusion of colloids (8 ml/kg).


RESULTS
Twenty-eight volume challenges were performed in 23 patients. Before volume expansion, DeltaPP correlated with DeltaP(PLET) (r2 = 0.71, p<0.001). Changes in cardiac index after volume expansion significantly (p<0.001) correlated with baseline DeltaPP (r2 = 0.76) and DeltaP(PLET) (r2 = 0.50). The patients were defined as responders to fluid challenge when cardiac index increased by at least 15% after the fluid challenge. Such an event occurred 18 times. Before volume challenge, a DeltaPP value of 12% and a DeltaP(PLET) value of 14% allowed discrimination between responders and non-responders with sensitivity of 100% and 94% respectively and specificity of 70% and 80% respectively. Comparison of areas under the receiver operator characteristic curves showed that DeltaPP and DeltaP(PLET) predicted similarly fluid responsiveness.


CONCLUSIONS
The present study found DeltaP(PLET) to be as accurate as DeltaPP for predicting fluid responsiveness in mechanically ventilated septic patients.
Feissel
Marc
M
Medical Intensive Care Unit, Centre Hospitalier, Belfort, France.
Teboul
Jean-Louis
JL
Merlani
Paolo
P
Badie
Julio
J
Faller
Jean-Pierre
JP
Bendjelid
Karim
K
D000368:Aged; D005440:Fluid Therapy; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods*; D011446:Prospective Studies; D012121:Respiration, Artificial; D018805:Sepsis